Hospice services are Kentucky Medicaid Provider Type (44). To bill Kentucky Medicaid, hospice providers must be:
- Licensed in the state in which they operate. In Kentucky, hospice providers must contact the
Office of Inspector General Division of Health Care to obtain licensing.
- Enrolled as an active Medicaid provider and, if applicable, with the managed care organization (MCO) of any beneficiary it serves.
Covered Services
Hospice services are available to beneficiaries who have a terminal diagnosis with a life expectancy of six months or less as certified by a physician. Hospice services provide care the beneficiary needs to live as fully and comfortably as possible. Hospice also provides assistance to a beneficiaries' families as they adjust to the patient's illness and death. Hospice services are available in home, in a nursing facility or in an intermediate care facility for individuals with intellectual disabilities.
Eligibility
To receive hospice services, beneficiaries must complete the MAP-374 - Election of Medicaid Hospice Benefit Form. Beneficiaries receive treatment for conditions related to their terminal illness by their hospice provider. Beneficiaries younger than 21 are eligible to receive curative treatment for their terminal illness concurrently with hospice services. If an individual is eligible for Medicare and Medicaid (dual eligibility), the hospice benefit must be elected and revoked simultaneously under both programs.
Benefits
Hospice benefits consist of two 90-day periods. An additional 60-days of hospice benefits are covered until revocation or termination for other reasons such as ineligibility or death. Recertification is required for each 60-day extension benefit period.
Send the MAP-374, MAP-375, MAP-376, MAP-378, and MAP-403 by fax to DMS at (502) 564-0039 or by
email.
Mail or fax the MAP-377, MAP-383, MAP-384 and MAP-397 to:
Carewise Health
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: 800-292-2392, Option 9
Hospice providers must meet the coverage provisions and requirements of
907 KAR 1:330 . Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations and the requirements of any MCO in which they participate. All services must be medically necessary.
Verify Eligibility
Verify eligibility by contacting the automated voice response system toll-free at (800) 807-1301 or using the web-based KYHealth-Net System.
Reimbursement
Hospice services are reimbursed per 907 KAR 1:340.
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 period.
Prior Authorizations
Some services may require prior authorization. Hospice services requiring prior authorization must contact
CareWise.
Claims Submission
Kentucky Medicaid currently contracts with
Gainwell Technologies to process fee-for-service (FFS) claims. Each MCO processes its own claims.
Coding
Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals
Appeal requests made on denied FFS claims must be submitted to
Gainwell Technologies. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Timely Filing
Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - Gainwell Technologies - (800) 807-1232
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance - Gainwell Technologies - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan by Molina - (800) 578-0775
United Healthcare Community Plan - (866) 633-4449
WellCare of Kentucky - (877) 389-9457