Department for Medicaid Services
Important Kentucky Medicaid updates and announcements:
 |
What's New |
 |
Gov. Beshear Launches kynect: Kentucky's Healthcare Connection.
May 15, 2013 - Governor Steve Beshear today announced the launch of public education and awareness efforts for the state's health benefit exchange, called kynect: Kentucky's Healthcare Connection.
Press Release
Visit kynect, Kentucky's Healthcare Connection
Gov. Beshear Expands Health Coverage to more than 300,000 Kentuckians
May 9, 2013 - Gov. Steve Beshear today announced the inclusion of 308,000 more Kentuckians in the federal Medicaid health insurance program. The expansion, together with the creation of the Health Benefit Exchange, will ensure that every Kentuckian will have access to affordable health insurance.
Press Release
Governor's Healthier Kentucky website
Medicaid Managed Care Provider Forum Update
May 21, 2013 - Providers may now view the Location Information for Regions 1 thru 6 and register for the upcoming forums. If you are unsure in which region you are located, see the Medicaid Managed Care (MCO) Region Map. We recommend you arrive early to visit with our exhibitors, meet fellow attendees, as well as providing ample time for any adverse parking or traffic situations.
Note: All times listed below are local times.
The agenda for the day is:
- 8:00AM - 9:00AM: Registration
- 9:00AM - 11:30AM: Provider Information general session - Secretary of Cabinet and Commissioners for Medicaid, Public Health and Behavioral Health; DOI Executive Staff. Topics include overview of managed care, appeals process, and prompt pay process.
- 11:30AM - 1:00PM: Lunch break: no organized functions planned for lunch, each attendee is responsible for their own lunch.
- 1:00PM - 3:30PM: MCO/Provider Billing session with all MCOs in your region: Topics include proper coding, prior authorizations, dealing with denials, grievance process, proper contacts with MCO's.
Thursday, May 30, 2013 Medicaid Provider Forum Meeting Information
Region: Region 5
Location: University of Kentucky
Address: UK Student Center, 404 S. Limestone St., Lexington KY 40508
Phone: (859) 257-9000
For directions, click here
UK Student Center houses all locations for the forum:
• Worsham Theater Lobby - Registration
• Worsham Theater – General Session and one breakout session
• Center Theater – Breakout session
• Room 230 – Breakout session
Meal options: For the lunch break on your own, UK has reasonably price options contained within the Student Center. There are five restaurants, including Sbarro, Subway, Panda Express, Ovid Express, Chick-fil-A, plus Starbucks and other retail outlets.
Parking: For directions and parking, click here. Parking rate is $5 per car for the whole day
April 29, 2013 - At the governor's request to provide enhanced educational efforts to improve the Medicaid managed care system, CHFS will sponsor educational forums in each of the eight Medicaid regions. For more information about the location and dates of the forums, refer to the Medicaid Provider Notice Forums. Please note that the meeting date for the Murray, Ky. forum has changed.
April 22, 2013 - Read the Medicaid Managed Care Educational Forums - Save the Date Letter regarding the governor's enhanced educational efforts to improve the Medicaid managed care system.
Prompt Payment Update
May 9, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Address: C/O Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: (502) 564-6034
Toll Free: (800) 595 - 6053, Option 1
April 17, 2013 - Read the General Provider Letter #A-93 - Medicaid MCO Prompt Payment Complaints to be Reviewed by the Department of Insurance (DOI)
April 5, 2013 - Read the Letter from Gov. Steve Beshear explaining his veto of House Bill 5.
Enhanced Primary Care Update
Please read the following letter General Provider Letter #A-92 - Self Attestation - Adjusted Primary Care Payments March 22, 2013 regarding the deadline to self attest.
For more information, refer to the FAQs. Please note that only providers may self-attest for Adjusted Primary Care Services.
More information and to self-attest
Effective Jan. 1, 2013, health care providers who provide eligible primary care services to Medicaid clients are eligible to be paid the Medicare rates effective calendar years 2013 and 2014. The enhanced rate is available for fee-for-service providers with Kentucky Medicaid and eligible providers enrolled in the Kentucky managed care program.
For more information, refer to the Kentucky Medicaid Enhanced Primary Care Payments Update. As more information becomes available, it will be posted.
View the DMS Commissioner's Legislative Appearances
If you would like to see the commissioner's testimony before legislative committees, see the Commissioner's Legislative Appearances page at left.
Return to the top
|
Medicaid Managed Care Information |
|
Attention Members - Information on how to change your Managed Care Organization (MCO)
Federal regulations allows members to change their through a process called Disenrollment for Cause. This process is for members who want to change their current MCO and are not within their 90-day timeline to change. For more information on the process, refer to How to change your MCO
Region 31 Managed Care Organization Update
November 2012 - Letters in both English and Spanish have been mailed with details regarding newly assigned MCO. View the: Region 31 Assignment letter: English - Versión en Español; Region 31 Side by Side Comparison: English - Versión en Español.
Members have from Nov. 13 to change from your assigned MCO to another MCO, call us toll-free at (855) 446-1245. You have until Dec. 14 to call us to make a change and choose a different plan. You can call Monday through Friday from 8 a.m. to 5 p.m. pm Eastern time.
Medicaid Managed Care Contracts Awarded for Jefferson and Surrounding Counties
(Oct. 4, 2012) - The Commonwealth of Kentucky has signed contracts with four managed care partners to provide health care services to approximately 175,000 Medicaid recipients in Louisville and 15 surrounding counties.
(Tuesday, May 29, 2012) - The Kentucky Department for Medicaid Services has released the Examination of Passport Health Plan.
MCO Updates
March 20, 2012 - Dental Comparison Grid
March 5, 2012 - Medicaid Members Can Receive Replacement Medications in Aftermath of Storms
Nov. 18, 2011 - Managed Care Policy for Out of Network Dental Providers
Nov. 8, 2011 - Managed Care Policy For Out-Of-Network Providers
Oct. 25, 2011 - General Provider Letter #A-86 - regarding the coming Nov. 1 implementation.
Oct. 25, 2011 - Letters have been mailed to Medicaid members with details regarding the start of managed care on Nov. 1. The letter provides information about the member's managed care organization (MCO) assignment. This letter also provides information regarding the MCOs' covered benefits, services and cost-sharing amounts as well as additional information for instructing members on how they may change MCOs. Members will be able to change MCOs for 90 days after managed care begins.
Oct. 10, 2011 - Important prior authorization information regarding respiratory syncytial virus (RSV) vaccine: Magellan Medicaid Administration, the pharmacy benefit administrator for the Department for Medicaid Services, is handling prior authorizations (PAs) for the RSV vaccine for dates of service prior to Nov. 1, 2011. For services rendered on or after that date, the member's assigned managed care organization (MCO) will be responsible for authorizations. The MCOs will honor all existing PAs issued by Magellan for at least 30 days on or after Nov. 1.
Sept. 21, 2011 - Nov. 1, 2011 MCO Member Update Letter
Sept. 19, 2011 - Medicaid Managed Care Implementation Extended until Nov. 1 in Response to Hospitals' Request.
Sept. 12, 2011 - Kentucky Receives Federal Approval to Implement Medicaid Managed Care.
Aug 2011 - New Managed Care website: Kentucky Medicaid is pleased to announce that it now has a new managed care website for members and providers.
Aug 2011 - During August, letters were mailed to Medicaid members with details regarding their newly assigned managed care organization (MCO).
Aug. 19, 2011 - General Provider Letter #A-84 - Additional information and guidance relating to the expansion of Managed Care in the Kentucky Medicaid program..
Aug. 5, 2011 - DMS MCO Payment Policy Clarification for Hospitals Questions and Answers .
July 22, 2011 General Provider Letter #A-83 - Expansion of managed care in the KY Medicaid program.
Return to the top
|
Provider Updates |
|
Attention providers who bill paper, professional crossover claims.
The Medicare Coding Sheet has been revised. You may obtain the newest revision at Kentucky Medicaid Management Information System along with the updated billing instructions. For questions, please contact Provider Inquiry at (800) 807-1232.
Attention Hospital and Physician Providers
(Oct. 17, 2012) - Important information regarding Newborn Assignment to MCOs. Click to read the Hospital Provider Letter #A-248; Physicians Provider Letter #A-373 - Newborn assignment to MCOs
Attention Non-Managed Care Organization Providers
Due to the expiration of American Recovery and Reinvestment Act (ARRA) enhanced funding, the Department for Medicaid Services is returning to pre-ARRA cash management cycles. For more information, read the General Provider Letter #A-88 - Changes to the Medicaid (NON-Managed Care Organization) Claims Payment Cycle (12/01/12)
Centers for Medicare and Medicaid Services (CMS) ICD-10 Implementation Presentation
The Cabinet for Health and Family Services, in collaboration with the Department for Medicaid Services (DMS), is hosting an on site visit from CMS to discuss processes for ICD-10 implementation on Nov. 15-16, 2012.
This two day session will be aired via webinar and is open to all organizations including providers of Medicaid services, trading partners, contractors, Managed Care Organizations, and other interested parties. Information about the sessions are available on the "What's New" section of the DMS ICD-10 website.
New ICD-10 Deadline - Oct. 1, 2014
HHS has announced the final rule that delays the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014.
For more information, refer to the announcement or the final rule or visit the DMS ICD-10 page.
Provider Enrollment Notice
(Sept. 12, 2012) - If you are a home medical equipment provider and are required to be licensed by the KY Board of Pharmacy as such, please submit a copy of your license to KY Medicaid. For more information regarding this new requirement (effective Sept. 30, 2012), please visit the KY Board of Pharmacy website. Please mail a copy of your license to:
KY Medicaid
PO Box 2110
Frankfort, KY 40602
Please also include your KY Medicaid provider number on the copy of the license.
Important Notice for KY Medicaid Recipients and Providers
(Tuesday, Aug. 21, 2012) - Effective Oct. 1, 2012, there will be changes to Non-Emergency Medical Transportation. Read the important notice regarding Region 5 Non-Emergency Medical Transportation.
5010 Announcement
Attention all providers: As of Jan. 1, 2012, all electronic claims submissions must be in the X12 5010 format. Please refer to your billing instructions for additional information required on the CMS1500 and UB04 paper claim forms due to 5010 implementation.
Attention KY Health Net Users: All claims paid prior to Dec. 29, 2011 will not have the Copy Claim or the Adjust Claim function through KY Health Net. Any adjustments to claims paid prior to Dec. 29, 2011 will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services
Provider Enrollment Notice
(Sept. 28, 2011) - When sending any type of correspondence to Kentucky Medicaid provider enrollment, please write your NPI and/or Kentucky Medicaid provider number on each document. If you submit documents for multiple providers submitted in the same envelope, please staple or paperclip each providers own documents separately. Although, we prefer that you do not attach multiple providers' documents in the same envelope.
EHR Incentive Program Information
In order to keep Kentucky Medicaid providers updated on the new EHR incentive program, a new website has been developed for hospitals and providers. You may view this website by either using the left hand navigation button for Kentucky EHR Initiative Program or go directly to the website
Physician Pricing Update
The procedure code J7300 new pricing will be $645.84 with an effective date of 7-1-11. This change has been made on the physicians fee schedule located on the fee and rate schedule page.
Physician Provider Update
ESSURE In-Office Placement
Effective Date of Service (DOS) 1/1/2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400 for Place of Service (POS) 11 (office). Physicians can continue to bill 58565 for the placement of the product and payment will remain at $338.62. These two codes must be billed on the same DOS and supporting documentation retained in the patient's chart for placement of product. Prior Authorization will continue to be required.
If 58565 is billed with Place of Service (POS) 22, the payment for the profession fee will be $338.62.
Physician Provider Update as of June 2011
Refer to the Physician NDC Code Update for changes in billing.
To review other Provider Updates and other information for providers, refer to the Provider Resources page.
Provider Enrollment Updates
Update for KY non-Medicaid Prescribing Providers as of June 2011
MAP Form Update effective June 1, 2011
To review other Provider Enrollment Updates, refer to the Provider Enrollment page.
Return to the top
|
Program Updates |
|
New Application for Medicare Savings Programs
Feb. 5, 2010 - Do you have Medicare? Kentucky Medicaid provides partial financial assistance with Medicare premiums, deductibles and coinsurance through the Medicare Savings Program for qualified Medicare beneficiaries, specified low-income Medicare beneficiaries and qualifying individuals who are not entitled to the full Medicaid benefit package.
Apply Now - fill out an application for the Kentucky Medicare Savings Program.
Attention Providers and Parents
Kentucky children may be eligible for free or low-cost health insurance through the Kentucky Children's Health Insurance Program (KCHIP).
KCHIP Application Process Training Presentation provides information about filling out the new application.
To view more programs and services, refer to the Program and Services page.
Return to the top
|
Policy Updates |
|
DMS does not provide guidance on billing
The Department for Medicaid Services does not provide guidance on how companies should bill for services, but will direct you to applicable regulations.
If you receive direction from staff about how to bill, the department will not be bound by such instruction, unless it was given by a director or commissioner.
Older updates
To review more updates and/or clarifications, refer to the Policy Clarifications page.
Return to the top
|