Home-delivered meals are Kentucky Medicaid provider type 48. To bill Kentucky Medicaid, home-delivered meals providers must be:
Covered Services
Home-delivered meals are provided to qualified Home and Community Based (HCB) waiver participants at their place of residence. A home-delivered meals provider must meet requirements in
907 KAR 7:010. Services must be performed in 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.
Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based
KYHealth-Net System.
Reimbursement
Home-delivered meals are reimbursed per 907 KAR 7:015. Current reimbursement rates for the HCB waiver are available on the
DMS Fee and Rate Schedule webpage.
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.
Service Authorization
Case managers approve
1915(c) HCBS waiver services. Carewise Health reviews requests for high-cost or high-skill services as part of the Kentucky Medicaid Utilization Management (UM) program. If you have questions, please contact the UM call center at (800) 292-2392.
Claims Submission
Kentucky Medicaid currently contracts with
Gainwell Technologies to process Medicaid fee-for-service claims.
Find FFS Provider Billing Instructions
Coding
Kentucky Medicaid requires providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal requests made on denied fee-for-service claims must be submitted to
Gainwell Technologies and include the reason for the request along with a hard-copy claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Regulations
907 KAR - Cabinet for Health and Family Services DMS Title Page
902 KAR 45 - Kentucky Food Code
907 KAR 7:005 - Certified waiver provider requirements
907 KAR 7:010 - HCB Waiver
907 KAR 7:015 - Reimbursement for HCB waiver services
910 KAR - Cabinet for Health and Family Services - Office of Aging Services Title Page
910 KAR 1:190 - Nutrition program for older persons
Provider Resources
Helpful Links
Search for MAP forms
Search for Provider Letters
HCB Waiver Information
HCB Provider Information
Home-Delivered Meals Provider Summary
Medicaid Waiver Management Application (MWMA) Guides and Information
Incident Reporting:
Instructional Guide and
FAQ
Service Authorization Crosswalks, Training, and Resources
Provider Inquiry Resources