Department for Medicaid Services
Important Kentucky Medicaid updates and announcements:
Information regarding KY Kids Recovery grant program
(2/3/14) - The Substance Abuse Treatment Advisory Committee is seeking assistance in helping to spread the word about the acceptance of submissions for the KyKidsRecovery juvenile substance abuse treatment grants. For more information, click below to:
You may also call: (855) 450-5646 #KYKidsRecovery.
Electronic Annual Disclosure of Ownership Update
(1/22/14) - The Electronic Annual Disclosure of Ownership (EADO) process has been temporarily disabled for system maintenance. If you have an EADO currently in process, you may be contacted for further information if additional information is need to process your EADO.
Attention Providers: Policy Clarification Updates
Attention SCL Providers
(01/07/14) - Below are training presentations from the SCL Big Day Presentation.
SCL2 BIG DAY TRAINING - DDID
- Mary's Story - by Alice Blackwell (forms attached: Service Definitions, Service Chart, FAQ) - An introduction to the new SCL2 Waiver services.
- Exceptional Support Protocol - by Mary Mann (no forms attached) - This training offers a review of the protocol requirements and submission processes.
- Using SIS Data -by Mary Mann (no forms attached) - Using SIS information with the person centered team in the development of the person centered POC.
- Case Management Documentation - by Haley Hammond and Mary Mann (no forms attached) - SCL2 forms and the processes associated with the Level of Care and Prior Authorization requests.
- Prior Authorization Review Tool - by Jeff White (webinar, no forms attached) - Demonstration on how to use the Prior Authorization Review Tool (PART).
SCL2 Big Day Training FAQ's 10 page document. This is also attached and accessible within Mary's Story.
SCL2 PDS TRAINING - DAIL
(12/18/13) - The SCL2 Participant Directed Service (PDS) Webinar Presentation Recordings is now available and can also be accessed through College of Direct Support (CDS) Reference List for those who have an account. If you do not have an account, this is your reference. Contained in this document are the links to our Provider Webinars and various recorded trainings and presentations.
Recently added are training presentations from the SCL2 Big Day Training as well as the FAQ's derived from them. Please note that some presentations may have forms/documents attached within them and instructions are also on this attachment on how to view and/or download them.
Some forms are in PDF format. PDF format requires an Adobe Reader. If you do not have Adobe Reader, you can download it from here.
Important Announcement regarding Provider Enrollment due to the Medicaid expansion
Nov. 18, 2013 - Starting Nov. 18, 2013, providers may submit an enrollment application for these New Provider Types. Although enrollment requirements are still being determined, each entity/individual must be licensed and submit their NPI documentation as well as SSN or FEIN verification. Applications will be held and processed once CMS approval is received and the regulations and enrollment requirements are finalized. DMS will provide new information as it becomes available.
The QMB limitation will be removed from these QMB Provider Types effective Jan. 1, 2014 subject to CMS approval. If you are currently enrolled in this provider type you will automatically be transitioned.
For more information, please refer to the DMS Provider Enrollment website.
Important Notice Regarding Non-Emergency Medical Transportation
Kentucky Medicaid eligibility is expanding Jan. 1, 2014
Kentucky Spirit information for members and providers
Update - Frequently Asked Questions for the Kentucky Spirit Transition
July 2, 2013 - Read the:
New webpage for the Kentucky Medicaid Terminated and Excluded Provider List
June 25, 2013 - The Kentucky Department for Medicaid Services maintains a list of providers whose Medicaid provider agreement has either been terminated or the provider has been placed on an exclusion list.
View this list
New Web page regarding the Affordable Care Act
Information or updates on the Affordable Care Act (ACA) including Medicaid expansion, kynect: Kentucky's Healthcare Connection or adjusted primary care payments
Prompt Payment Update
Oct. 11, 2013 - Department of Insurance (DOI) Medicaid Prompt Payment Contact Information
Department of Insurance
Medicaid Prompt Payment Compliance Branch
P.O. Box 517
Frankfort, KY 40601-0517
Phone: (502) 564-6106
Toll Free: (800) 595 - 6053, Option 5
To learn more about the Medicaid MCO Complaint process and how to file a complaint, please call or visit the webpage for the Medicaid Prompt Payment Compliance Branch.
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.
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.
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||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.
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 Kentucky Medicaid program.
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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:
PO Box 2110
Frankfort, KY 40602
Please also include your Kentucky 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.
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.
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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.
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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.
To review more updates and/or clarifications, refer to the Policy Clarifications page.
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