Kentucky Medicaid identifies specialized children's clinics/child advocacy centers as Provider Type (13). To enroll or bill Kentucky Medicaid specialized children's clinics/child advocacy centers must be:
Once enrolled as a Kentucky Medicaid provider, specialized children's clinics become child advocacy centers.
Kentucky Medicaid partners with the Department for Community Based Services to administer child advocacy centers to provide services to children who have been sexually abused. The child receives a comprehensive examination at one of the clinics across the state designed to make the child feel safe and minimize trauma associated with victimization and examination.
Child advocacy centers must meet the coverage requirements of
907 KAR 3:160 to provide covered services. Any services performed must fall within the scope of practice for any provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations. All services must be medically necessary.
How do I verify eligibility?
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System.
Reimbursement for SBHS is in accordance with 907 KAR 1:715.
Duplication of Service
The department shall not reimburse for a service provided to a beneficiary by more than one provider, of any program in which the service is covered, during the same time period.
CareWise provides prior authorizations for any fee-for-service (FFS) beneficiary. Each MCO provides prior authorizations for its beneficiaries
Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service (FFS) claims. Each MCO processes its own claims.
Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. KY Medicaid requires the use of CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.
Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Claims must be received within 12 months of the date of service or six months from the Medicare pay date whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - DXC - (800) 807-1232
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (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 Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - 855) 300-5528
Humana - (855) 852-7005
Passport Health Plan - (800) 578-0775
WellCare of KY - (877) 389-9457