Go to Kentucky.gov home page
Kentucky Cabinet for Health and Family Services (Banner Imagery) - Go to home page

Department for Medicaid Services

What's New

Attention Behavioral health Services Organization (BSHO) Providers

For questions regarding providing BHSO services, please refer to the DBHDID BHSO page and review the recent 2015 BSHO Webinar. For questions not addressed in the webinar, please email us.

The BHSO Medicaid Billing Manual is under development and will be posted in the near future.

Home and Community Based Waiver Renewal

(Apr. 8, 2015) - The Cabinet for Health and Family Services Department for Medicaid Services hereby provides a 30-day public notice of and comment period for its intent to submit to the Centers for Medicare and Medicaid Services a renewal for the Home and Community Based (HCB) waiver. The current HCB waiver expires June 30, 2015 and a renewed waiver must be submitted and approved by July 1, 2015

The renewal of the HCB waiver includes changes to comply with federal requirements set forth by Final Rule - CMS 2249-F - 1915(i) State Plan Home and Community-Based Services, five-year period for waivers, provider payment reassignment, setting requirements for community first choice and CMS 2296-F - 1915(c) Home and Community-Based Services Waivers (final rule). The renewal also includes changes to enhance waiver services.

To receive a hard copy of the HCB waiver renewal application, please email or call (502) 564-4321

Please submit written comments regarding this public notice by email or by postal mail May 10, 2015 to:

Department for Medicaid Services
HCB Waiver Amendment
Commissioners Office
275 E. Main Street, 6W-A
Frankfort, KY 40621

Notice to all providers regarding Electronic Funds Transfer

(Feb. 18, 2015) - The electronic funds transfer (EFT) update function via KY Health Net will be disabled on March 6, 2015. To update your EFT, please contact provider enrollment at 1 (877) 838-5085 for further instructions. We apologize for any inconvenience.

CMS Final Rule Webinar

(Dec. 18, 2014) - Update - The Centers for Medicare and Medicaid Services (CMS) has adopted new final federal regulations which address home- and community-based setting requirements for Medicaid waivers. View a webinar on this topic conducted on June 5 by CHFS staff. Or, you may review the handout or the Q and A document about the CMS final regulations.

The final rule provides for a five-year transition process to allow Kentucky to implement this rule to support continuity of services for Medicaid participants and minimize disruptions in services during implementation. The submitted Statewide Transition Plan offers the steps DMS will take to effectively plan for and execute the transition with public engagement..

Return to the top

Medicaid Managed Care Information

Attention Members - Information on how to change your Managed Care Organization (MCO)

Federal regulations allow members to change their managed care organizations outside the 90-day timeline to change. The process is called disenrollment for cause.

Learn more about

Attention Providers

Read the General Provider Letter #A-97 - Medicaid Managed Care Open Enrollment (Oct. 1, 2014)

Kentucky Medicaid Open Enrollment Information for Jan. 1, 2015

The Department for Medicaid Services currently is in open enrollment. Letters have been sent to members who are eligible to change their current managed care organization (MCO).

For more information about covered benefits, services and the associated cost included in the letter, see:

Your open enrollment period is from: Oct. 27, 2014 through Dec. 12, 2014. To make a change, call us, toll-free at (855) 446-1245 , Monday through Friday from 8 a.m. to 5 p.m. pm Eastern time.

Please note: Changes to your MCO will not take effect until Jan. 1, 2015.

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 older announcements.

Return to the top

Provider Updates

Attention Providers: Policy Clarification 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.

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.

Physician Pricing Update

  • 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.
  • ESSURE In-Office Placement - Effective Date of Service (DOS) Jan. 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.

Return to the top

Program Updates

Kentucky Medicaid eligibility is expanding Jan. 1, 2014

More information

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


Last Updated 4/15/2015
Privacy | Security | Disclaimer | Accessibility Statement