Provider Resources

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

Welcome to the KY Medicaid Provider Resources page. Please refer to one of the links listed below to for:

• What's New *New MCO Information*
  • DMS E-Alerts *New*
• Provider Updates
• Lock-In Updates
• Helpful Information
• HIPPA 5010/ICD-10 Information
• Billing Information
• Prior Authorization
• Program Integrity Updates

Medicaid Managed Care Information

Important prior authorization information regarding RSV (respiratory syncytial virus) vaccine (Oct. 10, 2011) - 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 November 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.

New Managed Care Website (Aug. 23, 2011) - Kentucky Medicaid is pleased to announce that it now has a new managed care website for members and providers. This website is intended to assist Medicaid members and providers in finding information about the transition to managed care.

• Update Regarding Expansion of Managed Care (Aug. 19, 2011) - To view the updates, refer to the General Provider Letter #A-84 - Additional information and guidance relating to the expansion of Managed Care in the Kentucky Medicaid program. 
• DMS MCO Payment Policy Clarification for Hospitals (Aug. 5, 2011) - refer to the Hospital MCO Questions and Answers.
• Important Information Regarding Expansion of Managed Care - For more information and guidance relating to the expansion of managed care in the Kentucky Medicaid program.

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2011 Provider Updates

• 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 (New) - Effective Date of Service (DOS) 1/1/2011, Physicians performing in-office placement of Essure will be reimbursed for A4264 at a rate of $1400.00 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

Older Provider Updates

• DME updates (November 2010)
• Important Provider Enrollment Information regarding new phone hours and email address.

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Lock-In Program Update

Providers who serve or plan to serve Medicaid Lock-In Program members are encouraged to review a recent DMS Letter and Lock-In Program Notice relating to changes in this program.

The Lock-In Program was developed to identify, manage and monitor members who use Medicaid services at an amount or frequency that is not medically necessary in accordance with established utilization guidelines.

If you have any questions relating to the letter, you may contact (877) 298-6108 and select the lock-in option

Changes to Lock-In Program

Changes to the Kentucky Medicaid Lock-In Program were effective July 1, 2010. The changes are included in 907 KAR 1:677E. This regulation includes references to the June 2010:

• Lock-In Table of Controlled Substances
• Lock-In Table of Emergency Medical Conditions
• Lock-In Member Referral Form.

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How do I enroll as a KY Medicaid Provider?

• Provider Enrollment website.
• Provider Enrollment forms
• National Provider Identifier (NPI)

Provider Forms

• Prior authorization forms
• Provider relations forms
• Reports/Forms for PCC, RHC and FQHCs
  • Medicaid Universal Cost Report and Instructions
  • MAP - 100501- Prospective Payment System Adjustment form

Provider Letters

• 2011 Provider Letters (New)
• Proficiency Provider Letter (Oct. 25, 2005)

Publications

• Colorectal Cancer Screening Tips for Providers (April 2009)
• Fluoride Varnish Manual (Oct. 2007)
• Final employee education guidance for false claims recovery deficit reduction act of 2005, Section 6032 (03/07) - DRA 6032 - Employee Education About False Claims Recovery FAQs.
• HIPAA Information for KY Medicaid.

Workshop-Conference Call Information

Archive Spring Seminar Information - HP Enterprise Services, in conjunction with the Kentucky Department for Medicaid Services, would like to invite you to join us for our Spring Seminar. To print the workshop packet materials, refer to the KYMMIS Provider Workshop website.

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

• Open Door Forum Invitation
• PERM Overview for Providers
• PERM Providers page of the CMS website

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Attention Providers! KY Medicaid and HP Enterprise Services EDI Unit now has EDI testing available.

For more information on what you need to do, please refer to the EDI Testing Steps.

KY Medicaid ICD-10 Survey Results Are In !

June 2011

The KY Medicaid ICD-10 Survey was conducted from May 15, 2011, to June 18, 2011. The survey was open for a month and consisted of 8 questions. All Provider types were invited to participate in the survey. Thanks again to the 230 providers, or their designees, who participated in the survey.

View the survey Results.

For more information, etc. refer to the HIPPA 5010/ICD 10 Transition website

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Announcements

• 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 Overpayaments 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.

Resources

• Provider Billing Manuals
• Provider Companion Guides
• Provider DDE User Manuals

Codes

• Cardiac Catheter Codes (Aug. 2, 2004)

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Announcements

• Radiology Codes Requiring Prior Authorization (Jan. 1, 2010)

• Important information regarding children's services (Nov. 17, 2006)

Letters

• Provider Letter A-5 - New Automated Prior Authorization System for School Based Health Services Programs (Oct. 20, 2006)
• Provider Letter # A-10 - KyHealth Choices - Prior Authorization Requirements for Chiropractic Services (Oct. 3, 2006)
• KyHealth Choices - Prior Authorization (PA) Requirements for Radiology Procedures and Therapy Services (Sept. 12, 2006)
• KyHealth Choices Prior Authorization Requirements A-70.doc (08/10/06)
• KyHealth Choices - Prior Authorization Information (Aug. 2, 2006) - Information to help expedite prior authorization requests. Consists of the KyHealth Choices - Kentucky Medicaid Program Update (July 14, 2006) and the KyHealth Choices Prior Authorization Call Checklist (Aug. 2, 2006).
• KyHealth Choices- Kentucky Medicaid Program Update (July 14, 2006)

Frequently Asked Questions (FAQs)

FAQs for the Prior Authorization Provider Letter Dated July 14, 2006 (July 31, 2006) - Answered questions regarding the new Prior Authorization process.

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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

• CMS 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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