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Notice

In response to the COVID-19 state of emergency, the Centers for Medicare and Medicaid Services has authorized delay of certain Medicare cost reports. As a result, the Department for Medicaid Services also will grant any cost report extensions that Medicare has officially granted. At this time, the following fiscal year-end cost report extensions have been granted:

​Fiscal Year-End​Revised Due Date

Oct. 31, 2019

​June 30, 2020

​Nov. 30, 2019

​June 30, 2020

​Dec. 31, 2019

July 31, 2020

Please call (502) 564 - 8196 if you have any questions and ask for the staff referenced below based on provider type.

​Provider Type
​DMS Contact
​Home Health 
​Tara Brewer
​Hospital
​Barb Carter
​Nursing Facility
​Lynette Gurney

Home health (HH) services are recognized in Kentucky Medicaid as Provider Type (34). To enroll and bill Kentucky Medicaid, a home health service provider must be:

All services and/or supplies must meet medical necessity criteria for the treatment of illness per 907 KAR 3:130.

Covered Services

HH services are available to Medicaid beneficiaries of all ages and are intended to be short-term in duration. HH services must be prescribed by a physician and follow a written plan of care to help the Medicaid beneficiary receive medically necessary and reasonable care to remain at home. Teaching the beneficiary or family members, whenever possible, appropriate care techniques for the beneficiaries' condition and needs should occur in the episode of care. HH services can include intermittent skilled nursing services; physical, speech and occupational therapies; non-routine medical supplies required for an episode of care; medical social services; and home health aide services.

Home health agencies must meet the coverage provisions of 907 KAR 1:030 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.

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.

Recertification

Requests for recertifications may be submitted for review up to five business days prior to the service plan start date. If a request for re-certification is not submitted prior to the expiration of the current certification period, the re-certification shall begin on the date that a completed packet is received by the QIO. The physician shall sign, date and recertify the plan of care no less frequently than every two months, with a maximum of 60 days per certification period.

Service Limitations

An annual limit of 20 is allowed for the following:

  • Occupational therapy service visits per beneficiary
  • Physical therapy service visits per beneficiary and
  • Speech-language pathology service visits per beneficiary.

The limits may be exceeded if additional services are determined to be medically necessary by the department; or if the beneficiary is not enrolled with MCO or the MCO in which the beneficiary is enrolled.  Prior authorization by the department is required for each visit that exceeds the limit for a beneficiary who is not enrolled with a MCO. 

Non-Covered Services

Procedures not considered medically necessary shall not be covered by Kentucky Medicaid. Other services not covered include a domestic or housekeeping service unrelated to the health care of a beneficiary; a medical social service unless provided in conjunction with another service; supplies for personal hygiene; drugs; disposable diapers for a beneficiary age three years and younger, regardless of a medical condition; except for the first week following a home delivery, a newborn or postpartum service without the presence of a medical complication shall; and a beneficiary who has elected to receive hospice care is not eligible for coverage under the home health program.

Verify eligibility 

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

Reimbursement

Reimbursement for HH Services is in accordance with the HH Fee Schedule and 907 KAR 1:031.

Duplication of Service

The department will 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.  For example, if a beneficiary is receiving a speech-language pathology service from a speech-language pathologist enrolled with the Medicaid program, the department will not reimburse for a speech-language pathology service provided to the same beneficiary during the same time period via the home health services program.

Prior Authorization

All services and/or supplies must be prior authorized to ensure the service or modification of the service is medically necessary and adequate for the needs of the beneficiary. HCPCS codes are required on prior authorization requests and claims submitted for payment for revenue codes 270 non-routine medical supplies and 279 nutritional supplements. 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 service claims. Each MCO processes its own claims.

Coding

Kentucky Medicaid utilizes 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 the UB-04 billing forms. Providers will need to bill Kentucky Medicaid using the correct revenue 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 an MCO claim.

Timely Filing

Claims must be received within 12 months from the date of service (DOS) or six months from the Medicare pay date whichever is longer, or within 12 months from 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
Provider Questions - (855) 824-5615
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
Rate Setting Branch (502) 564-4321

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        

 

Contact Information

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