Kentucky Medicaid identifies licensed behavioral analyst services providers as Provider Type (63) individual or (639) group. To enroll and bill Kentucky Medicaid, licensed behavioral analyst service providers must be:
- Licensed in Kentucky with the Applied Behavior Analyst Licensing Board
- Enrolled as an active Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary served.
Covered Services
If determined medically necessary licensed behavioral analysts might assess beneficiaries with behavioral concerns, study changes the environment has on behavior or implement plans to improve specific behaviors.
Licensed Behavioral Analyst providers must meet the coverage provisions and requirements set forth in
907 KAR 15:010 in order to provide covered services. 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.
How do I verify eligibility?
You may verify eligibility by contacting the automated voice response system at (800) 807-1301 or using the web-based KYHealth-Net System.
Reimbursement
Reimbursement for licensed behavioral analyst services is defined in 907 KAR 15:015.
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 service is covered during the same time period.
Prior Authorization
For fee-for-service (FFS) beneficiaries who require prior authorization for additional services deemed medically necessary, contact Gainwell Technologies. For MCO beneficiaries who require prior authorization for additional medically necessary services, contact the beneficiary's MCO for more information.
Claims Submission
Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. Each MCO processes its own claims.
Coding
Kentucky 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. 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 need to bill Kentucky Medicaid using the correct CPT codes
Claim Appeals
Appeal requests made on denied FFS claims must be submitted to Gainwell Technologies. 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 of the date of service or six months from the Medicare pay date whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Provider Inquiry Resources
If you have questions or need more information, please review the Medicaid Contacts List to find additional support from Kentucky Medicaid.