2021 Behavioral Health and Substance Abuse Fee Schedule Mass Adjustment
The 2021 Behavioral Health and Substance Abuse Fee Schedule was not implemented until March 18, 2021. This requires DMS to mass adjust claims back to the effective date of Jan. 1, 2021. Providers may see adjustments that could negatively or positively impact reimbursement claims with dates of services from Jan. 1, 2021 to March 18, 2021. Providers should see adjustments on the cycle dated Sept. 3, 2021.
Providers asked to report missed or canceled appointments
KYHealthNet now has a panel for entering missed and canceled appointments. The commonwealth recognizes that when a member misses an appointment or cancels with little notice this is a loss of revenue to your organization and delays another member access to quicker service. We ask you to take a few seconds and provide us information about those missed or canceled appointments so we can act to reduce those cases. Thank you in advance for your help in this effort.
This panel allows you to enter information when a patient either misses or cancels scheduled appointments. If you have any questions about how to enter information on this new panel, please see the
User Guide and Video.
guidance issued May 21, 2021 Kentucky Medicaid providers are not permitted to charge members for missed or canceled appointments.
Correcting Medicaid Member Incarceration Status Errors
Kentucky Medicaid has a new form providers can use to help members who are incorrectly listed as incarcerated in
KYHealthNet. Please review the
guidance for reporting incarceration errors and the new
MAP-INC form for more information.
Prior Authorization Information - Update
DMS is reinstating the ability for MCOs and FFS to require
prior authorization (PA) for inpatient medical and surgical services, including concurrent review, effective June 1, 2021. PA will not be required for all covered Behavioral Health and SUD services until further notice. DMS will continue to evaluate.
Eligibility and Benefits Transaction Saving Opportunities
The Centers for Medicare and Medicaid Services National Standards Group released a new
administrative simplification fact sheet detailing potential health care industry time and cost savings from conducting fully electronic
eligibility and benefits inquiry and response transactions.
Technical criteria for reviewing Ancilliary Services for Adults and Pediatrics
Technical Criteria for Reviewing Ancillary Services for Adults
Technical Criteria for Reviewing Ancillary Services for Pediatrics
COVID 19 Vaccine Provider Letter
(Dec. 30, 2020) - All Kentucky Department for Medicaid Services providers seeking to receive and administer the COVID-19 vaccine must enroll with the Kentucky Department for Public Health (KDPH) as soon as possible at
vaccine provider enrollment.
A vaccine provider enrollment checklist is provided with instructions for enrollment. After reviewing the information, direct questions related to vaccine provider enrollment to
Urine Drug Testing Policy
Urine Drug Testing Policy (Effective July 1, 2020)
Cost Report Update
(July 14, 2020) The Centers for Medicare and Medicaid Services authorized the delay of some Medicare cost reports. The KY Department for Medicaid Services also grants the same extension to providers who received an extension approval through CMS or the designated Medicare administrative contractor.
Please call (502) 564-8196 if you have any questions and ask for the staff referenced below based on provider type.
Kentucky Medicaid COVID-19 Information