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Hearing aid dealer is identified in Kentucky Medicaid as Provider Type (50) individual or (509) group. To enroll or bill Kentucky Medicaid, a hearing aid service provider must be:

Covered Services

Hearing aids dispensed by hearing aid dealers are covered for persons younger than 21. Follow-up visits, checkups and certain hearing aid repairs also are covered.

Hearing aid dealers must meet the coverage provisions and requirements of 907 KAR 1:038 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 all relevant state Medicaid regulations. All services must be medically necessary.

Verifying eligibility

Verify eligibility by calling the automated voice response system at (800) 807-130 or by using the web-based KYHealth-Net System.

Hearing aid services are reimbursed per the Kentucky Medicaid Audiology Fee Schedule and 907 KAR 1:039.

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

Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid fee-for-service (FFS) claims. Each MCO processes its own claims.

Claims Submission

Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid fee-for-service claims. Each MCO processes its own 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.

Claim Appeals

Appeal requests 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. 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:
Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Provider Enrollment or Revalidation - (877) 838-5085
Prior Authorization - CareWise - (800) 292-2392 assistance - Gainwell Technologies - (800) 205-4696
Policy Questions - (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

Contact Information