Update: CMS requires the collection of whether a hospital (PT 01) and a psychiatric hospital (02) is a Teaching Facility, which refers to a hospital engaged in an approved GME residency program in medicine, osteopathy, dentistry, or podiatry. As such, KY DMS has revised the MAP-811 (New Enrollment) and the MAP-900 -(Revalidation) to capture this information.
KY DMS is implementing a new enrollment system, which requires a provider's email address. This email address will be connected to the provider's KY Medicaid Number (existing and newly issued), and is required to secure accounts. The email address used cannot be the credentialing contact email address, only the provider's.
Prescribing providers already have an email address they use for KASPER through KY Online Gateway (KOG); for these provider types, this is the preferred email.
Ordering, Referring and Prescribing Provider Information
A General Provider Letter - Ordering, Referring and Prescribing Providers (PDF) and FAQ document (PDF) was mailed to a provider on Feb. 1, 2017 regarding ordering, referring and prescribing providers enrolling as Medicaid providers.
Questions regarding this notice may be directed to DMS Provider Services at (855) 824-5615, Monday through Friday, 8 a.m. to 5:30 p.m. Eastern time.
Per 42 CFR 455.460, certain providers are subject to an application fee for Initial Enrollment and Revalidation. Generally, the application fee applies to institutional providers as defined by Centers for Medicare and Medicaid Services (CMS) and not to individual professionals, such as physicians.
Below are the provider types that are subject to this fee:
- Hospital (01)
- Skilled Nursing Facility (12)
- Community Mental Health Center (30)
- Federally Qualified Health Center (31)
- Home Health Agency (34)
- Rural Health Clinic (35)
- Ambulatory Surgical Center (36)
- Independent Clinical Laboratory (37)
- End-Stage Renal Disease Facility (39)
- Hospice (44)
- Ambulance Service Supplier (55)
- Portable X-Ray Supplier (86)
- Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (90)
- Comprehensive Outpatient Rehabilitation Facility (91)
CMS sets the application fee amount, which may be adjusted annually. The application fee for 2018 is $569. If you are subject to the fee, please submit a check payable to Kentucky State Treasurer along with the enrollment or revalidation packet. For more information, please see the Federal Register notice.
Providers having paid an application fee to Medicare or to another state agency will not be required to make payment. KY Medicaid Provider Enrollment verifies proof of payment during the enrollment and revalidation process
Fingerprint-based Criminal Background Check (FCBC) - Helpful Information
KY Medicaid providers considered “high” risk according to the provisions of 42 CFR 455.434 recently received a letter indicating the requirement to comply with Fingerprint-based Criminal Background Check (FCBC).
“High” risk can apply to individual or organizational providers and is defined by two federal regulations, 42 CFR 424.518(c) and 455.450(e). Providers in this category include
- Home Health Agencies (HHAs);
- Durable Medical Equipment suppliers (DMEs);
- Providers excluded by HHS/OIG or another state’s Medicaid Program within the previous ten (10) years;
- Providers that have been on a payment suspension at some time in the last 10 years; and/or
- Providers that upon enrollment or revalidation are found to have an outstanding overpayment of $1500 or more owed to DMS. This does not apply to providers with an overpayment under appeal, in a payment plan or on hold.
Further, a person with five (5) percent or more direct or indirect ownership in a “high” risk provider are required to undergo a national (FCBC).
Letters were processed to be sent at the end of May 2017, but many did not get posted until mid-June. Providers receiving their notices late are requested to comply with the FCBC requirement within 30 days of receipt of their letter.
Please note that some providers with an established accounts receivable were sent the FCBC letter in error. Those providers will be receiving a letter to rescind the FCBC requirement. KY Medicaid has called or emailed the providers affected by the erroneous notice.
Please contact Provider Enrollment at (877) 838-5085 if you have any questions. Thank you for your attention.