​​​​​​​​​​​​What is KyHealth Net?

KyHealth Net is a web-based system that gives Medicaid providers instant access to pertinent member information, claims inquiries, prior authorization inquiries, remittance advice viewer, and claims submission. ​

Please keep in mind the information contained on the KyHealth Net system is highly confidential and access is strictly limited to those with valid reasons. It is the responsibility of the provider and the system administrator to ensure all those with access understand and comply with appropriate use of this data. We strongly recommend creation and implementation of internal office guidelines for appropriate and inappropriate use of this data.

To Access KyHealth Net

To create a KyHealth Net account, complete the PIN Release form and send it to the EDI helpdesk along with a copy of your driver's license. You can send it by email or fax. Please mark it as attention: EDI Helpdesk. 

• ​Email: ​ky_edi_helpdesk@gainwelltechnologies.com
  
• Fax:  502-209-3242 or 502-209-3240 
  

You may obtain a copy of the PI​N Release form from the KYMMIS website​. For questions about the PIN Release form contact the EDI helpdesk at 800-205-4696.

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

Start using KyHealth Net

Features of KyHealth Net

• Prior Authorization (PA)
   KyHealth Net has a PA link that offers the PA checklist, radiology prior authorization code list, PA letters, PA inquiry, school-based health services (only available to school-based health providers), and Medical Supplies, Equipment, and Appliances prior authorization smart sheets. 
  
• Internet Claim Submission
  KyHealth Net has a claims wizard that offers interactive screens that walk you through the claim submission process.
• Immediate Claim Adjudication on Internet Claims
  Claims submitted via KyHealth Net are adjudicated immediately, and responses are provided in real-time. This allows you to correct denied claims and resubmit them immediately.
• Remittance Advice
  The remittance advice statements are formatted differently. Sample remittance advice pages with corresponding explanations are included in the Provider Billing Inst​ructions.
• Claim Status Inquiry
  KyHealth Net has a claim inquiry engine where you can search by member ID, patient account number, date type, from and through date of Service, ICN or TCN, and claim status to view detailed claim information. This does not include pharmacy or managed care organization data.
• Member Information
  Available information includes eligibility, card issuance data, waiver, managed care, third party liability, spend down, patient liability, copay/coinsurance/cost share history, poverty indicator, Kentucky health plan type, and dental and vision coverage.
• Service Limitations
  A history of a member's paid vision, dental, hearing and ultrasound services.
• Nursing Facilities
  A listing of members 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 Medicaid paid for each member. It does not include pending Medicaid prescriptions, prescriptions Medicaid denied, or prescriptions covered by any other insurance or self-pay.
• Diagnostic Related Group (DRG) Letters
  Providers can view available DRG letters. 
  
• Provider References
  This includes procedure and diagnosis code reference search, third-party liability​ carriers information, and a provider resources documentation link.
• Provider Status
  This shows the status of the currently logged-in provider, such as identification numbers, ID type, taxonomies, group practice, contracts, licenses, effective and end dates, revalidation information, and addresses on file.