KyHealth Net System
ATTENTION ALL PROVIDERS: As of 1/1/2012, 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 HEALTHNET Users: All claims paid prior to 12/29/2011 will not have the (Copy Claim) or the (Adjust Claim) function through KY Health Net. Any adjustments to claims paid prior to 12/29/2011 will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services
What is KyHealth Net?
KyHealth Net is a web-based system designed to allow Medicaid Providers instant access to pertinent member information, claim inquiry, PA inquiry, RA viewer and claim submission. A user manual is available for downloading and is designed to assist you in navigating through the system. (Refer to the User Manuals section listed on the right.)
If at any time you have questions please email your inquiries to the EDI helpdesk or contact them by phone at (800) 205-4696.
Please keep in mind the information contained on the KyHealth Net system is highly confidential and access should be strictly limited to those with valid reasons. It is the responsibility of the provider and the system administrator to ensure all persons with access understand the appropriate use of this data. We highly recommend the creation and implementation of guidelines within your office outlining appropriate and inappropriate uses of this data.
||To Access KyHealth Net
To create a KyHealth Net account, complete the PIN Release form and send it to the EDI helpdesk along with a copy of your driver license to fax 502-209-3242 or 502-209-3240 attention: EDI Helpdesk.
You may also obtain a copy of the PIN Release from form the KYMMIS website .
For questions about the PIN Release form contact the EDI helpdesk at (800) 205-4696.
Note: You will be required to change your account password every 30 days.
Start using KyHealth Net
||Features of KyHealth Net
- Prior Authorization (PA)
The new KyHealth Net has a PA link which offers the PA checklist, Radiology Prior Authorization Code List, PA Letters and PA inquiry.
- Internet Claim Submission
The new KyHealth Net has a "claims wizard", which offers interactive screens that walk you through the claim submission process.
- Immediate Claim Adjudication on Internet Claims
Claims submitted via KyHealth Net will be adjudicated immediately, and provide a real-time response. This will allow you the opportunity to correct denied claims, and resubmit them immediately.
- Remittance Advices
The new Remittance Advice statements will be formatted differently. Sample Remittance Advice pages with corresponding explanations are included in the Provider Billing Instructions.
- Claim Status Inquiry
KyHealth Net has a claim inquiry engine where you can search by member ID, Patient account number, Date Type, ICN or TCN and Claim Status to view detailed claim information. This does not include Pharmacy or Passport data.
- Member Information
Includes county, eligibility, card issuance data, waiver, third party liability, spend down, patient liability, presumptive eligibility, copay/coinsurance history, poverty indicator, and Lock-In provider information.
- Service Limitations
A history of a members paid vision, dental, hearing and ultrasound services.
- Nursing Facilities
A listing of member assigned to a nursing facility including the certification number and dates along with the eligibility segments. Available to Nursing Facilities only.
- Pharmacy History
A listing of prescriptions paid by Medicaid for each member. Does not include prescriptions denied or pending by Medicaid, or prescriptions covered by any other insurance or self pay.
- Qualifying Income Trust (QIT)
Listing of members, assigned to a particular provider, meeting the criteria for needing a QIT to maintain Medicaid eligibility.
- Regional Transportation Broker Listing
A listing of members assigned to a specific regional transportation broker. Available to brokers only.