Specialized children's clinics/child advocacy centers are identified as Provider Type 13. To enroll or bill Kentucky Medicaid, specialized children's clinics/child advocacy centers must be:
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Certified by the
Department for Community Based Services as specialized children's services clinics.
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Enrolled as a Kentucky Medicaid and, if applicable, enrolled with any managed care organization of any beneficiary it serves.
Once enrolled as a Kentucky Medicaid provider, specialized children's clinics become child advocacy centers.
Covered Services
Kentucky Medicaid partners with the Department for Community Based Services to administer
child advocacy centers to provide services to children who have been sexually abused. The child receives a comprehensive examination at one of the clinics across the state designed to make the child feel safe and minimize the trauma associated with victimization and examination.
Child advocacy centers must meet the coverage requirements of
907 KAR 3:160 to provide covered services. Any services performed must fall within the scope of practice for any provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations. All services must be medically necessary.
Verify Eligibility
Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.
Prior Authorization
Each MCO provides prior authorization for its beneficiaries.
Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit Prior Authorizations.
Claims Processing
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net. Coding
Kentucky Medicaid requires providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal requests for denied FFS claims must be submitted to Gainwell Technologies. The request must include the Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please review the Kentucky Medicaid Contact List to find additional support from Kentucky Medicaid.