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Important Kentucky Medicaid updates and announcements

What's New

WEBINAR ANNOUNCEMENT – Level of Care Policy and Process Changes

The Department for Medicaid Services (DMS) is beginning a new project to transform its level of care (LOC) policies and processes for nursing facility, hospice, and intermediate care facility for individuals with intellectual disabilities (ICF-IID) services. This project will transition the existing paper-based LOC processes to a technology system where providers will be able to electronically submit their LOCs through a self-service portal.

DMS is hosting a virtual webinar to share the upcoming LOC policy and process changes with providers. This webinar will review changes to the existing process and policies, as well as new policies that will be instituted as a part of the LOC transformation. DMS strongly encourages attendance, as the content will prepare providers to transition to the new processes.

The webinar is offered on two days to best accommodate providers' schedules. The webinar content will be the same on both dates. The webinar lobby will be open 30 minutes prior to each webinar.

Wednesday, August 23rd, 2017
10:00 a.m.-12:00 p.m., Eastern Time

Thursday, August 31st, 2017
10:00 a.m.-12:00 p.m., Eastern Time

Webinar Information
Everyone is a Guest. Guest access and entry into the webinar is blocked until the webinar room opens at 9:30 AM, Eastern Time.

On the date of the webinar, Click Here To Join The Webinar.. The “2017 DMS Webinars” page will open. Click “Enter as a Guest” and type your agency name or your first name and last name in the field marked “Name,” then click on the box that says “Enter Room.”

Level 1 PASSR delay,

Attention Providers - Due to revisions, the July 1, 2017 implementation date for the new Level 1 PASSR form stated in the March 2017 Provider Letter has been delayed. Please continue to use the current Level I PASRR Screening form until further notice from the Department for Medicaid Services. Please also be advised the new MAP 4095 PASRR Significant Change Form will be implemented on 7/1/17 as planned.

For additional questions, please feel free to call or email either Vicki Barber at 502-564-6890 or Benita Jackie at 502-782-6217.

Important Notice Regarding Non-Emergency Medical Transportation

Beginning July 1, 2017, Federated Transportation Services of the Bluegrass (FTSB) will provide brokerage services for all non-emergency medical transportation for Medicaid transportation eligible recipients living in Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Pendleton, and Owen Counties. Persons who are eligible for transportation services and the trips that are covered by the non-emergency medical transportation program are not changing.

Read the Important Member Notice Regarding Non-Emergency Transportation

KYHealth Card Update

Effective May 6, 2017, the Department for Medicaid Services will be updating the KyHealth Card as a cost saving measure for the Commonwealth. Currently Fee-For-Service members receive a plastic card containing a magnetic strip on the back for swipe capability. Due to the expense of the card and the minimal functionality of the strip the Department has decided to issue a printed, perforated card without swipe capability. The information printed on the card will remain the same.

Provider Notice regarding Member Cards

Effective March 31, 2017 members enrolled in an MCO will no longer receive a KyHealth Choices card. Members will receive a card from the MCO with which they are enrolled. This change is being made to reduce duplication of effort as all required Medicaid information is located on the MCO card. This change does not affect Fee For Service members.

In addition, members who have had six months or more loss in eligibility will not receive a new card.

SCL Waiver renewal officially approved by CMS

(March 29, 2017) - The Department for Medicaid Services has been notified by the Centers for Medicare and Medicaid Services that renewal of the Supports for Community Living (SCL) Medicaid Waiver will be implemented April 1, 2017. The SCL waiver renewal period is effective March 1, 2017 through Feb. 28, 2022.

Beginning April 1, 2017, providers will implement SCL regulations 907 KAR 12:010 and 907 KAR 12:020 effective June 3, 2016.

Please remember to refer to SCL Provider Letter #A-49 about documentation requirements for dates of service beginning March 15, 2017. The Department for Medicaid Services will follow those documentation requirements, exceptional support protocols and the guidance provided about billing audits and information on technical assistance included with that provider letter. Effective April 1, 2017, all exceptional support requests must be submitted through the Medicaid Waiver Management Application. No exceptional support requests will be accepted via fax to the Division of Developmental and Intellectual Disabilities in the Department for Behavioral Health, Development and Intellectual Disabilities.

With approval of the waiver renewal, notices of allocation for funding will be sent to individuals who currently meet emergency criteria and are on the SCL emergency waiting list.

Slots:
As part of the renewal, 240 additional slots have been approved. Information will be provided in the near future about allocation of these slots.

LOC and POC process:

  • For applications submitted in the Medicaid Waiver Management Application (MWMA): All LOC assessments and POCs must be submitted within MWMA.
  • For applications not submitted within MWMA: Fax the initial LOC assessment and initial person centered service plan to Carewise Health at (800) 807-8843.

Upon approval of the person-centered service plan the case manager is to transition the person into MWMA and complete all subsequent LOC assessments and person centered service plans within MWMA.

All future applications for placement on the SCL waiting list must be submitted through MWMA.

We are pleased that CMS has moved forward with the SCL waiver renewal approval. Thank you for your important work for people engaged in the SCL waiver program.

PASSR Statewide Training Information

(March 10, 2017) -The Departments for Medicaid Services (DMS) and Behavioral Health, Developmental and Intellectual Disabilities (BHDID) have worked with the Centers for Medicare and Medicaid Services (CMS), to develop a more comprehensive Preadmission Screening and Resident Review (PASRR) process. The statewide implementation date for both forms is July 1, 2017.

Read the Nursing Facility/ICF/IID Provider Letter - Pre-admission Screening and Resident Review Revisions (Mar. 10, 2017)

Two statewide training sessions are available as listed below:

First Training Session:
Date: Wednesday, April 26, 2017 (a.m. and p.m. sessions)
AM Session: Registration: 8:30 to 9 a.m. and Training Session: 9 a.m. to noon
PM Session: Registration: 12:30 to 1 p.m. and Training Session: 1 to 4 p.m.
Training site: GAPS Training Room, 801 Teton Trail, Frankfort, KY. 40601
Note: There are no vending machines available at the GAPS Training site

2nd Training Session
Date: Wednesday, May 24, 2107 (a.m. and p.m. sessions)
AM Session: Registration: 8:30 to 9 a.m. and Training Session: 9 a.m. to noon
PM Session: Registration: 12:30 to 1 p.m. and Training Session: 1 to 4 p.m.
Training site: GAPS Training Room, 801 Teton Trail, Frankfort, KY. 40601
Note: There are no vending machines available at the GAPS Training site.

Registration is limited to two employees per ICF/IID and/or nursing facility.

On-line registration

Materials Needed for Training

Ordering, Referring and Prescribing Provider Information

A General Provider Letter - Ordering, Referring and Prescribing Providers (PDF) and FAQ document (PDF) was mailed to provider on Feb. 1, 2017 regarding ordering, referring and prescribing providers enrolling as Medicaid providers.

Questions regarding this notice may be directed to DMS Provider Services at (855) 824-5615, Monday through Friday, 8 a.m. to 5:30 p.m. Eastern time.

Third Party Review Process (SB20)

Senate Bill 20 established the right for a provider who has exhausted the written internal appeals process of a Medicaid managed care organization (MCO) to an external independent third-party review of the MCO final decision that denies, in whole or part, a health care service to an enrollee or a claim for reimbursement to a provider for a health care service rendered by the provider to an enrollee of the MCO. The legislation also afforded a provider or an MCO the right to an administrative hearing.

907 KAR 17:035 establishes the process for the external independent third-party review and 907 KAR 17:040 establishes the process for an administrative hearing.

Beginning with the dates of service on or after Dec. 1, 2016, providers may submit a request for an external independent third-party review within 60 calendar days of receiving a final decision from the MCO internal appeal process.

Provider Letter #A-102 Senate Bill 20

MCO Contact Information

Attention Providers - HCB and SCL Waiver Therapy Transition

Attention HCB and SCL Waiver Providers - Please see guidance for providers and use the referenced forms below to transition physical therapy, occupational therapy and speech language pathology services from the Waivers to State Plan. This applies only to members in the HCB and SCL Waiver.

If you have any questions about transition of prior authorizations or billing, please email HPE. If you have questions about the State Plan therapy benefit, please contact DMS Division of Policy and Operations by email or by phone at 502-564-6890

Update: (Feb. 15, 2017) - Please view the presentation and the materials from the SCL Waiver Transition webinar

Update: (May 31, 2016) - Please view the Presentations materials from the HCBS Waiver Transition Webinar.

(Mar. 17, 2016) - Provider type 76 - Multi-Therapy Agency, is expected to be effective in June 2016. Providers may begin submitting applications to enroll in Medicaid as this provider type on May 15, 2016 but applications will be held and will not be processed until state regulations are final. The information provided for this provider type is subject to change pending adoption of state regulations.

For more information about the new therapy process, please read the

If you have questions about the therapy process, contact the Department of Medicaid Services at 502-564-7540. If you have any questions regarding enrollment after May 15, 2016, please contact Provider Enrollment at 1-877-838-5085.

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Public Notices

Covered Outpatient Drug Reimbursement

The Cabinet for Health and Family Services, Department for Medicaid Services (DMS), pursuant to the requirements of 42 CFR § 447.205, hereby provides public notice of the following actions regarding pharmacy reimbursement to be effective April 1, 2017.

view the Ppublic notice for Covered Outpatient Drug Reimbursement

Public Notices

The Kentucky Department for Medicaid Services gives notice of the following proposed actions regarding Community Mental Health Centers services and reimbursement provided under the state plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

View Public Notices.

HCBS Final Rules - Heightened Scrutiny

The Cabinet for Health and Family Services Department for Medicaid Services, in accordance with 42 CFR 441.301, hereby provides a 30-day public notice and comment period for its first submission of Home and Community Based Services waiver settings requiring heightened scrutiny.

View Public Notice for HCBS Final Rules - Heightened Scrutiny

ABI Public Notice - Waiver Renewal Application

The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Acquired Brain Injury (ABI) waiver. The current ABI waiver expired on Dec. 31, 2016 and a renewed waiver must be submitted. The renewal of ABI includes changes to comply with federal requirements set forth by Final Rule - CMS 2249-F 1915(i) State Plan Home and Community-Based Services, Five-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice and CMS 2296-F 1915(c) Home- and Community-Based Services Waivers (Final Rule).

View the ABI waiver renewal application.

If you would like to receive a hard copy of the ABI waiver renewal application, please email or call (502) 564-4321

Public Comment - Please email comments or submit via postal mail by Feb. 25, 2017 to:
Department for Medicaid Services
ABI Waiver Renewal
Commissioners Office
275 E. Main St., 6W-A
Frankfort KY 40621

MPW Public Notice - Waiver Renewal Application

The Cabinet for Health and Family Services, Department for Medicaid Services hereby provides a 30-day public notice and comment period for its intent to submit to the Centers for Medicare and Medicaid Services (CMS) a renewal for the Michelle P. waiver (MPW). The current MPW expired Aug. 31, 2016, and a renewed waiver must be submitted. The renewal of MPW includes changes to comply with federal requirements set forth by Final Rule - CMS 2249-F – 1915(i) State Plan Home and Community-Based Services, Five-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice and CMS 2296-F 1915(c) Home and Community-Based Services Waivers (final rule).

View the MPW Waiver Renewal Application Part A - MPW Waiver Renewal Application Part B

To receive a hard copy of the MPW waiver renewal application, please email or call 502-564-4321.

ABI-LTC Waiver Renewal

(May. 6, 2016) The Cabinet for Health and Family Services, Department for Medicaid Services hereby provides a 30-day public notice and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Acquired Brain Injury-Long Term Care (ABI-LTC) waiver. The current ABI-LTC waiver expires June 30, 2016 and a renewed waiver must be submitted and approved by July 1, 2016.

The renewal of the ABI-LTC waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F–1915(i) State Plan Home and Community-Based Services, Five-Year Period for Waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice, and CMS 2296-F 1915(c) Home and Community-Based Services Waivers (Final Rule). In addition, the renewal reflects several programmatic changes, including transition of payment for physical, occupational and speech therapy services to the Medicaid state plan, revisions in participant-directed services processes, assessment/reassessment and waiting list processes.

View the ABI-LTC Waiver Renewal

To receive a hard copy of the ABI-LTC waiver renewal application, please email or call 502-564-4321

Supports for Community Living Waiver Renewal

(April 29, 2015) The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice of and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Supports for Community Living (SCL) waiver. The current SCL waiver expires Aug. 31, 2015, and a renewed waiver must be submitted and approved by Sept. 1, 2015.

The renewal of the SCL waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F-1915(i) State Plan Home and Community-Based Services, five-year period for waivers, Provider Payment Reassignment, Setting Requirements for Community First Choice and CMS 2296-F 1915(c) Home and Community-Based Services Waivers (final rule).

If you would like to receive a hard copy of the SCL waiver renewal application, please call 502-564-4321 or request by email.

Public Comment
If you wish to submit written comments regarding this public notice please email them or send them by postal mail by May 28, 2015, to:

Department for Medicaid Services
HCB Waiver Amendment
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

Home and Community Based Waiver Renewal

(Apr. 8, 2015) - The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice of and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Home and Community Based (HCB) waiver. The current HCB waiver expires June 30, 2015 and a renewed waiver must be submitted and approved by July 1, 2015

The renewal of the HCB waiver includes changes to comply with federal requirements set forth by Final Rule-CMS 2249-F-1915(i) State Plan Home and Community-Based Services, five-year period for waivers, provider payment reassignment, setting requirements for community first choice and CMS 2296-F-1915(c) Home and Community-Based Services Waivers (final rule). The renewal also includes changes to enhance waiver services.

To receive a hard copy of the HCB waiver renewal application, please email or call 502-564-4321

Please submit written comments regarding this public notice by email or by postal mail by May 10, 2015, to:

Department for Medicaid Services
HCB Waiver Amendment
Commissioners Office
275 E. Main St., 6W-A
Frankfort, KY 40621

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Final Rule/Wavier Announcements

CMS Final Rule Webinar

(Dec. 19, 2016) - The Centers for Medicare and Medicaid Services has adopted new final federal regulations which address home- and community-based setting requirements for Medicaid waivers.

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. The submitted Statewide Transition Plan offers the steps DMS will take to effectively plan for and execute the transition with public engagement.

If you would like to receive a hard copy of the Statewide Transitional Plan, please either email or call 502-564-4321.

View the KY Statewide Transition Plan *Updated*

Older announcements

View a webinar on this topic conducted on June 5, 2014 by CHFS staff. Or, you may review the handout or the Q and A document about the CMS final regulations.

Upcoming HCBS Final Rule - Stakeholder Engagement Meeting

The Cabinet for Health and Family Services is hosting meetings for providers to provide input on the Home and Community-Based Services (HCBS) Final Rules implementation. CHFS encourages participation from stakeholders as it continues to develop the processes for ongoing compliance with the HCBS Final Rules.

Update - April 27, 2017 Webinar Meeting presentation

Update - September 2016 Webinar meeting presentation

Please see the attachments below for the February 2016 meetings

Attention HCB Waiver Providers and Members

(Aug. 15, 2016) Read the HCB Waiver 2 Announcement- New

We are pleased to announce that the Cabinet for Health and Family Services, Department for Medicaid Services has received approval from the Centers for Medicare and Medicaid Services for the Home and Community Based Waiver (HCB2 - KY.0144.R06.00) renewal with an effective date of Aug. 1, 2016.

Read the HCB2 Announcement

Attention HCB Waiver Providers

(July 1, 2016) - On April 1, 2016, the new Home and Community Based (HCB) Waiver Program regulations, 907 KAR 7:010 and 907 KAR 7:015, became effective. However, DMS filed an e-regulation on June 30, 2016, amending the regulation to make it contingent upon Centers for Medicare and Medicaid Services (CMS) approval of the HCB Waiver Renewal. DMS is currently waiting for approval from CMS for the Waiver Renewal. Therefore, the HCB Waiver Program will continue to operate under the current Waiver as well as the regulations which may be found at 907 KAR 1:160 and 907 KAR 1:170. Notification of CMS approval will be provided once it is received. DMS anticipates approval in the next 15 to 30 days. If you have any questions, please contact DMS at 502-564-5560.

Attention SCL Providers

On June 3, 2016, the new Supports for Community Living (SCL) Waiver Program regulation, 907 KAR 12:010, became effective. However, at Section 17(2), the regulation is contingent upon Centers for Medicare and Medicaid Services (CMS) approval of the SCL Waiver. DMS is currently waiting for approval from CMS for the waiver. Therefore, the SCL Waiver Program will continue to operate under the previous regulation which may be found at 907 KAR 12:010. Notification of CMS approval will be provided once it is received. If you have any questions, please contact DMS or call 502-564-1647.

Public Comment
To submit written comments regarding this public notice please do so by emailing them or by mailing them to the following address by April 24, 2016. The ABI-LTC waiver renewal application was submitted to CMS on April 28th, 2016.

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Medicaid Managed Care Information

KY Department for Medicaid Services Managed Care Open Enrollment Information- 2017

The Department for Medicaid Services will conduct open enrollment for recipients in a Managed Care plan starting Oct. 24, 2016, and ending Dec. 16, 2016.

For more information about covered benefits, services and the associated cost included in the letter, see:

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.

All plan changes made during Open Enrollment will take effect Jan. 1, 2017.

Attention Members - Coventry Cares of KY has changed its name.

CoventryCares of Kentucky is now Aetna Better Health of Kentucky. The official change took place Feb. 1, 2016.

You do not have to take any action. The new name in no way affects your care. Nothing about your services or benefits will change. You will begin to see Aetna Better Health of Kentucky information in the mail. You will have a new ID card mailed to you. Please visit Aetna Better Health of Kentucky's new website.

If you have questions about this change, please call Member Services at 1-855-300-5528, (TTY 711 and TDD 1-800-627-4702), Monday - Friday, 7 a.m. to 7 p.m. Eastern time.

Attention Members - 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

Prompt Payment Update

Oct. 11, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Address:
Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: 502-564-6106
Toll Free: 1-800-595-6053, Option 5
EMail

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.

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Provider Updates

Attention Providers

For 2016, CMS will be hosting several Payment Error Rate Measurement conference calls to providers for 2016. Please review the Provider Call information to learn when calls will be available.

Notice

The Cabinet for Health and Family Services, Department for Medicaid Services Preventive and Wellness Initiative provided enhanced reimbursement rates for certain preventive and wellness services beginning Jan. 1, 2015. In accordance with the Medicaid State Plan and 907 KAR 3:017, this initiative ends June 30, 2016. Starting July 1, 2016, any codes paid at the enhanced rate reverts to those rates listed on the current Kentucky Medicaid Physicians and/or Clinical Diagnostic Laboratory fee schedules.

Attention Providers: Correction to Notice Regarding Revalidation

(May 6, 2016) - The notice sent recently regarding Kentucky Medicaid no longer accepting the Medicare revalidation letter contained information that may be confusing to providers. Only providers who receive a letter from Medicaid regarding their revalidation may be subject to termination if they do not submit a MAP-900. Providers do not need to submit a MAP-900 until they are notified by letter to revalidate, which occurs every five years. Providers can check their revalidation date by logging into KYHealthNet. Medicaid sends a 60-day and 30-day letter prior to the due date.

We regret the confusion. If you have any questions, please send us an email or call 1-877-838-5085.

Attention Behavioral health Services Organization (BSHO) Providers

For questions regarding providing BHSO services, please refer to the DBHDID BHSO page and review the recent 2015 BSHO Webinar. For questions not addressed in the webinar, please email us.

The BHSO Medicaid Billing Manual is under development and will be posted in the near future.

To all providers participating in the Kentucky Medicaid EHR Incentive Program

The Kentucky Medicaid EHR Incentive Program will accept program year 2015 meaningful use attestations beginning at 8 a.m. Eastern time Thursday, April 7. The system will not be available beginning at 4 p.m. Eastern time April 6.

Please keep in mind all attestations must be submitted for program year 2015 by 11:59 p.m. Eastern time May 31, 2016.

Please contact us if you have questions.

Adjusted Primary Care Payment Update

Sept. 17, 2015 - In accordance with the Patient Protection and Affordable Care Act (ACA), certain physicians were eligible to receive adjusted Medicaid payments for primary care services. The federal government fully financed the difference between the state Medicaid payment rate and the applicable Medicare rate for Calendar Years 2013 and 2014 to pay the providers an enhanced rate. At the end of that period, the enhanced federal funding for this program ended. A 6-month claim run-out period was allowed for providers to submit claims for dates of service in CY 2013-14 not yet submitted/processed; as well as any claim adjustments/corrections per the CMS final rule.

The final cycle for the adjusted primary care payment rate, which includes the claim run-out period as well as the reconciliation, will process Oct. 1, 2015.

For more information about the Adjusted Primary Care payments, please refer to the KY Medicaid Affordable Care Act Information page.

If you have questions, please contact the Division of Policy and Operations at 502-564-6890.

Attention Providers

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.,

(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For more information on the process, read the EPSDT Prior authorizations for PT OT ST provider notice (July 9, 2015)

Please contact HP at 1-800-807-1232 for assistance and if you have questions about submitting prior authorizations under the EPSDT PT-45 number to replace prior authorizations approved under the new provider type.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact Catherann Terry at 502-564-9444, ext. 2120.

Attention Providers Clarification for Dentists.

Dentists who currently do not bill ICD-9 codes do not have to convert to ICD-10. However, Oral Surgeons currently billing ICD-9 codes will be required to comply with ICD-10. For more information about Kentucky Medicaid's implementation of ICD-10, including how to test for readiness, please visit the DMS ICD-10 website.

Attention Providers

View the CMS National Provider Call - Countdown to ICD 10 dated Aug. 27, 2015

Notice to all providers regarding Electronic Funds Transfer

(Feb. 18, 2015) - The electronic funds transfer (EFT) update function via KY Health Net will be disabled on March 6, 2015. To update your EFT, please contact provider enrollment at 877-838-5085 for further instructions. We apologize for any inconvenience

Attention Providers: Policy Clarification Updates

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.

5010 Announcement

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.

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Program Updates

Attention Department for Medicaid Services providers/partners

The Department for Medicaid Services is aware of issues with the new benefind system, which processes all benefit programs administered by the Department for Community Based Services. It has resulted in discontinuation letters being sent in error or the system incorrectly showing an individual as ineligible. The Cabinet for Health and Family Services is taking action to ensure that no individual loses benefits as a result. If a person was eligible for Medicaid benefits in March, the person will automatically be eligible for benefits in April.

The Cabinet and DCBS are working with its technology partner, Deloitte, on system issues to stop the incorrect notices and properly reflect eligibility. Medicaid requests that providers continue to provide necessary services and prescriptions to members during this time.

Kentucky Medicaid eligibility is expanding Jan. 1, 2014

More information

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.

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Policy Updates

 

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.

Older updates

To review more updates and/or clarifications, refer to the Policy Clarifications page.

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Spotlight
 

 

 

Last Updated 8/10/2017