The First Steps program is recognized in Kentucky Medicaid as Provider Type (24). To enroll or bill Kentucky Medicaid, a First Steps service provider must be:
Covered Services
First Steps is a statewide early intervention program that provides services to children with developmental disabilities from birth to age 3 and their families. First Steps is Kentucky's response to the federal Infant-Toddler Program. First Steps offers comprehensive services through a variety of community agencies and service disciplines and is administered by the
Department for Public Health in the Cabinet for Health and Family Services.
First Steps providers must meet the coverage provisions and requirements of
902 KAR 30.160 and
902 KAR 30.200. 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 KY Medicaid regulations. All services must be medically necessary.
Verifying eligibility
Verify eligibility by contacting the automated voice response system toll free at (800) 807-1301 or use the web-based
KYHealth-Net System.
Reimbursement
First Steps Providers are reimbursed as defined in 902 KAR 30.200
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
902 KAR 30.200 requires prior authorization for services that exceed limits from the Department of Public Health. CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Each MCO provides prior authorization 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
KY Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. KY 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 need to bill KY 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 if appealing an MCO claim.
Timely Filing
Claims must be received within 12 months from the date of service (DOS) or six months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial. Please refer to the MCO 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:
First Steps - (877) 417-8377 (or, 1-877-41STEPS)
Billing Questions -
DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.netassistance - 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