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They may be less familiar with the Medicare Advantage program (aka MA or Medicare Part C) and Medicare Prescription Drug programs (aka Medicare Part D or PDP).

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KyHealth.Many people understand that the Medicare program provides hospital benefits under Medicare Part A and professional service benefits under Medicare Part B.

Provider Enrollment or Recertification - (877) 838-5085 If you can't find the information you need or have additional questions, please direct your inquiries to:įirst Steps - (877) 417-8377 (or, 1-877-41STEPS) Please refer to the MCO if appealing an MCO claim. Please refer to the MCO if appealing an MCO claim.Ĭlaims 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. The request must include the reason for the request along with a hard copy claim. Providers need to bill KY Medicaid using the correct CPT codes.Īppeal requests made on denied FFS claims must be submitted toĭXC. KY Medicaid requires the use of CMS 1500 billing forms. KY Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. 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 currently contracts withĭXC to process the Kentucky Medicaid fee for service (FFS) claims. Each MCO provides prior authorization for its beneficiaries. CareWise provides prior authorizations for fee-for-service (FFS) beneficiaries. Prior Authorizationsĩ02 KAR 30.200 requires prior authorization for services that exceed limits from the Department of Public Health. 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.

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Verify eligibility by contacting the automated voice response system toll free at (800) 807-1301 or use the web-basedįirst Steps Providers are reimbursed as defined in 902 KAR 30.200 All services must be medically necessary. Providers must follow KY Medicaid regulations. Listing of a service in an administrative regulation is not a guarantee of payment. Any services performed must fall within the scope of practice for the provider. First Steps offers comprehensive services through a variety of community agencies and service disciplines and is administered by theĭepartment for Public Health in the Cabinet for Health and Family Services.įirst Steps providers must meet the coverage provisions and requirements ofĩ02 KAR 30.200. First Steps is Kentucky's response to the federal Infant-Toddler Program. Enrolled as an active Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary it serves.įirst Steps is a statewide early intervention program that provides services to children with developmental disabilities from birth to age 3 and their families.To enroll or bill Kentucky Medicaid, a First Steps service provider must be:ĭepartment for Public Health in the Cabinet for Health and Family Services The First Steps program is recognized in Kentucky Medicaid as Provider Type (24). Office of the Ombudsman and Administrative Review.Office of Application Technology Services.DPH Division of Maternal and Child Health.Office for Children with Special Health Care Needs.Division of Prevention and Quality Improvement.Division of Epidemiology and Health Planning.Division of Program Quality and Outcomes.Advisory Council for Medical Assistance.2022 Kentucky Fatherhood Virtual Summit.Division of Family Resource and Youth Services Centers.Department for Family Resource Centers and Volunteer Services.Division of Administration and Financial Management.Department for Community Based Services.Department for Behavioral Health, Developmental and Intellectual Disabilities.Department for Aging and Independent Living.

Humana medicare timely filing