Kentucky Medicaid identifies Residential Crisis Stabilization providers as Provider Type (26). In order to enroll and bill Kentucky Medicaid Residental Crisis Stabilization providers must be:

• Providers must contact the Office of Inspector General (OIG) for a survey/license.
• Enrolled as a Kentucky Medicaid Provider, and if applicable, enrolled with the Managed Care Organization (MCO) of any beneficiary they wish to treat.

Covered Services

Residential Crisis Stabilization services are provided in Crisis Stabilization Units. Crisis Stabilization Units are community-based, residential programs that offer an array of services including screening, assessment, treatment planning, individual, group, and family therapy, and peer support in order to stabilize a crisis and divert the individual from a higher level of care. It is not part of a hospital. They are used when individuals in a behavioral health emergency cannot be safely accommodated within the community, and are not in need of hospitalization but need overnight care.

Residential Crisis Stabilization Units must meet the coverage provisions and requirements set forth in 907 KAR 15:070 in order 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 all relevant Kentucky Medicaid regulations. All services must be medically necessary.

How do I verify eligibility?

Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System.

Reimbursement

Reimbursement information for Residential Crisis Stabilization Units is in accordance with the Behavioral Health and Substance Abuse Fee Schedules and 907 KAR 15:075.

No 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 service is covered, during the same time period.

Prior Authorizations

CareWise provides prior authorizations for any Fee for Service beneficiary. Each MCO provides prior authorizations for its beneficiaries

Claims Submission

Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service (FFS) claims. Each MCO processes its own claims.

Coding

Kentucky Medicaid utilizes 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 Correct 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. KY Medicaid requires the use of CMS 1500 billing forms. Providers will need to 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. Please refer to the MCO in question, if appealing an MCO claim.

Timely Filing

Claims must be received within 12 months from the date of service (DOS) or 6 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
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance -DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (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