Kentucky Medicaid identifies Behavioral Health Multi-Specialty Group (BHMSG) services as Provider Type (66). In order to enroll or bill Kentucky Medicaid, BHMSG service providers must be:
- Licensed in the state in which they operate. In Kentucky, BHMSG service providers must contact the
Office of Inspector General (OIG).
- Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary for whom it provides services.
What are BHMSG services?
They are medically necessary services furnished by Behavioral Health specialists through face-to-face interaction with the beneficiary with a mental and/or substance abuse disorder. They may include but are not limited to assessment, service planning, Individual outpatient therapy, group outpatient therapy, collateral outpatient therapy, or crisis intervention services, family outpatient therapy, among other BH services.
Telehealth is billable for this provider type.
How do I verify eligibility?
A BHMSG must meet the coverage provisions and requirements set forth in 907 KAR 15:010 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.
Additional Limits and Noncovered Services
The following services or activities shall not be covered
- a service provided to a resident of a nursing facility; intermediate care facility for individuals with an intellectual disability; inmates of a federal, local, or state jail, detention center; or prison; or an individual with intellectual disability without documentation of an additional psychiatric diagnosis
- Psychiatric or psychological testing for another agency, including a court or school, that does not result in the individual receiving psychiatric intervention or behavioral health therapy from the provider
- Consultation or educational service provided to a recipient or to others
- Collateral therapy for an individual aged 21 years or older;
- A telephone call, an email, a text message, or other electronic contacts that do not meet the requirements stated in the definition of "face-to-face", travel time; field trip, recreational activity, a social activity; or physical exercise activity group.
- A consultation by one provider or professional with another shall not be covered except regarding collateral outpatient therapy.
- A third party contract unless a diagnosis is made and documented in the beneficiary medical record within three visits, the service shall not be covered.
Reimbursement for BHMSG services is in accordance with the Behavioral Health Fee Schedule and 907 KAR 15:015.
Duplication of Service
The department shall 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.
CareWise provides prior authorizations for any fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service claims. Each MCO processes its own claims.
Kentucky Medicaid uses 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 CMS 1500 billing forms. Providers will need to bill Kentucky Medicaid using the correct CPT codes.
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 in question, if appealing an MCO claim.
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 in question, 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
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