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Provider Resources

What's New

Adjusted Primary Care Payment Update

Sept. 17, 2015 - In accordance with the Patient Protection and Affordable Care Act (ACA), certain physicians were eligible to receive adjusted Medicaid payments for primary care services. The federal government fully financed the difference between the state Medicaid payment rate and the applicable Medicare rate for Calendar Years 2013 and 2014 to pay the providers an enhanced rate. At the end of that period, the enhanced federal funding for this program ended. A 6-month claim run-out period was allowed for providers to submit claims for dates of service in CY 2013-14 not yet submitted/processed; as well as any claim adjustments/corrections per the CMS final rule.

The final cycle for the adjusted primary care payment rate, which includes the claim run-out period as well as the reconciliation, will process October 1, 2015.

For more information about the Adjusted Primary Care payments, please refer to the KY Medicaid Affordable Care Act Information page.

If you have questions, please contact the Division of Policy and Operations at 502-564-6890.

ICD-10 Clarification for Dentists.

Dentists who currently do not bill ICD-9 codes do not have to convert to ICD-10. However, Oral Surgeons currently billing ICD-9 codes will be required to comply with ICD-10. For more information about Kentucky Medicaid's implementation of ICD-10, including how to test for readiness, please visit the DMS ICD-10 website.

Attention Providers

KY Medicaid ICD-10 Frequently Asked Questions September 2015

ICD-10 Quick Start Guide September 2015

View the CMS National Provider Call - Countdown to ICD 10 dated Aug. 27, 2015

Read the General Provider Letter #A101 - Eligibility Status (Aug. 12, 2015) and MAP-22 - Medicaid Member Address Change Form  (rev. Sept. 2015)

Read the General Provider Letter #A-100 - Implementation of ICD-10 (Aug. 12, 2015)

Attention Providers

Providers serving waiver members may request prior authorizations under their EPSDT PT-45 provider number for physical, occupational and speech therapies.,

(July 9, 2015) - Effective immediately and until further notice, providers serving waiver members with a prior authorization approved under a new physical, occupational or speech therapy provider type number may ask to replace it with a prior authorization under their EPSDT PT-45 number. Providers serving waiver members also may continue to submit new prior authorizations under their EPSDT PT-45 number until further notice.

For more information on the process, read the EPSDT Prior authorizations for PT OT ST provider notice (July 9, 2015)

Please contact HP at 1 (800) 807-1232 for assistance and if you have questions about submitting prior authorizations under the EPSDT PT-45 number to replace prior authorizations approved under the new provider type.

For questions about the EPSDT therapy services procedure codes and rates or other questions about EPSDT special services, contact Catherann Terry at (502) 564-9444, ext 2120.

2015 WellCare Provider Summit

For more information about the upcoming 2015 WellCare Summit, view the Flyer.

Attention Presumptive Eligibility Providers

(May 18, 2015) - Read the letter regarding Presumptive Eligibility transitioning to the KY Health Benefits Exchange System

Attention Behavioral health Services Organization (BSHO) Providers

(Mar. 25 2015) - For Questions regarding providing BHSO services, please refer to the DBHDID's 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 currently under development and will be posted in the near future.

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 March 6, 2015. To update your EFT, please contact provider enrollment at 1 (877) 838-5085 for further instructions. We apologize for any inconvenience.

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Medicaid Managed Care Information

MCO Provider Workshops

Prompt Payment Update

Read the General Provider Letter #A-93 - Medicaid MCO Prompt Payment Complaints to be Reviewed by the Department of Insurance (DOI)

Read the Letter from Governor Beshear explaining his veto of House Bill 5.

Cabinet Releases Medicaid Managed Care Request for Proposal

June 12, 2013 - The Finance and Administration Cabinet released a Medicaid managed care request for proposal (RFP) Affordable Care Act (ACA)expansion. Services are to begin on Jan. 1, 2014 for members enrolled through Medicaid expansion under the federal ACA in seven Medicaid regions and July 1, 2014 for specified members eligible for Medicaid under eligibility criteria in place prior to the ACA expansion for the same seven managed care regions. The RFP is available on the Commonwealth of Kentucky eProcurement website. Any questions related to this procurement must be directed to the Office of Procurement Services, Finance and Administration Cabinet. Contact information is available on the eProcurement site.

More information and updates on the Medicaid expansion, kynect: Kentucky's Healthcare Connection or adjusted primary care payments

KY Spirit information for members and providers

July 2, 2013 - Read the:

Managed Care Organization (MCO) prior-authorization critical issue resolution mailbox:

Due to providers having critical issues with obtaining MCO Prior-Authorizations, DMS/MCO Oversight Branch has established a resolution mailbox for providers to report:

  • when there has been no response,
  • an untimely response,
  • or any other issues with the MCO Prior Authorization (PA) process.

Note: This mailbox is not to be used in lieu of the normal PA process.

Older Updates

(March 20, 2012) - Dental Comparison Grid

(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. 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 November 1.

(Aug. 23, 2011) - Kentucky Medicaid is pleased to announce that it now has a new managed care website for members and providers.

(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) - refer to the DMS MCO Payment Policy Clarification for Hospital Questions and Answers.

(July 22, 2011) General Provider Letter #A-83 - Expansion of managed care in the KY Medicaid program.

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Provider Updates

Attention Providers: Policy Clarification Updates

Older Provider Updates

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: 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.

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.

Nursing Facilities Update June 2011 - New Significant Change in Condition/Disposition Form. For more information, refer to the revised (MAP-4095) - PASRR Significant Change/Discharge Data.

Physician Provider Update as of June 2011- Refer to the Physician NDC Code Update for changes in billing.

Provider Enrollment Update as of June 2011 - Update for KY non-Medicaid Prescribing Providers as of June 2011

Provider Enrollment Update effective June 1, 2011 - MAP Form Update

Provider Enrollment Update effective March 25, 2011 - Final Rule indicates that certain providers will be required to pay an application fee..

Provider Enrollment Update - Medicaid Provider Updated Licenses. Refer to the Provider Enrollment or Credentialing website for more information.

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

DME updates (November 2010)

DRG Information Released (Oct. 2007)

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Resource Information

Provider Forms


Archive Conference Call Information - June 16, 2010, CMS Payment Error Rate Measurement (PERM) Project Information documents.

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HIPPA 5010/ICD-10 Information

Notice Final Rule posting

This final rule changes the compliance date from Oct. 1, 2014 to Oct. 1, 2015 for the ICD-10-CM for diagnosis coding and the ICD-10-PCS for inpatient hospital procedure coding, including the official ICD-10-CM and ICD-10-PCS guidelines for coding and reporting. It also requires the continued use through Sept. 30, 2015 of the ICD-9-CM for diagnoses and procedures including the ICD-9-CM guidelines for coding and reporting.

For more information, refer to the DMS ICD-10 website.

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Billing Information

Urgent Notice from our Fiscal Agent HP.

Due to a systems upgrade, the following functions will be delayed or stopped on Friday, Oct. 10, 2014 until approximately 2 a.m., Monday, Oct. 13, 2014.

  • Friday 10 a.m. - All claims submitted via a vendor/clearinghouse will be stopped and held in a queue. Acknowledgements will be sent once processing starts on Monday at approximately 2 a.m.
  • Friday noon - The financial cycle will start at noon instead of 6 p.m.
  • Friday 3 p.m. to Saturday 3 a.m. - The DMS and HP member helpdesks will not be able to perform member updates until approximately 3 a.m. Saturday.
  • Friday 9 p.m. KYHealth Net will become unavailable. This includes presumptive eligibility confirmations and applications. It will become fully available on Sunday, Oct. 12 at 3 p.m. with intermittent availability on Saturday.

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


Policy Update -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.

Important Information for Kentucky Medicaid Providers Regarding Overpayments - Read the General Medicaid Provider Letter regarding Overpayments dated Feb. 21, 2011.

Kentucky Medicaid has implemented the National Correct Coding Initiative (NCCI) - As specified in the Affordable Care Act, Kentucky Medicaid has implemented the NCCI. For more information, please review the Provider Letter #A-81 - National Correct Coding Initiative (NCCI) dated Oct. 1, 2010. If you have additional questions, you may: Email the CHFS DMS Webmaster; Call Provider Relational at (800) 807-1232; Visit the CMS National Correct Coding Initiative website

Information regarding CT Scan Diagnoses

Direct Deposit System for Medicaid Provider Payments

Have you enrolled yet with the new direct deposit system for Medicaid provider payments? Direct deposit guarantees rapid availability of funds and eliminates lost payments. For more information, contact Provider Enrollment at (877) 838-5085.



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Prior Authorization
Program Integrity

Medicaid Partnering with Revenue for Tax Intercept - Effective May 15, the Department for Medicaid Services and the Department of Revenue have combined efforts to collect outstanding debts due to any Commonwealth of Kentucky agency. To learn more how this may affect you, refer to the Revenue Tax Intercept Letter.

Information Regarding Medicaid Provider Updated License.- Please refer to the Kentucky Provider Enrollment website for more information.

Information regarding Excluded Providers - On Jan. 16, 2009, the Centers for Medicare and Medicaid Services issued a letter to state Medicaid directors repeating a long standing policy and clarifying federal statutory and regulatory prohibitions regarding providers from participation in federal health care programs. For more information, refer to the following letters.

Kentucky Medicaid General provider Letter regarding excluding providers

You may also visit the Office of the Inspector General Exclusions Program website for the List of Excluded Individuals/Entities.

DMS List of Excluded Providers
Excluded/termed provider list

To view more information about Program Integrity, refer to their website.

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Contact Us

For questions or assistance on:

  • Provider Services, call (855) 824-5615
  • Provider Enrollment, email Provider Enrollment or call (877) 838 5085
  • ICD-10 questions or KyHealth-net assistance, email EDI helpdesk or call (800) 205-4696

    Last Updated 9/24/2015