The Acquired Brain Injury (ABI) and Acquired Brain Injury Long Term Care (ABI LTC) waivers are Kentucky Medicaid provider type 17. To bill Kentucky Medicaid, ABI and ABI LTC providers must:
- meet the provider participation requirements in 907 KAR 3:090 for the ABI waiver and/or 907 KAR 3:210 for the ABI LTC waiver.
- be enrolled as a Kentucky Medicaid provider.
The Acquired Brain Injury Branch operates two waivers that provide services to adults with an acquired brain injury.
- The ABI waiver is for adults with acquired brain injury who can benefit from intensive rehabilitation services designed to help them reenter the community.
- The ABI LTC waiver is for adults with an acquired brain injury who have reached a plateau in their rehabilitation level and require maintenance services to live safely in the community.
Services include individual and group counseling, behavior supports, companion/community living supports, and residential supports. ABI and ABI LTC services help individuals live in the community as independently as possible.
An ABI waiver provider must meet the coverage provisions and requirements of 907 KAR 3:090 and 907 KAR 3:100. An ABI LTC waiver provider must meet the coverage provisions and requirements of 907 KAR 3:210. 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 state Medicaid regulations. All services must be medically necessary.
Verify eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System.
ABI waiver services are reimbursed per 907 KAR 3:100 . ABI LTC waiver services are reimbursed per 907 KAR 3:210.
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 period.
Carewise Health no longer approves services for ABI and ABI LTC waiver participants. Case managers now approve most services. Please read the service authorization provider letter for details. Kentucky Medicaid reviews requests for high-cost or high-skill services. If you have questions, please email the 1915(c) Waiver Help Desk or call (844) 784-5614.
Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid fee-for-service claims.
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 Current 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.
Appeal requests made on denied fee-for-service claims must be submitted to Gainwell Technologies. The request must include the reason for the request along with a hard-copy claim.
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:
Billing Questions -Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
ABI Waiver Policy Questions - (844) 784-5614
Prior Authorization - (844) 784-5614
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth-Net assistance - Gainwell Technologies - (800) 205-4696
For more specific inquiries, view the 1915(c) waiver "Who To Call" listing.