Non-Emergency
Transportation Services are recognized in Kentucky Medicaid as
Provider Type 56. In order to enroll as an non-emergency transportation
provider with Kentucky Medicaid,
see the Kentucky Medicaid Provider Enrollment website.
Covered Services
Non-emergency medical transportation is for Medicaid members who do not have access to free transportation that suits their medical needs and need to be transported to a Medicaid-covered service performed by a Medicaid enrolled provider. Non-emergency covers non-emergency ambulance stretcher services if the eligible beneficiary is confined to a bed before and after the ambulance trip or the member must be moved only by stretcher to receive medically necessary Medicaid-covered medical services.
For transportation outside a member's medical service area or for specialty care, a referral from the primary care physician is required.
Non-Emergency Transportation Service providers must meet the coverage provisions and requirements of 907 KAR 3:066. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Non-Covered Services
Procedures considered not medically necessary are not covered by KY Medicaid. Non-covered services include cosmetic surgery (except DMS approved), translation services, phone calls, court-ordered testing, fertility services, copying of records, office supplies, investigational research, postmortem examinations and missed appointments.
Requesting Services
Non-emergency medical transportation services are available through the Human Service Transportation Delivery (HSTD) program a regional brokerage system. Depending on a member's medical needs, transportation is provided by taxi, van, bus or public transit. Wheelchair service also is provided if medically necessary. To find your regional broker, please see the HSTD Brokerage Listing. For program policies and complaints, contact the Office of Transportation Delivery at (888) 941-7433.
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
Reimbursement for NEMT services are listed on the Kentucky Medicaid Transportation fee schedule located
on the Fee Schedule Home Page.
Reimbursement for transportation services is defined in 907 KAR 3:066.
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
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.
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 transportation 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 direct your inquiries to:
- Billing Questions- Gainwell Technologies, (800) 807-1232, ky_provider_inquiry@gainwelltechnologies.com
- Provider Questions- (855) 824-5615
- Prior Authorization- Gainwell Technologies, (800) 292-2392, (800) 644-5725, (800) 807-8842
- Provider Enrollment, Maintenance, and Revalidation- (877) 838-5085
- KYHealth.net assistance- Gainwell Technologies, (800) 205-4696, ky_edi_helpdesk@gainwelltechnolgies.com
- Pharmacy Questions- (502) 564-6890, dmsweb@ky.gov
- Pharmacy Clinical Support Questions- (800) 477-3071
- Pharmacy Prior Authorization- (844) 336-2676
- Physician Administered Drug (PAD) list- (502) 564-6890
Managed Care Organizations
*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.