Kentucky Medicaid identifies licensed clinical alcohol and drug counselors (LCADC) as Provider Type (67) individual or (679) group. To enroll and bill Kentucky Medicaid, LCADC service providers must be:
- Licensed in Kentucky with the
Board of Alcohol and Drug Counselors.
- Licensed in accordance with KRS 309.0833.
- In compliance with the requirements of KRS 309.0831.
- In compliance with the requirements of KRS 309.0833.
- Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary served.
Covered Services
If determined medically necessary, LDAC providers engage professionally and for compensation in alcohol and drug counseling and appraisal activities by providing services involving the application of counseling principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems, emotional conditions, or mental conditions of individuals or groups.
Licensed clinical alcohol and drug counselors, associates, certified alcohol and drug counselors and alcohol and drug peer support specialists must meet the coverage provisions of 907 KAR 15:010 to provide covered services. All services must be performed within the scope of practice for any provider. Providers must follow Kentucky Medicaid regulations and the requirements of the MCO in which they participate.
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
Reimbursement for services is in accordance with
907 KAR 15:015.
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 time period.
Prior Authorization
Gainewell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Claims Submission
Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky FFS claims. Each MCO processes its own claims.
Coding
KY Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY 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 KY 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 within 12 months from the date of service (DOS) or 6 months from the Medicare pay date, whichever is longer, or within 12 months from the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Provider Inquiry Resources
If you have questions or need more information, please review the Medicaid Contacts List to find additional support from Kentucky Medicaid.