Kentucky Medicaid identifies targeted case management and rehab services provided through Title V Services as Provider Type (23). To enroll in or bill Kentucky Medicaid Title V services must:
- Be the Title V agency, in Kentucky the Department for Public Health (DPH)
- Be the Title V agency and may provide services directly or through an agreement with the Department for Community-Based Services (DCBS) as the state agency responsible for child and adult protective services
- Have a signed inter-agency agreement with the DPH or DCBS as an enrolled entity
- Be enrolled as a Kentucky Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary it serves.
Title V also is a program for which
DCBS provides services for children younger than in the custody/supervision of DCBS or at risk of being in DCBS custody and Medicaid-eligible
adults 21 and older who meet DCBS definition of adult in need of protective services.
Services include targeted case management, private child care, therapeutic foster care and day treatment along with a comprehensive evaluation regarding appropriate placement.
Title V providers must meet the coverage provisions and requirements of 907 KAR 3:020 to provide covered services. Any services performed must fall 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. All services must be medically necessary.
How do I verify eligibility?
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System.
Reimbursement for Title V services is in accordance with
907 KAR 3:020.
Duplication of Service
If a beneficiary is receiving services from a speech-language pathologist enrolled with the Kentucky Medicaid Program, the department will not reimburse for the speech-language pathology service provided to the same beneficiary during the same time period via the home health program.
CareWise provides prior authorizations for any fee-for-service (FFS) beneficiary. Each MCO provides prior authorizations for its beneficiaries
Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid FFS claims. Each MCO processes its own claims.
Kentucky Medicaid uses 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. KY Medicaid requires the use of CMS 1500 billing forms. Providers need to bill Kentucky Medicaid using the correct CPT codes.
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. Please refer to the MCO if appealing an MCO claim.
Claims must be received by the later of 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. Please refer to the MCO if appealing an MCO claim.
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
General Provider Questions - (855) 824-5615
Adult Protective Services - (502) 564-7043
DCBS Child Protective Services - (502) 564-2136
DPH Division of Maternal and Child Health -
DPH Division of Public Health Protection and Safety - (502) 564-7398
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (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
Provider MCO Information
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan- (800) 578-0775
WellCare of KY - (877) 389-9457