The KEIS program is recognized in Kentucky Medicaid as Provider Type (24). To enroll or bill Kentucky Medicaid, a KEIS service provider must be:
Covered Services
KEIS is a statewide early intervention program that provides services to families of children with developmental disabilities from birth to age 3. KEIS offers comprehensive services through a variety of community agencies and service disciplines and developmental service agencies. It is administered by the
Department for Public Health in the Cabinet for Health and Family Services.
KEIS 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
KEIS Providers are reimbursed as defined in 902 KAR 30:200.
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 Authorizations
902 KAR 30:200 requires prior authorization for services that exceed limits from the Department of Public Health. Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit Prior Authorizations.
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.
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.
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please review the Kentucky
Medicaid Contact List to find additional support from Kentucky Medicaid.