Comprehensive Outpatient Rehabilitation Facilities Services - PT (91)

Comprehensive Outpatient Rehabilitation Facilities Services (CORF) is identified in Kentucky Medicaid as Provider Type (91). To enroll and bill Kentucky Medicaid, CORF service providers must be:

be enrolled with Medicare
Licensed in the state in which they operate. In Kentucky, hospitals 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.

CORF is limited to Medicare deductible and coinsurance payments for Qualified Medicare Beneficiary (QMB). A facility enrolls under a separate provider number as a CORF provider to bill for deductible and coinsurance amounts applicable to QMB beneficiary receiving services covered under the CORF program.

Covered Services

CORF serve providers must provide coordinated outpatient diagnostic, therapeutic, and restorative services, at a single fixed location, to outpatients for the rehabilitation of injured, disabled or sick individuals. Physical therapy, occupational therapy, and speech-language pathology services may be provided in an off-site location.

The following are considered "core" services that a CORF must provide:

physician CORF service - consultation with and medical supervision of non-physician staff, establishment and review of the plan of treatment and other medical and facility administration activities
physical therapy services, social or psychological services.

CORFs are surveyed every six years at a minimum.

CORF facilities must meet the coverage provisions and requirements set forth in 902 KAR 020:230 in order 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.

Verify eligibility

Verify eligibility by calling the automated voice response system at (800) 807-1301, or visit the web-based KYHealth-Net System.

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 same service is covered, during the same time period.

Prior Authorizations

CareWise provides prior authorizations for 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 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 mutually exclusive or incidental. KY 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 must bill on the UB-04 billing form. Providers will bill Kentucky Medicaid using the correct EOB 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 in question, if appealing an MCO 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. Please refer to the MCO in question, 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:
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