KyHealth Net System

What is KyHealth Net?

KyHealth Net is a web-based system that gives Medicaid providers instant access to pertinent member information, claims inquiries, PA inquiries, RA viewer and claims submission. A user manual is available to download designed to help you navigate the system (refer to user manuals listed on the right).

Please email questions or support requests to the EDI helpdesk or phone at (800) 205-4696.

Please keep in mind the information contained on the KyHealth Net system is highly confidential and access is strictly limited to those with valid reasons. It is the responsibility of the provider and the system administrator to ensure all those with access understand and comply with appropriate use of this data. We strongly recommend creation and implementation of internal office guidelines for 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 form from 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)
     KyHealth Net has a PA link which offers the PA checklist, radiology prior authorization code list, PA letters and PA inquiry, school-based health services (only available to school-based health providers) and DME prior authorization smart sheets
  • Internet Claim Submission
    KyHealth Net has a claims wizard that offers interactive screens that walk you through the claim submission process.
  • Immediate Claim Adjudication on Internet Claims
    Claims submitted via KyHealth Net are adjudicated immediately and real-time response is provided. This gives you the opportunity to correct denied claims and resubmit them immediately.
  • Remittance Advice
    The 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, from and thru date of Service, ICN or TCN and claim status to view detailed claim information. This does not include pharmacy or MCO data.
  • Member Information
    Includes eligibility, card issuance data, waiver, managed care, third party liability, spend down, patient liability, copay/coinsurance/cost share history, poverty indicator, Kentucky health plan type and dental and vision coverage.
  • 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.
  • DRG Letters
    View available diagnostic related group letters.
  • Provider References
    Includes procedure and diagnosis code reference search, TPL carriers information and a provider resources documentation link.
  • Provider Status
    Includes status on currently logged in provider, such as identification numbers, ID type, taxonomies, group practice, contracts, licenses, effective and end dates, revalidation information and addresses on file.

​What's New

Kentucky Medicaid asks providers to report missed or canceled appointments

(April 26, 2021) KYHealthNet now has a panel for entering missed and canceled appointments. The commonwealth recognizes when a member misses an appointment or cancels with little notice this is a loss of revenue for your organization and denies another member access to quicker service. Please take a few seconds to provide us with information about missed or canceled appointments so we can act to reduce those cases. On the new system panel, enter information when a patient misses or cancels a scheduled appointment(s). If you have any questions about how to enter information on this new panel, please see the User Guide and Video.

Thank you in advance for contributing to this effort.

Prior Authorization Information - Update