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Kentucky Medicaid identifies Acquired Brain Injury (ABI) waiver services as provider type 17. To enroll in and bill Kentucky Medicaid ABI providers must:

  • have an acquired brain injury certification letter from Kentucky Department for Medicaid Services  Acquired Brain Injury Branch; and
  • be enrolled as a Kentucky Medicaid provider.

Covered Services

What are ABI and ABI Long-Term Care (LTC) waiver services? 

The Acquired Brain Injury Branch operates two waivers that provide services to adult Medicaid members with an acquired brain injury. These services give participants the support they need to live in the community.

  • The ABI waiver is for adults with an acquired brain injury who can benefit from intensive rehabilitation services. The services are designed to help participants reenter the community and live independently.
  • The ABI LTC waiver is for adults with an acquired brain injury who have reached a plateau in their rehabilitation level. They require maintenance services to live safely in the community.

How do I verify beneficiary eligibility? 

You may verify eligibility by:

  • contacting the automated voice response system at (800) 807-1301
  • using the KYHealth-Net System 

ABI waiver providers must meet the coverage provisions and requirements of 907 KAR 3:090 and 907 KAR 3:210 to provide covered services. Any services performed must fall within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations. All services must be medically necessary.

Reimbursement

Reimbursement for ABI waiver services is in accordance with 907 KAR 3:100 and 907 KAR 3:210. Specialized medical equipment and supplies are reimbursed on a per-item basis based on a reasonable cost as negotiated by the department if the equipment or supply is not covered through the Medicaid durable medical equipment program and provided to an individual participating in the ABI waiver program.

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.

Service Authorizations

Carewise Health no longer approves services for 1915(c) HCBS waiver participants. Case managers now approve most services, however, Kentucky Medicaid reviews requests for high-cost or high-skill services. If you have questions, please email the 1915(c) Waiver Help Desk or call (877) 784-5614.  

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service (FFS) claims.

Coding

Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify codes 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 DXC. The request must include the reason for the request along with a hard-copy claim.

Timely Filing

Claims must be received within 12 months from the date of service or six months from the Medicare pay date, whichever is longer, or within 12 months of the most recent Kentucky Medicaid denial.

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 
ABI Waiver Policy Questions - (844) 784-5614
Prior Authorization - (844) 784-5614
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696

For more specific inquiries, view the 1915(c) waiver "Who To Call" listing

Contact Information

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