Rehabilitative Distinct Part Units (PDU) are recognized in Kentucky Medicaid as Provider Type (93). In order to enroll and may bill Kentucky Medicaid Rehabilitative DPU must be:
- meet the requirements of 42 CFR § 485.645
- licensed in Kentucky or the state in which they participate.
- enrolled as a Kentucky Medicaid Provider, and if applicable, enrolled with the Managed Care Organization (MCO) of any beneficiary it provides services for.
What are Rehabilitative services? Rehabilitation units may help produce a positive financial margin for a hospital by transforming unused capacity into a revenue-generating enterprise and securing cost-based reimbursement from Medicare.
Rehabilitative DPUs must meet the coverage provisions and requirements set forth in 906 KAR 1:110. Any services performed fall within the scope of practice for any provider. Listing of a service in the administrative regulation is not a guarantee of payment. Providers must follow the Kentucky Medicaid regulations. Providers must also follow the requirements of the MCO for which they participate. All services must be medically necessary.
Reimbursement: Reimbursement for Rehabilitative DPU services is in accordance with 907 KAR 10:815.
Duplication of Service: The department shall 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 For Fee for Service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Kentucky Medicaid currently contracts with DXC 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 codes that are mutually exclusive or incidental. 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 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
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - DXC - (800) 807-1232
General Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance -DXC - (800) 205-4696
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