The Intermediate Care Clinic for Development and Intellectual Disabilities (ICC/IID/DD) program is identified in Kentucky Medicaid as Provider Type (10) and may bill Kentucky Medicaid under this provider type number. In order for an ICC/IID/DD clinic to provide services to a Medicaid beneficiary, it must:
- be licensed in Kentucky
- be enrolled as a Kentucky Medicaid provider
Covered Services
What are ICC/IID/DD Clinic services? ICC/IDD/DD Clinics provides medically necessary preventive, diagnostic, therapeutic, rehabilitative, or palliative services that are furnished by a facility that is not part of a hospital but is organized and operated to provide medical care to outpatients. To be eligible to receive specialty IC clinic services, the patient must be a Kentucky Medicaid beneficiary; have a mental illness, intellectual disability, or developmental disability; and meet the patient status criteria established in 907 KAR 1:022, Section 4 (4)or (5).
How do I verify eligibility? Once eligibility has been obtained, you may verify continued eligibility by one of the following methods:
- by contacting the Automated Voice Response System at (800) 807-1301
- by using the Web-basedKYHealth-Net System
ICC/IDD/DD Clinics must meet the coverage provisions and requirements set forth in 907 KAR 3:225. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Reimbursement: ICC/IID/DD Clinics are reimbursed per 907 KAR 3:230.
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 service is covered during the same time period.
Prior Authorizations
ICC/IID/DD Clinic services requiring prior authorization must contact
CareWise.
Claims Submission
Kentucky Medicaid currently contracts with
DXC to process the Kentucky Medicaid fee for service (FFS) claims.
Coding: Kentucky Medicaid utilizes the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15) Kentucky Medicaid requires the use of CMS 1500 billing forms. (eff: 02/12) Providers will need to bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied FFS claims must be submitted to
DXC. The request must include the reason for the request along with a hard copy claim.
Timely Filing: Claims must be received within 12 months from the date of service (DOS) or 6 months from the Medicare pay date whichever is longer, or within 12 months from 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:
Billing Questions - DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Behavioral Health DBHDID Facilities - (502) 564 - 4527
Prior Authorization -
CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance -
DXC - (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