The Intermediate Care (IC) Clinics for Developmental and Intellectual Disabilities are Kentucky Medicaid as Provider Type (10). To bill Kentucky Medicaid, IC Clinics must be:
- Licensed in Kentucky.
- Enrolled as an active Kentucky Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary for who it provides services.
Covered Services
IC Clinics provide medically necessary preventive, diagnostic, therapeutic, rehabilitative, and/or palliative services to Kentucky Medicaid members who have a mental illness, intellectual disability, or developmental disability and who meet the patient status criteria established in 907 KAR 1:022, Section 4 (4)or (5).
IC Clinics must meet the coverage provisions and requirements of 907 KAR 3:225. Services must be performed within the scope of practice of any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations and the requirements of the MCO in which they participate, if applicable.
Verify Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or using the web-based KYHealth-Net System.
Reimbursement
IC Clinics are reimbursed per 907 KAR 3:230.
Duplication of Service
Kentucky Medicaid 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.
Prior Authorizations
CareWise provides prior authorization for fee-for-service beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Claims Submission
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid fee-for-service (FFS) claims. Each MCO processes its own claims.
Coding
Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding System 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 CPT codes.
Claim Appeals
Appeal requests made on denied FFS claims must be submitted to Gainwell Technologies. 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 the longer of either 12 months from the date of service or six months from the Medicare pay date 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:
Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
DBHDID IC Clinics - (502) 564-4527
Prior Authorization -
CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - Gainwell Technologies - (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