The Department for Medicaid Services and the Department for Community Based Services
partners together in administering some programs for Medicaid eligible children such as Specialized Children's Services Clinics. In order for a Specialized Children's Center or Child Advocacy Center entity to provide services to a Medicaid beneficiary,
All services must be medically necessary. Once enrolled as a Medicaid provider, Specialized Children's Service Clinics become Child Advocacy Centers.
Child Advocacy Center entities must meet the coverage provisions and requirements set forth in 907 KAR 3:160 in order to provide covered services. All services must be performed within the scope of practice for any provider. The Child Advocacy Centers provide services to children who have been sexually abused. The child receives a comprehensive examination at one of the clinics across the state. These clinics are designed to make the child feel safe and minimize the trauma associated with the victimization and examination.
Kentucky Medicaid currently contracts with to process Medicaid claims. (Each MCO contracts with their own billing agent.) DXC
Kentucky Medicaid utilizes National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental.
Coding: The RHC Program uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15)
Claim Appeals: Appeal requests made on denied claims must be submitted to DXC. The request must include the reason of the request along with a hard copy claim.
Timely Filing: Claims must be received within 12 months from the date of service (DOS) or 6 months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Assisted Drug (PAD) List - Pharmacy Branch - (502) 564-6890