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Provider Resources

What's New

Attention Providers: Policy Clarification Updates

New CMS 1500 Provider Letters

New Provider Letters

KY Spirit information for members and providers

July 2, 2013 - Read the:

New webpage for the KY Medicaid Terminated and Excluded Provider List.

June 25, 2013 - The Kentucky Department for Medicaid Services maintains a list of providers whose Medicaid provider agreement has either been terminated or the provider has been placed on an exclusion list. To view this list, either click on the Medicaid Terminated and Excluded Provider List located on the left or click here.

Cabinet Releases Medicaid Managed Care Request for Proposal

June 12, 2013 - The Finance and Administration Cabinet released a Medicaid Managed Care Request for Proposal (RFP) ACA Expansion. Services are to begin on January 1, 2014, for members enrolled through Medicaid expansion under the federal Affordable Care Act (ACA) in seven (7) Medicaid Regions and July 1, 2014, for specified members eligible for Medicaid under eligibility criteria in place prior to the ACA expansion for the same seven (7) Managed Care Regions. The RFP is available on the Commonwealth of Kentucky's eProcurement website. Any questions related to this procurement must be directed to the Office of Procurement Services, Finance and Administration Cabinet. Contact information is available on the eProcurement site.

For more information and updates on the Medicaid expansion, kynect: Kentucky's Healthcare Connection or adjusted primary care payments, click here.

Prompt Payment Update

(04/17/13) - Read the General Provider Letter #A-93 - Medicaid MCO Prompt Payment Complaints to be Reviewed by the Department of Insurance (DOI)

(04/05/13) - Read the Letter from Governor Beshear explaining his veto of House Bill 5.

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 the 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 (12/01/12)

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 1 (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

Provider Enrollment Notice

(Oct. 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's website. Please mail a copy of your license to:

KY Medicaid
PO Box 2110
Frankfort, KY 40602

Please also include your KY Medicaid provider number on the copy of the license.

Managed Care Organization (MCO) prior-authorization critical issue resolution mailbox:

Due to providers having critical issues with obtaining MCO Prior-Authorizations, DMS/MCO Oversight Branch has established a resolution mailbox for providers to report:

  • when there has been no response,
  • an untimely response,
  • or any other issues with the MCO Prior Authorization (PA) process.

Note: This mailbox is not to be used in lieu of the normal PA process.

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Medicaid Managed Care Information

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Provider Updates

2011 Provider Updates

  • 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: 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.
  • 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 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.
  • Nursing Facilities Update June 2011 - New Significant Change in Condition/Disposition Form. For more information, refer to the revised (MAP-4095) - PASRR Significant Change/Discharge Data.
  • Physician Provider Update as of June 2011- Refer to the Physician NDC Code Update for changes in billing.
  • Provider Enrollment Update as of June 2011 - Update for KY non-Medicaid Prescribing Providers as of June 2011
  • Provider Enrollment Update effective June 1, 2011 - MAP Form Update
  • Provider Enrollment Update effective March 25, 2011 - Final Rule indicates that certain providers will be required to pay an application fee..
  • Provider Enrollment Update - Medicaid Provider Updated Licenses. Refer to the Provider Enrollment or Credentialing website for more information.
  • 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

Older Provider Updates

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Lock-In Information

The Lock-In Program was developed to identify, manage and monitor members who use Medicaid services at an amount or frequency that is not medically necessary in accordance with established utilization guidelines.

If a member is enrolled in a MCO, please contact the specific MCO for more information.

Helpful Information

KY Medicaid Provider Enrollment Information

Provider Forms

Provider Letters

Publications

Workshop-Conference Call Information

Attention all ABI, SCL, ADC, HANDS, First Steps, Title 5, HCB, Hospice, NF, ICFMR and School Based Services Providers - HP Enterprise Services, in conjunction with the Kentucky Department for Medicaid Services, would like to invite you to join us for our Spring Webinar. This webinar is designed to offer providers instruction and assistance with billing claims to Kentucky Medicaid. Each session will provide a comprehensive reference listing, KyHealth Net instruction, and information on 5010 changes.

Registration will be comprised of email responses only. Please e-mail your date/time selection.

Archive Spring Seminar Information - HP Enterprise Services, in conjunction with the Kentucky Department for Medicaid Services, would like to invite you to join us for our Spring Seminar. To print the workshop packet materials, refer to the KYMMIS Provider Workshop website.

Archive Conference Call Information - June 16, 2010, CMS Payment Error Rate Measurement (PERM) Project Information documents.

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HIPPA 5010/ICD-10 Information

Centers for Medicare and Medicaid Services (CMS) ICD-10 Implementation Presentation

The Cabinet for Health and Family Services, in collaboration with the Department for Medicaid Services (DMS), is hosting an on site visit from CMS to discuss processes for ICD-10 implementation Nov. 15-16, 2012.

This two day session will be aired via Webinar and is open to all organizations including providers of Medicaid services, trading partners, contractors, Managed Care Organizations, and other interested parties. Information about the sessions are available on the "What's New" section of the DMS ICD-10 website.

New ICD-10 Deadline - Oct. 1, 2014

HHS has announced the final rule that delays the ICD-10 compliance date from Oct. 1, 2013 to Oct. 1, 2014.

For more information, refer to the announcement or the final rule or visit the DMS ICD-10 page.

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Billing Information

Announcements

  • 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.
  • Important Information for Kentucky Medicaid Providers Regarding Overpayments - Read the General Medicaid Provider Letter regarding Overpayments dated Feb. 21, 2011.
  • Kentucky Medicaid has implemented the National Correct Coding Initiative (NCCI) - As specified in the Affordable Care Act, Kentucky Medicaid has implemented the NCCI. For more information, please review the Provider Letter #A-81 - National Correct Coding Initiative (NCCI) dated Oct. 1, 2010. If you have additional questions, you may: Email the CHFS DMS Webmaster; Call Provider Relational at (800) 807-1232; Visit the CMS National Correct Coding Initiative website
  • Information regarding CT Scan Diagnoses

Direct Deposit System for Medicaid Provider Payments

Have you enrolled yet with the new direct deposit system for Medicaid provider payments? Direct deposit guarantees rapid availability of funds and eliminates lost payments. For more information, contact Provider Enrollment at (877) 838-5085.

Resources

Codes

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Prior Authorization Information
Program Integrity

Medicaid Partnering with Revenue for Tax Intercept - Effective May 15, the Department for Medicaid Services and the Department of Revenue have combined efforts to collect outstanding debts due to any Commonwealth of Kentucky agency. To learn more how this may affect you, refer to the Revenue Tax Intercept Letter.

Information Regarding Medicaid Provider Updated License.- Please refer to the Kentucky Provider Enrollment website for more information.

Information regarding Excluded Providers - 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, refer to the following letters.

Kentucky Medicaid General provider Letter regarding excluding providers

You may also visit the Office of the Inspector General Exclusions Program website for the List of Excluded Individuals/Entities.

DMS List of Excluded Providers
Excluded/termed provider list

To view more information about Program Integrity, refer to their website.

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Last Updated 2/12/2014
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