KyHealth-Net System

KyHealth Choices has implemented a new Medicaid Management Information System (MMIS) which includes a new KYHealth-Net system.  The new system will provide significant enhancements for providers.

Listed below are some changes providers will encounter with the implementation of the new system.

To access the new KyHealth-Net, you must have a single sign on account (not the same User ID you use to access KyHealth-Net currently). 

PIN letters have been sent to all active providers, with instructions for activating the single sign on account.

If you have not activated your new account, contact the EDI helpdesk at 1-800-205-4696 or send inquiries via email to KY_EDI_Helpdesk@eds.com.

Note:  You will be required to change your account password every 30 days.

Once you have activated your account, click here to start using the KyHealth-Net now!

• Prior Authorization (PA) *New*
  The new KyHealth-Net has a PA link which offers the PA checklist, Radiology Prior Authorization Code List, PA Letters and PA inquiry. 
• Internet Claim Submission  *New*
  The new KyHealth-Net has a “claims wizard,” which offers interactive screens that walk you through the claim submission process.
• Immediate Claim Adjudication on Internet Claims *New*
  Claims submitted via KyHealth-net will be adjudicated immediately, and provide a real-time response.  This will allow you the opportunity to correct denied claims, and resubmit them immediately. 
• Remittance Advices
  The new Remittance Advice statements will be formatted differently.  Sample Remittance Advice pages with corresponding explanations are included in the new Billing Instructions.
• Claim Status Inquiry 
  The new KyHealth-Net has a claim inquiry engine where you can search by member ID, Patient account number, Date Type, ICN or TCN and Claim Status to view detailed claim information.   Does not include Pharmacy or Region 3 data.
• Member Information
  Includes county, eligibility, card issuance data, waiver, third party liability, spend down, patient liability, presumptive eligibility, copay/coinsurance history, poverty indicator, KenPAC provider and Lock-In provider information.
• Service Limitations
  A history of a members paid vision, dental, hearing and ultrasound services.
• KenPAC
  A list of current KenPAC member for which the provider received a management fee payment.  Available to KenPAC providers only.
• Nursing Facilities
  A listing of member assigned to a nursing facility including the certification number and dates along with the eligibility segments.  Available to Nursing Facilities only.
• Pharmacy History
  A listing of prescriptions paid by Medicaid for each member.  Does not include prescriptions denied or pending by Medicaid, or prescriptions covered by any other insurance or self pay.
• Qualifying Income Trust (QIT)
  Listing of members, assigned to a particular provider, meeting the criteria for needing a QIT to maintain Medicaid eligibility.
• Regional Transportation Broker Listing
  A listing of members assigned to a specific regional transportation broker.  Available to brokers only.