Kentucky Medicaid identifies
Community Mental Health Centers (CMHC) as Provider Type (30). To enroll and bill Kentucky Medicaid, CMHCs must be:
- Licensed in the state in which they operate. In Kentucky, CMHC service providers must contact the Office of Inspector General Division of Health Care for a survey/license
- Enrolled as a Medicaid active provider, and if applicable, enrolled with the managed care organization (MCO) of any beneficiary for whom it provides services.
Covered CMHC Services
CMHCs provide a comprehensive range of accessible, coordinated, direct or indirect mental health services through Kentucky's 14 regional Mental Health / Intellectual and Developmental Disability (MH/IDD) boards. Regional boards are private, nonprofit organizations serving residents of designated multicounty regions. Rehabilitative mental health and substance use services may be either on-site, defined as the CMHC, leased and donated space or off-site which includes the recipient’s home, congregate living facility not otherwise reimbursed by Medicaid, except an institute for mental disease, school or daycare center, senior citizen’s center, and family resource and youth center.
If a CMHC awishes to serve as a primary care center it must meet the coverage provisions and requirements of
907 KAR 1:047 to provide covered services. All services must be performed within the scope of practice for any provider.
CMHC providers must meet the coverage provisions and requirements of 907 KAR 1:044 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Verifying eligibility
Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or use the web-based KYHealth-Net System.
Reimbursement
Reimbursement for a CMHC facility is provided by
907 KAR 1:045 and may refer to the
CMHC Reimbursement Manual for more information.
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered, during the same time.
Prior Authorizations
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 Submission
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 Contacts List to find additional support from Kentucky Medicaid.