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Hospital Services

Services Covered

Most inpatient hospital services are covered as long as the inpatient stay is justified as medically necessary. Certain hospital outpatient and emergency room services are also covered.

Will I need to pay for hospital services?

  • A co-pay of $50 will be assessed for each inpatient hospital visit.
  • A co-pay of $3 will be assessed for each visit to the emergency room which is determined to be not an emergency.
Hospital Types

Acute Care Hospital facilities provides both inpatient and outpatient services, including emergency room services.

  • Critical Access Hospital facilities may qualify as a critical access hospital if the facility meets other state and federal criteria.
  • Diagnosis Related Group (DRG) means a clinically-similar grouping of services that can be expected to consume similar amounts of hospital resources

Psychiatric Inpatient Hospitals

Other Hospital Programs

Disproportionate Share Hospital (DSH) Program prior to billing a patient and submitting hospital service expenses to Medicaid as uncompensated, a hospital uses the Indigent Care Eligibility form to determine if the patient meets DSH guidelines.

If Questions?

Regarding policy, contact
Division of Policy and Operations
Benefits Branch
275 East Main St
6W-D
Frankfort, KY 40621
Phone: (502) 564-6890
E-mail: CHFS DMS Webmaster

Regarding Rates, contact:
Division of Fiscal Management
Rate Setting Branch
275 East Main St
6W-C
Frankfort, KY 40621
Phone: (502) 564-8196

Regarding Billing, contact EDS at (800) 807-1232 or visit their website.

Regarding Enrollment, contact Provider Enrollment at (877) 838-5085 Monday to Friday 8 a.m. - 4:30 p.m. ET or visit their website.

Regarding Members: contact Member Services at (800) 635-2570 from 8 a.m. to 5 p.m. Eastern time Monday - Friday.

Archive Fee Schedules

Hospital Outpatient Laboratory Fee Schedule

 

Regulations, Provider Letters, Billing Information and Forms
 

Regulations

Provider Letters

To view other letter(s), go to the Provider Letter page

Billing Information

Forms
Obstetric Notification form

Note: The Obstetric Notification form is to be used by providers to notify KY Medicaid of admissions for a normal delivery. A normal delivery is defined as a vaginal delivery or a scheduled cesarean section for a term pregnancy of 38 - 42 weeks. The form is to be faxed to EDS after the delivery to obtain the authorization number.

 

Last Updated 2/20/2014
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