Kentucky Medicaid recognizes emergency transportation providers as Provider Type (55). To enroll and bill Kentucky Medicaid, an emergency transportation provider must be:

• licensed with the state of Kentucky
• enrolled as a Kentucky Medicaid Provider and if applicable, enrolled with the managed care organization (MCO) of any beneficiary they serve.

Medicaid covers only medically necessary transportation to and from a Medicaid-covered service.

Covered Services

What are Emergency Ambulance Transportation Services? Emergency ambulance services are covered when the eligible member is transported in an emergency condition, usually to hospital, resulting from an accident, serious injury or acute illness that makes it impossible to use other types of transportation.

How do I verify beneficiary eligibility? You may verify eligibility by:

• contacting the Automated Voice Response System at (800) 807-1301
• using the web-based KYHealth-Net System

Emergency transportation providers must meet the coverage provisions and requirements of 907 KAR 1:060. All 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 all relevant Kentucky Medicaid regulations. All services must be medically necessary.

Not Covered: Procedures considered not medically necessary are not covered by KY Medicaid. Non-covered services include cosmetic surgery (except DMS approved), translation services, phone calls, court-ordered testing, fertility services, copying of records, office supplies, investigational research, postmortem examinations and missed appointments.

Reimbursement: Reimbursement for transportation services is provided in the Kentucky Medicaid Transportation Fee Schedule and defined in 907 KAR 1:061.

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 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 Gainwell Technologies to process 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 codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Current 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 must bill Kentucky Medicaid using the correct 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 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:
Billing Questions - Gainwell Technologies - (800) 807-1232
General Provider Questions - (855) 824-5615
Office of Transportation Delivery at (888) 941-7433
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance - Gainwell Technologies - (800) 205-4696

Provider MCO Information

Anthem - (800) 205-5870
Aetna Better Health of KY - (855)300-5528
Humana - (855) 852-7005
Molina - (800) 578-0775
WellCare of KY - (877)389-9457