Department for Medicaid Services
ATTENTION ALL PROVIDERS: As of 1/1/2012, 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 HEALTHNET Users: All claims paid prior to 12/29/2011 will not have the (Copy Claim) or the (Adjust Claim) function through KY Health Net. Any adjustments to claims paid prior to 12/29/2011 will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services
Welcome to the Kentucky Department for Medicaid Services website. Please refer to one of the links listed below to read important updates and announcements regarding this program:
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Medicaid Managed Care Information |
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MCO Updates for Providers and Members
Providers: Managed Care Policy for Out of Network Dental Providers (Nov. 18, 2011) Managed Care Policy For Out-Of-Network Providers (Nov. 8, 2011) or Download a General Provider Letter #A-86 - regarding the coming Nov. 1 implementation. (Oct. 25, 2011.)
Members: (Oct. 25, 2011) Letters have been mailed to Medicaid members with details regarding the start of managed care on Nov. 1. The letter provides information about the member's managed care organization (MCO) assignment. This letter also provides information regarding the MCOs' covered benefits, services and cost-sharing amounts as well as additional information for instructing members on how they may change MCOs. Members will be able to change MCOs for 90 days after managed care begins.
Important prior authorization information regarding RSV (respiratory syncytial virus) vaccine
(Oct. 10, 2011) Magellan Medicaid Administration, the pharmacy benefit administrator for the Department for Medicaid Services, is handling prior authorizations (PAs) for the RSV vaccine for dates of service prior to November 1, 2011. For services rendered on or after that date, the member's assigned managed care organization (MCO) will be responsible for authorizations. The MCOs will honor all existing PAs issued by Magellan for at least 30 days on or after November 1.
Updated Member Information Regarding Medicaid Managed Care
(Sept. 21, 2011) - For updated information, view the Nov. 1, 2011 MCO Member Letter.
Medicaid Managed Care Implementation Extended until Nov. 1 in Response to Hospitals' Request
FRANKFORT, Ky. (Sept. 19, 2011) - Cabinet for Health and Family Services (CHFS) Secretary Janie Miller today announced that the implementation date for Medicaid Managed Care, targeted for Oct. 1, 2011, will be extended one month, an option provided in the contracts with managed care organizations. The Cabinet has granted the extension in response to a request from the Kentucky Hospital Association (KHA), which has assured the Cabinet that a one-month extension to Nov. 1, 2011, will allow hospitals adequate time to sign contracts and prepare for implementation. View entire news release.
Kentucky Receives Federal Approval to Implement Medicaid Managed Care
(Sept. 12, 2011) The Kentucky Cabinet for Health and Family Services (CHFS) has received approval from the Centers for Medicaid and Medicare Services (CMS) to operate the Medicaid managed care organization waiver program. The waiver allows Kentucky to implement a mandatory managed care program for virtually all Medicaid recipients in the state outside of the Passport region, which operates under a separate CMS waiver. View entire news release.
New Managed Care Website
Kentucky Medicaid is pleased to announce that it now has a new managed care website for members and providers. This website is intended to assist Medicaid members and providers in finding information about the transition to managed care coming Nov. 1.
During August, letters were mailed to Medicaid members with details regarding their newly assigned managed care organization (MCO). This letter also provided information regarding the MCOs' covered benefits, services and cost-sharing amounts as well as additional information on how to change MCOs, if desired. The deadline to change MCOs has been extended to Oct. 5. Members will also be able to change within 90 days after managed care begins on Nov. 1.
Updated Information Regarding Expansion of Managed Care
(Aug. 19, 2011) To view the updates, refer to the General Provider Letter #A-84 - Additional information and guidance relating to the expansion of Managed Care in the Kentucky Medicaid program.
DMS MCO Payment Policy Clarification for Hospitals
(Aug. 5, 2011) For more information, refer to the Hospital MCO Questions and Answers .
Important Information Regarding Expansion of Managed Care
For more information and guidance relating to the expansion of managed care in the Kentucky Medicaid program.
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Provider Updates |
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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.
KY Medicaid and HP Enterprise Services EDI Unit now has EDI testing available
For more information on what you need to do, please refer to the EDI Testing Steps.
KY Medicaid ICD-10 Survey Results Are In June 2011
The KY Medicaid ICD-10 Survey was conducted from May 15, 2011 to June 18, 2011. The survey was open for a month and consisted of eight questions. All Provider types were invited to participate in the survey. Thanks again to the 230 providers (or their designees) who participated in the survey.
View the survey Results.
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) 1/1/2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400.00 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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Program Updates |
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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 for information on filing out the new application.
To view more programs and services, refer to the Program and Services page.
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Policy Updates |
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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.
Older updates
DME updates as of November 2010
Important information regarding children's services (Nov. 17, 2006)
Important Information regarding the three Branded Drug Allowance
Direct Deposit System for Medicaid Provider Payments
Home and Community Based Waiver (HCBW) and Adult Day Health Care (ADHC) Changes Effective July 1, 2005
To review more updates and/or clarifications, refer to the Policy Clarifications page.
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