Kentucky Medicaid identifies Licensed Psychological Practitioners (LPP) services as Provider Type (84) individual, or (849) group. To enroll and bill Kentucky Medicaid, LPP service providers must be:
- Licensed in the state in which they are located. In Kentucky licensed with the Board of Examiners of Psychology
- Licensed Psychological Practitioners (LPP) must be licensed according to KRS 319.053
- Licensed Psychological Associates and Certified Psychologists must be licensed according to KRS 319.064 and KRS 319.056, respectively.
- Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO)of any beneficiary served.
If determined medically necessary, they are licensed professionals who are qualified to provide direct services to beneficiaries. Their work may include case management, administering and interpreting cognitive and personality tests, diagnosing mental illness, creating treatment plans, and conducting psychotherapy.
How do I verify eligibility? Once eligibility has been obtained, you may verify continued eligibility by one of the following methods:
- by contacting the Automated Voice Response System at (800) 807-1301
- by using the Web-basedKYHealth-Net System
LPPs and Certified psychologist with autonomous functioning must meet the coverage provisions and requirements set forth in 907 KAR 15:010 in order 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 for in which they participate.
Non-Covered Services: Procedures not considered medically necessary shall not be covered by Kentucky Medicaid.
Reimbursement: Reimbursement for LPPs and Certified psychologist with autonomous functioning services is in accordance with the Behavioral Health Fee Schedule and is defined in 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.
For Fee for Service beneficiaries who require prior authorization for additional services that are deemed medically necessary, contact CareWise. For MCO beneficiaries who require prior authorization for additional services that are medically necessary, contact the beneficiaries MCO for more information.
Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service (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 codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Correct 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. (eff: 10/1/15) Kentucky Medicaid requires the use of UB-04 billing forms. Providers must bill using the Revenue Codes listed in the back of the billing manual.
Claim Appeals: Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO in question, 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 in question, if appealing an MCO claim.
Provider Contact Information
Billing Questions - DXC
- (800) 807-1232
Provider Questions - (855) 824-5615
Provider Enrollment or Revalidation - (877) 838-5085
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