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Provider Resources

What's New

2016 Provider Workshop Information

Attention Providers

For 2016, CMS will be hosting several Payment Error Rate Measurement (PERM) conference calls to providers for 2016. Please click on the Provider Call information to learn when the calls will be available.

Adjusted Primary Care Payment Update

Sept. 17, 2015 - In accordance with the Patient Protection and Affordable Care Act (ACA), certain physicians were eligible to receive adjusted Medicaid payments for primary care services. The federal government fully financed the difference between the state Medicaid payment rate and the applicable Medicare rate for Calendar Years 2013 and 2014 to pay the providers an enhanced rate. At the end of that period, the enhanced federal funding for this program ended. A 6-month claim run-out period was allowed for providers to submit claims for dates of service in CY 2013-14 not yet submitted/processed; as well as any claim adjustments/corrections per the CMS final rule.

The final cycle for the adjusted primary care payment rate, which includes the claim run-out period as well as the reconciliation, will process Oct. 1, 2015.

For more information about the Adjusted Primary Care payments, please refer to the KY Medicaid Affordable Care Act Information page.

If you have questions, please contact the Division of Policy and Operations at 502-564-6890.

ICD-10 Clarification for Dentists.

Dentists who currently do not bill ICD-9 codes do not have to convert to ICD-10. However, Oral Surgeons currently billing ICD-9 codes will be required to comply with ICD-10. For more information about Kentucky Medicaid's implementation of ICD-10, including how to test for readiness, please visit the DMS ICD-10 website.

Attention Providers

KY Medicaid ICD-10 Frequently Asked Questions September 2015

ICD-10 Quick Start Guide September 2015

View the CMS National Provider Call - Countdown to ICD 10 dated Aug. 27, 2015

Read the General Provider Letter #A101 - Eligibility Status (Aug. 12, 2015) and MAP-22 - Medicaid Member Address Change Form  (rev. Sept. 2015)

Read the General Provider Letter #A-100 - Implementation of ICD-10 (Aug. 12, 2015)

Attention Providers

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.

(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For more information on the process, read the EPSDT Prior authorizations for PT OT ST provider notice (July 9, 2015)

Please contact HP at 1-800-807-1232 for assistance and if you have questions about submitting prior authorizations under the EPSDT PT-45 number to replace prior authorizations approved under the new provider type.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact Catherann Terry at 502-564-9444, ext 2120.

2015 WellCare Provider Summit

For more information about the upcoming 2015 WellCare Summit, view the Flyer.

Attention Presumptive Eligibility Providers

(May 18, 2015) - Read the letter regarding Presumptive Eligibility transitioning to the KY Health Benefits Exchange System

Notice to all providers regarding Electronic Funds Transfer

(Feb. 18, 2015) - The electronic funds transfer (EFT) update function via KY Health Net will be disabled March 6, 2015. To update your EFT, please contact provider enrollment at 1-877-838-5085 for further instructions. We apologize for any inconvenience.

Attention Behavioral health Services Organization (BSHO) Providers

(Mar. 25 2015) - For Questions regarding providing BHSO services, please refer to the DBHDID's BHSO page and review the recent "2015 BSHO Webinar". For questions not addressed in the webinar, please email us.

The BHSO Medicaid Billing Manual is currently under development and will be posted in the near future.

Notice to all providers regarding Electronic Funds Transfer

(Feb. 18, 2015) - The electronic funds transfer (EFT) update function via KY Health Net will be disabled March 6, 2015. To update your EFT, please contact provider enrollment at 1 (877) 838-5085 for further instructions. We apologize for any inconvenience.

Attention Providers

Read the General Provider Letter #A-97 - Medicaid Managed Care Open Enrollment (Oct. 1, 2014)

Urgent Notice from our Fiscal Agent HP.

Due to a systems upgrade, the following functions will be delayed or stopped on Friday, Oct. 10, 2014 until approximately 2 a.m., Monday, Oct. 13, 2014.

  • Friday 10 a.m. - All claims submitted via a vendor/clearinghouse will be stopped and held in a queue. Acknowledgements will be sent once processing starts on Monday at approximately 2 a.m.
  • Friday noon - The financial cycle will start at noon instead of 6 p.m.
  • Friday 3 p.m. to Saturday 3 a.m. - The DMS and HP member helpdesks will not be able to perform member updates until approximately 3 a.m. Saturday.
  • Friday 9 p.m. KYHealth Net will become unavailable. This includes presumptive eligibility confirmations and applications. It will become fully available on Sunday, Oct. 12 at 3 p.m. with intermittent availability on Saturday.

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.

Provider Letters

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 agreements have been terminated or the provider has been placed on a Medicaid Terminated and Excluded Provider list

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) Affordable Care Act (ACA)expansion. Services are to begin on Jan. 1, 2014 for members enrolled through Medicaid expansion under the federal  ACA in seven 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 managed care regions. The RFP is available on the Commonwealth of Kentucky 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.

More information and updates on the Medicaid expansion, kynect: Kentucky's Healthcare Connection or adjusted primary care payments

Prompt Payment Update

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

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

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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Helpful Information

KY Medicaid Provider Enrollment Information

Provider Forms

Provider Letters


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

Notice Final Rule posting

This final rule changes the compliance date from Oct. 1, 2014 to Oct. 1, 2015 for the ICD-10-CM for diagnosis coding and the ICD-10-PCS for inpatient hospital procedure coding, including the official ICD-10-CM and ICD-10-PCS guidelines for coding and reporting. It also requires the continued use through Sept. 30, 2015 of the ICD-9-CM for diagnoses and procedures including the ICD-9-CM guidelines for coding and reporting.

For more information, refer to the DMS ICD-10 website.

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Billing Information


  • 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.



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Prior Authorization
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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Site Updates

Last Updated 12/7/2017