Kentucky Medicaid identifies Community Mental Health Centers (CMHC) Provider Type (30). To enroll and bill Kentucky Medicaid, CMHC service providers must be:

• Licensed in the state in which they operate. In Kentucky, CMHC service providers must contact the Office of Inspector General Division of Health Care for a survey/license
  
• Enrolled as a Medicaid active provider, and if applicable, enrolled with the managed care organization (MCO) of any beneficiary for whom it provides services. 
  

Covered CMHC Services

CMHCs provide a comprehensive range of accessible, coordinated, direct or indirect mental health services through Kentucky's 14 regional MH/IDD boards. Regional boards are private, nonprofit organizations serving residents of designated multicounty regions. Rehabilitative mental health and substance use services may be either on-site, defined as the CMHC, leased and donated space or off-site which includes the recipient’s home, congregate living facility not otherwise reimbursed by Medicaid, with the exception of an institute for mental disease, school or daycare center, senior citizen’s center, and family resource and youth center. 

If a CMHC also wishes to serve as a primary care center it must meet the coverage provisions and requirements of 907 KAR 1:047 to provide covered services. All services must be performed within the scope of practice for any provider. 

CMHC services providers must meet the coverage provisions and requirements of 907 KAR 1:044  to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment.  Providers must follow Kentucky Medicaid regulations. All services must be medically necessary. 

Verifying eligibility

Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.

Reimbursement

Reimbursement for a CMHC facility is provided by 907 KAR 1:045  and may refer to the CMHC Reimbursement Manual for more information.

Duplication of Service

The department willl not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.

Prior Authorizations

CareWise provides prior authorizations for any fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid FFS for service claims. Each MCO processes its own claims.

Coding

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 Current 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. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals

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 a MCO claim.

Timely Filing

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 a 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
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 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