Department for Medicaid Services
Announcement: Pre-release conference Oct. 21 for Medicaid Enterprise Management System request for proposals
The Commonwealth of Kentucky will conduct a pre-release conference concerning a request for proposals (RFP) for the Medicaid Enterprise Management System Tuesday, Oct. 21, at 10 a.m. Eastern time at:
12 Mill Creek Park
Conference Room 12A
Representatives from the Cabinet for Health and Family Services (CHFS) and the Finance and Administration Cabinet will present an overview of the scope of work proposed for the new RFP and take suggestions and recommendations regarding this important procurement. Interested parties also may submit written comments, suggestions and recommendations concerning the RFP to:
Don Speer, Executive Director
Office of Procurement Services
Finance and Administration Cabinet
Room 96 Capitol Annex
Frankfort, KY 40601
Vendors can schedule individual conferences with representatives from CHFS and Speer's office to discuss written comments and suggestions prior to the issuance of the RFP. While attendance at the pre-release conference is strongly encouraged, attendance is not mandatory to schedule individual conferences with state agency representatives.
Draft Medicaid Enterprise Management System RFP Scope of Work, Section 50 (pdf)
Important Kentucky Medicaid updates and announcements
Read the General Provider Letter #A-97 - Medicaid Managed Care Open Enrollment (Oct. 1, 2014)
Kentucky Medicaid Open Enrollment Information for Jan. 1, 2015
The Department for Medicaid Services currently is in open enrollment. Letters have been sent to members who are eligible to change their current managed care organization (MCO).
For more information about covered benefits, services and the associated cost included in the letter, see:
Your open enrollment period is from: Oct. 27, 2014 through Dec. 12, 2014. To make a change, call us, toll-free at (855) 446-1245 , Monday through Friday from 8 a.m. to 5 p.m. pm Eastern time.
Please note: Changes to your MCO will not take effect until Jan. 1, 2015.
CMS Final Rule Webinar
(June 13, 2014) - The Centers for Medicare and Medicaid Services (CMS) has adopted new final federal regulations which address home- and community-based setting requirements for Medicaid waivers. View a webinar on this topic conducted on June 5 by Cabinet for Health and Family Services staff. Or, you may review the handout or the Q and A document about the CMS final regulations.
The final rule provides for a five-year transition process to allow Kentucky to implement this rule to support continuity of services for Medicaid participants and minimize disruptions in services during implementation. This proposed transition plan offers the steps DMS will take to effectively plan for and execute the transition with public engagement.
View the Proposed Transition Plan on the Michelle P Waiver Website.
Return to the top
||Medicaid Managed Care Information
Attention Members - Information on how to change your Managed Care Organization
Federal regulations allow members to change their managed care organizations outside the 90-day timeline to change. The process is called disenrollment for cause. Learn more about how to change your managed care organization.
Prompt Payment Update
Oct. 11, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: (502) 564-6106
Toll Free: (800) 595 - 6053, Option 5
To learn more about the Medicaid MCO Complaint process and how to file a complaint, please call or visit the webpage for the Medicaid Prompt Payment Compliance Branch.
April 17, 2013 - Read the General Provider Letter #A-93 - Medicaid MCO Prompt Payment Complaints to be Reviewed by the Department of Insurance (DOI)
April 5, 2013 - Read the Letter from Gov. Steve Beshear explaining his veto of House Bill 5.
View older announcements.
Return to the top
Electronic Annual Disclosure of Ownership Update
Jan. 22, 2014 - The Electronic Annual Disclosure of Ownership (EADO) process has been temporarily disabled for system maintenance. If you have an EADO currently in process, you may be contacted for further information if additional information is need to process your EADO.
Attention Providers: Policy Clarification Updates
Important Announcement regarding Provider Enrollment due to the Medicaid expansion
Nov. 18, 2013 - Starting Nov. 18, 2013, providers may submit an enrollment application for these New Provider Types. Although enrollment requirements are still being determined, each entity/individual must be licensed and submit their NPI documentation as well as SSN or FEIN verification. Applications will be held and processed once CMS approval is received and the regulations and enrollment requirements are finalized. DMS will provide new information as it becomes available.
The QMB limitation will be removed from these QMB Provider Types effective Jan. 1, 2014 subject to CMS approval. If you are currently enrolled in this provider type you will automatically be transitioned.
For more information, please refer to the DMS Provider Enrollment website.
Attention providers who bill paper, professional crossover claims.
The Medicare Coding Sheet has been revised. You may obtain the newest revision at Kentucky Medicaid Management Information System along with the updated billing instructions. For questions, please contact Provider Inquiry at (800) 807-1232.
Attention all providers: As of Jan. 1, 2012, all electronic claims submissions must be in the X12 5010 format. Please refer to your billing instructions for additional information required on the CMS1500 and UB04 paper claim forms due to 5010 implementation.
Attention KY Health Net Users: All claims paid prior to Dec. 29, 2011 will not have the Copy Claim or the Adjust Claim function through KY Health Net. Any adjustments to claims paid prior to Dec. 29, 2011 will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services.
Physician Pricing Update
- Pricing Update - The procedure code J7300 new pricing will be $645.84 with an effective date of 7-1-11. This change has been made on the physicians fee schedule located on the fee and rate schedule page.
- ESSURE In-Office Placement - Effective Date of Service (DOS) Jan. 1, 2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400 for Place of Service (POS) 11 (office). Physicians can continue to bill 58565 for the placement of the product and payment will remain at $338.62. These two codes must be billed on the same DOS and supporting documentation retained in the patient's chart for placement of product. Prior Authorization will continue to be required. If 58565 is billed with Place of Service (POS) 22, the payment for the profession fee will be $338.62.
- Physician Provider Update as of June 2011 - Refer to the Physician NDC Code Update for changes in billing.
Return to the top
Kentucky Medicaid eligibility is expanding Jan. 1, 2014
New Application for Medicare Savings Programs
Feb. 5, 2010 - Do you have Medicare? Kentucky Medicaid provides partial financial assistance with Medicare premiums, deductibles and coinsurance through the Medicare Savings Program for qualified Medicare beneficiaries, specified low-income Medicare beneficiaries and qualifying individuals who are not entitled to the full Medicaid benefit package.
Apply Now - fill out an application for the Kentucky Medicare Savings Program.
Attention Providers and Parents
Kentucky children may be eligible for free or low-cost health insurance through the Kentucky Children's Health Insurance Program (KCHIP).
KCHIP Application Process Training Presentation provides information about filling out the new application.
To view more programs and services, refer to the Program and Services page.
Return to the top
DMS does not provide guidance on billing
The Department for Medicaid Services does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.
If you receive direction from staff about how to bill, the department will not be bound by such instruction, unless it was given by a director or commissioner.
To review more updates and/or clarifications, refer to the Policy Clarifications page.
Return to the top