Behavioral Health Multi-Specialty Groups (BHMSG) are recognized in Kentucky Medicaid Provider Type 66. To enroll as a BHMSG, providers must be:
Covered Services
BHMSG behavioral health specialists provide medically necessary services to Medicaid members with a mental and/or substance abuse disorder. Services may include but are not limited to:
- Assessment,
- Service planning,
- Individual outpatient therapy,
- Group outpatient therapy,
- Collateral outpatient therapy,
- Crisis intervention services, or
- Family outpatient therapy.
Telehealth is billable for this provider type.
A BHMSG must meet the coverage provisions and requirements of 907 KAR 15:010. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Verify Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301or by using the web-based KYHealth-Net System.
Reimbursement
BHMSG services are reimbursed per 907 KAR 15:015. Current reimbursement rates are available on the DMS Fee and Rate Schedule webpage.
Duplication of Service
The department 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 period.
Prior Authorizations
Gainwell Technologies provides prior authorizations for any fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization for its beneficiaries.
Claims Submission
Kentucky Medicaid currently contracts with Gainwell Technologies to process FFS claims. Each MCO processes its own claims.
Coding
Kentucky Medicaid requires APRN providers to bill on a CMS 1500 claim form 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 FFS claims must be submitted to Gainwell Technologies. The request must include the Provider Inquiry Form, the reason for the request, and 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.
Questions
If you have questions or need more information, please review the Medicaid Contacts List to find additional support from Kentucky Medicaid.