Providers Wanted for the Programs of All-Inclusive Care for the Elderly (PACE)
DMS will begin coverage for PACE providers in 2022. Please review the list of counties in need of PACE providers and the PACE provider FAQ for more information. Interested providers should email Justin Dearinger.
Prior Authorization Information - Update
FFS and MCOs will not require prior authorization (PA), nor deny a claim for no PA for provider type 93, Rehabilitation Distinct Part Unit, to be retrospectively effective August 13, 2021.
More Assistance Available for Kentucky Medicaid Providers Affected by COVID-19
U.S Department of Health and Human Services is making $25.5 billion available to Medicaid, Children's Health Insurance Program and/or Medicare providers. The funds are available through the American Rescue Plan and the Provider Relief Fund. Providers can apply for assistance beginning Sept. 29. For more information, read the announcement from DMS and
review the Provider Relief Fund Future Payments website.
Open Enrollment for 2022 Begins
Open Enrollment runs from Sept. 15 - Dec. 1, 2021.
View the Open Enrollment website for more information.
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.
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