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What is KyHealth Net?

KyHealth Net is a web-based system designed to allow Medicaid Providers instant access to pertinent member information, claim inquiry, PA inquiry, RA viewer and claim submission. A user manual is available for downloading and is designed to assist you in navigating through the system. (Refer to the User Manuals section listed on the right.)

If at any time you have questions please email your inquiries to the EDI helpdesk  or contact them by phone at (800) 205-4696.

Please keep in mind the information contained on the KyHealth Net system is highly confidential and access should be strictly limited to those with valid reasons. It is the responsibility of the provider and the system administrator to ensure all persons with access understand the appropriate use of this data. We highly recommend the creation and implementation of guidelines within your office outlining appropriate and inappropriate uses 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 license to fax 502-209-3242 or 502-209-3240 attention: EDI Helpdesk.

You may also obtain a copy of the PIN 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 which offers the PA checklist, Radiology Prior Authorization Code List, PA Letters and PA inquiry, School-Based Health Services (only available to school-based health providers) and DME Prior Authorization Smart Sheets
  • Internet Claim Submission
    KyHealth Net has a "claims wizard", which offers interactive screens that walk you through the claim submission process.
  • Immediate Claim Adjudication on Internet Claims
    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 Advice
    The Remittance Advice statements will be formatted differently. Sample Remittance Advice pages with corresponding explanations are included in the Provider Billing Instructions.
  • Claim Status Inquiry
    KyHealth Net has a claim inquiry engine where you can search by member ID, Patient account number, Date Type, From and Thru Date of Service,  ICN or TCN and Claim Status to view detailed claim information. This does not include Pharmacy or MCO data.
  • Member 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 members paid vision, dental, hearing and ultrasound services.
  • 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.
  • DRG Letters
    View available Diagnostic Related Group Letters. 
  • Provider References
    Includes procedure and diagnosis code reference search, TPL Carriers information and a Provider Resources documentation link. 
  • Provider Status
    Includes status on 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.