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KY Medicaid classifies behavioral health services (BHSO) as provider type (03). To enroll or bill Kentucky Medicaid, BHSO service providers must be:

Covered Services

BHSO services are medically necessary services provided by behavioral health specialists through face-to-face interaction with a beneficiary who has a mental and/or substance abuse disorder. Services include but are not limited to assessment, service planning, Individual outpatient therapy, group outpatient therapy, collateral outpatient therapy and crisis intervention services, family outpatient therapy, among other behavioral health services.  

BHSO must meet coverage provisions and requirements of 907 KAR 15:020 and 907 KAR 15:022 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 KY Medicaid regulations. All services must be medically necessary. 

Verifying eligibility

Verifying eligibility by contacting the automated voice response system toll-free at (800) 807-1301, or visit web-based KYHealth-Net System.

Reimbursement

Reimbursement for BHMSG services is in accordance with the Behavioral Health Fee Schedule and 907 KAR 15:015.

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 fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.

Claims Submission

KY Medicaid currently contracts with DXC to process 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. 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 CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals 

Appeal requests of denied FFS claims must be submitted to DXC. The appeal request must include the reason for the appeal along with a hard copy claim. Please refer to the MCO when appealing a 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 when appealing a 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
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - DXC - (800) 205-4696
CHFS DMS BH and SU Inquires - (502) 564-6890
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drugs (PAD) list - Pharmacy Branch - (502) 564-6890

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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