Prior Authorizations

Gainwell Technologies is the Kentucky Utilization Management (UM) contractor for Kentucky Medicaid. All Prior Authorization (PA) requests for Fee-for-Service (excluding Waiver, Hospice Level of Care, and Nursing Facility Level of Care) are processed by Gainwell Technologies.

CareWise Health is a subcontractor for Gainwell Technologies. CareWise processes Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Psychiatric, EPSDT Therapy, Prescribed Pediatric Extended Care (PPEC), and Nursing Facility (NF) ancillary prior authorizations.

Providers can access the KY UM Learning Management system (LMS) portal for PA requests at the link provided below:
bit.ly/KYUMTraining

All providers and staff who submit PA requests for traditional Kentucky Medicaid members (excluding Waiver, Hospice Level of Care, and Nursing Facility Level of Care) can access training.

Tip Sheets are available on the LMS under the course announcements section to offer additional assistance and provide updates as the KY UM program progresses. These include helpful hints on how to interact with "Gabby," the new voice bot, and the processing rules for Lack of Information. Please check periodically for the latest updates.

All training is accessible through the Kentucky UM LMS. You can register at bit.ly/KYUMTraining. When registering, please select "Provider" as your curriculum.

If providers have any questions or need assistance with scheduling training, please contact the training team at KYUMTraining@carewisehealth.com.

Below are the phone numbers and fax numbers for providers to call or fax PA requests:

Prior Authorization Phone Numbers:

Fax Number - Submitting PA Request