Targeted Case Management and Rehab Services - PT (23)

(SLP) services as Provider Type (79) individual or (799) group. In order to enroll or bill Kentucky Medicaid, SLP providers or SLP group must be:

  • licensed with the Kentucky Board of Speech-Language Pathology per KRS 334A or with the board in the state they live in;
  • enrolled as a Kentucky Medicaid provider, and if applicable, enrolled with the Managed Care Organization (MCO) of any beneficiary it provides services.

Covered Services

What are Independent Speech-Language Pathology services? If medically necessary, SLP providers evaluate diagnoses and treat difficulties involving speech, language, voice, fluency, and swallowing for a beneficiary. In order to receive services from a SLP provider,  an order must be signed by a KY Medicaid participating Physician, Advanced Practitioner Registered Nurse (APRN), Physician Assistant (PA) or Psychiatrist. (when applicable). A beneficiary may receive 20 visits per the calendar year,

How do I verify a beneficiary's Medicaid eligibility? You may verify eligibility by:

  • contacting the Automated Voice Response System at (800) 807-1301 
  • using the Web-based KYHealth-Net System   

SLP providers must meet the coverage provisions and requirements set forth in 907 KAR 8:030 in order to provide covered services.  Any services performed must fall within 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 Kentucky Medicaid regulations.  All services must be medically necessary.

Reimbursement:  Reimbursement for SLP services is in accordance with the SLP Rate Schedule and 907 KAR 8:035.

Duplication of Service:  If a beneficiary is receiving services from a speech-language pathologist enrolled with the Kentucky Medicaid Program, the department shall not reimburse for the speech-language pathology service provided to the same beneficiary during the same time period via the home health program.

Prior Authorizations: 907 KAR 8:030  Section 2(2b) states the limits may be exceeded if services are determined to be medically necessary. Prior authorization by the department shall be required for each speech-language pathology service that exceeds the limit for a beneficiary who is not enrolled with a MCO.   CareWise provides prior authorizations for any Fee for Service (FFS)  beneficiary. Each MCO provides prior authorizations for its beneficiaries

Claims Submission

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. KY 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 assistance -DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (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