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kentucky Medicaid

Passport Health Plan - Dental Program

As of October 1, 2012, Avesis Third Party Administrators, Inc. will be the dental program administrator for Kentucky Medicaid members located in Region 31 enrolled in Passport Health Plan (PHP).

Already in the PHP Dental Network?

If you were already contracted in the PHP network before 10/01/2012, you do not need to do anything to remain in the PHP network. However, please click here for details on what you must do to work with Avesis.

Want to join the PHP Dental Network?

If you are not yet contracted in the PHP network and are interested in participating in the PHP dental network, please complete the Credentialing and Contracting paperwork by clicking here. You must have a national provider identifier (NPI), current Medicaid ID number and fill out a Kentucky State Application. To apply for a NPI number click click here; to apply for a Kentucky Medicaid ID number click here.

Send Completed Materials by mail to Provider Services:

Mail To:

Avesis Third Party Administrators, Inc.
Attn: Kentucky Network Development
10324 South Dolfield Road
Owings Mills, MD 21117

Please click here to access PHP of Kentucky Medicaid Dental Care Program Provider Forms.


If you have any questions please contact one of our Provider Services Representatives at 866-909-1083.