Kentucky Medicaid identifies Behavioral Health Multi-Specialty Group (BHMSG) services as Provider Type (66). To enroll or bill Kentucky Medicaid, BHMSG service providers must be:
- Licensed in the state in which they operate. In Kentucky, BHMSG service providers must contact the
Office of Inspector General (OIG).
- Enrolled as a Medicaid active provider and, if applicable, enrolled with the managed care organization (MCO) of any member it serves.
Covered Services
BHMSG behavioral health specialists provide medically necessary, face-to-face 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.
Verify Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301or by using the web-based KYHealth-Net System.
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.
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
CareWise 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 uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system 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 must bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied fee-for-service claims must be submitted to Gainwell Technologies. The request must include the reason for the request along with a hard-copy claim.
Timely Filing: Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - 800-292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance - Gainwell Techonologies - (800) 205-4696
CHFS DMS BH and SU Inquires - (502) 564-6890
Pharmacy Questions - Pharmacy Policy Branch - (502) 564-6890
Report Fraud and Abuse - (800) 372-2970
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
*
Effective Jan. 1, 2025, Anthem is no longer an active Medicaid Managed Care Organization, or MCO, in Kentucky. However, they are responsible for the payment of claims, appeals, or disputes for dates of service up to and including Dec. 31, 2024.