Home health (HH) services are recognized in Kentucky Medicaid as Provider Type (34). To enroll and bill Kentucky Medicaid, a home health service provider must be:
Covered Services
HH services are available to Medicaid beneficiaries of all ages and are intended to be short-term in duration. HH services are physician-prescribed and must follow a written plan of care. HH services can include intermittent skilled nursing services; physical, speech, and occupational therapies; non-routine medical supplies required for an episode of care; medical social services; and home health aide services. HH provider qualifications, services, and limitations are defined in
907 KAR 1:030. 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.
Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based
KYHealth-Net System.
Recertification
Requests for recertifications may be submitted for review up to five business days before the service plan start date. If a request for re-certification is not submitted before the expiration of the current certification period, the re-certification shall begin on the date that a completed packet is received by the QIO. The physician shall sign, date and recertify the plan of care no less frequently than every two months, with a maximum of 60 days per certification period.
Reimbursement
HH services are reimbursed per the HH Fee Schedule and
907 KAR 1:031.
Find Current Fee and Rate Schedules
Find Archived Fee and Rate Schedules
Duplication of Service
Kentucky Medicaid 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.
Prior Authorization
Each MCO provides prior authorization for its beneficiaries.
Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit Prior Authorizations.
All services and/or supplies must be prior authorized to ensure the service or modification of the service is medically necessary and adequate for the needs of the beneficiary. Healthcare Common Procedure Coding System (HCPCS) codes are required on prior authorization requests and claims submitted for payment for revenue codes 270 non-routine medical supplies and 279 nutritional supplements.
Claims Submission
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Find FFS Provider Billing Instructions
Coding
Kentucky Medicaid requires providers to bill on a CMS-1500 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 for denied FFS claims must be submitted to Gainwell Technologies. The request must include the Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO 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.
Regulations
907 KAR - Cabinet For Health and Family Services DMS Title Page
907 KAR 1:030 - Home health agency services
907 KAR 1:031 - Payment for home health services
907 KAR 3:130 - Medical necessity and clinically appropriate determination basis
Provider Resources
Helpful Links
Search for Provider Letters
Search for MAP Forms
Home Health Manual
Medical Equipment, Supplies and Appliances
PT 34 - HH Services Provider Summary
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please review the Kentucky Medicaid Contacts List to find additional support from Kentucky Medicaid.