Program Integrity
Policy Update
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.
Notice
The Kentucky Medicaid Excluded/Termed Provider list is now provided in the following formats:
Attention: Important Announcement
To better monitor the prescriptions and care of Medicaid members, the Kentucky Department for Medicaid Services (DMS) will require all prescribing providers to enroll with DMS as credentialed practitioners. DMS will begin outreach to non-enrolled prescribers to assist with the enrollment process. Effective Sept. 1, 2010, DMS will no longer add non-Medicaid prescribers to its files. Effective Oct. 1, 2010, there will be no reimbursement for prescriptions by non-Medicaid providers, which will result in prescriptions denying. Please notify your patients that if they accept a prescription from a non-Medicaid provider, DMS will not pay for the prescription. For information about enrollment and to download an application (MAP 811) please visit our website.
If you have any questions or need assistance in completing the enrollment documentation, please contact the Provider Services Branch at 877-838-5085 Monday-Friday 10 a.m. to 4:30 p.m.
Announcement
Health Integrity Awarded Contracts to Identify Medicaid Overpayments
Health Integrity has been awarded two contracts by the Centers for Medicare and Medicaid Services (CMS) to serve as an audit Medicaid integrity contractor (Audit MIC). For more information, refer to the news release.
Attention Providers: Medicaid Partnering with Revenue for Tax Intercept
Effective May 15, 2010, the Department for Medicaid Services and the Department of Revenue have combined efforts to collect on outstanding debts due to any Commonwealth of Kentucky State agency.
To learn more how this may affect you, refer to the Revenue Tax Intercept Letter. The Program Integrity Division is responsible for
- Guarding against fraud, abuse and deliberate misuse of Medicaid program benefits by individual providers and recipients;
- Ensuring that Medicaid recipients receive necessary medical care at a level of quality consistent with that available to the general population;
- Assuring provider and recipient compliance with federal and state Medicaid rules and regulations;
The Program Integrity Division accomplishes this by working with the following functions:
Fraud and Abuse - Plans, develops and directs Agency efforts to identify, prevent and prosecute fraud, abuse and/or misuse in the Medicaid program. This includes verifying that medical services are appropriate and rendered as billed, that services are provided by qualified providers to eligible recipients, that payments for those services are correct and that all funds identified for collection are pursued
Provider Enrollment - Enrolls and updates information for new and existing KY Medicaid providers.
Third Party Liability - Identifies Medicaid recipients who have other medical insurance to ensure Medicaid is payor of last resort.
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Excluded Provider Information |
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On Jan. 16, 2009, the Centers for Medicare and Medicaid Services issued a letter to state Medicaid directors repeating a long standing policy and clarifying federal statutory and regulatory prohibitions regarding providers from participation in federal health care programs. For more information please review the following letters.
You may also visit the Office of the Inspector General Exclusions Program Web site for the List of Excluded Individuals/Entities.
Kentucky DMS List of Excluded Providers
Excluded/termed provider list
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