Kentucky Medicaid identifies Psychiatric Distinct Part Unit (DPU) providers as Provider Type (92). To enroll and bill Kentucky Medicaid, DPU service providers must:
- be an active Medicare DPU provider.
- meet the requirements of 42 CFR 412.25.
- contact the Office of Inspector General Division of Health Care for a survey/license.
- be enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary it serves.
Covered Services
In addition to 25 in-patient critical access hospital (CAH) beds, a CAH also may operate a psychiatric and/or rehabilitation DPU with up to 10 beds. These units must comply with the hospital conditions of participation.
Psychiatric DPUs must meet the coverage provisions and requirements in 906 KAR 1:110 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of services 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
Psychiatric DPU services are reimbursed per 907 KAR 10:815.
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 Authorization
CareWise provides prior authorizations for any fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Claims Submission
Kentucky Medicaid currently contracts with Gainwell Technologies to process FFS claims. Each MCO processes its own claims.
Coding
Kentucky Medicaid utilizes the National Correct Coding Initiative (NCCI) 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 (HCPCS) 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 will need to 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 of the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Provider Inquiry Resources
If you have questions or need more information, please review the Medicaid Contacts List to find additional support from Kentucky Medicaid.