Department for Medicaid Services
Important Kentucky Medicaid updates and announcements:
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.
Medicaid Open Enrollment Information
(June 2, 2014) - The Department for Medicaid Services is currently 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:
Members have until June 18, 2014 to change their MCOs. 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 July 1, 2014.
Attention Medicaid Members
May 14, 2014 - Please read the Important Notice Regarding Non-Emergency Medical Transportation which will begin on July 1, 2014 for members in Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall and McCracken counties.
Information regarding KY Kids Recovery grant program
Feb. 3, 2014 - The Substance Abuse Treatment Advisory Committee is seeking assistance spreading the word about submissions for the KyKidsRecovery juvenile substance abuse treatment grants. For more information, click below to:
You may also call: (855) 450-5646 #KYKidsRecovery.
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.
Important Notice Regarding Non-Emergency Medical Transportation
Kentucky Medicaid eligibility is expanding Jan. 1, 2014
New Web page regarding the Affordable Care Act
Information or updates on the Affordable Care Act (ACA) including Medicaid expansion, kynect: Kentucky's Healthcare Connection or adjusted primary care payments
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.
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||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.
View older announcements.
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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 Hospital and Physician Providers
(Oct. 17, 2012) - Important information regarding Newborn Assignment to MCOs. Click to read the Hospital Provider Letter #A-248; Physicians Provider Letter #A-373 - Newborn assignment to MCOs
Attention Non-Managed Care Organization Providers
Due to the expiration of American Recovery and Reinvestment Act (ARRA) enhanced funding, the Department for Medicaid Services is returning to pre-ARRA cash management cycles. For more information, read the General Provider Letter #A-88 - Changes to the Medicaid (NON-Managed Care Organization) Claims Payment Cycle (Dec. 1, 2012)
For more information, refer to the announcement or the final rule or visit the DMS ICD-10 page.
Provider Enrollment Notice
(Sept. 12, 2012) - If you are a home medical equipment provider and are required to be licensed by the KY Board of Pharmacy as such, please submit a copy of your license to KY Medicaid. For more information regarding this new requirement (effective Sept. 30, 2012), please visit the KY Board of Pharmacy website. Please mail a copy of your license to:
PO Box 2110
Frankfort, KY 40602
Please also include your Kentucky Medicaid provider number on the copy of the license.
Important Notice for KY Medicaid Recipients and Providers
(Tuesday, Aug. 21, 2012) - Effective Oct. 1, 2012, there will be changes to Non-Emergency Medical Transportation. Read the important notice regarding Region 5 Non-Emergency Medical Transportation.
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
Provider Enrollment Notice
(Sept. 28, 2011) - When sending any type of correspondence to Kentucky Medicaid provider enrollment, please write your NPI and/or Kentucky Medicaid provider number on each document. If you submit documents for multiple providers submitted in the same envelope, please staple or paperclip each providers own documents separately. Although, we prefer that you do not attach multiple providers' documents in the same envelope.
EHR Incentive Program Information
In order to keep Kentucky Medicaid providers updated on the new EHR incentive program, a new website has been developed for hospitals and providers. You may view this website by either using the left hand navigation button for Kentucky EHR Initiative Program or go directly to the website
Physician 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.
Physician Provider Update
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.
To review other Provider Updates and other information for providers, refer to the Provider Resources page.
Provider Enrollment Updates
Update for KY non-Medicaid Prescribing Providers as of June 2011
MAP Form Update effective June 1, 2011
To review other Provider Enrollment Updates, refer to the Provider Enrollment page.
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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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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.
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