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Welcome to the Kentucky Medicaid Management Information System (KYMMIS)
Thank you for visiting the Kentucky Medicaid Website.
Please use the navigation buttons at the left to navigate the site. If you have
any questions, send email to: KY EDI HelpDesk
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November 22, 2013
Below is a list of new provider types that we anticipate enrolling effective 1/1/2014 due to Medicaid expansion under the Affordable Care Act.
Please note that the new provider types are subject to change pending CMS approval. In addition, the regulations and enrollment requirements for each provider type are still being developed.
Starting November 18, 2013, providers may submit an enrollment application for these new provider types. Although enrollment requirements are still being determined, each entity/individual must be licensed and submit their NPI documentation as well as SSN or FEIN verification. Applications will be held and processed once CMS approval is received and the regulations and enrollment requirements are finalized. DMS will provide new information as it becomes available.
As with the current enrollment process, if a provider will be contracting with an MCO the provider will need to submit their application through the MCO of their choice.
New Provider Types
18 – Private Duty Nursing Agency
79 – Speech Language Pathologist
799 – Speech Language Pathologist Group
81 – Licensed Professional Clinical Counselor
819 – Licensed Professional Clinical Counselor Group
83 – Licensed Marriage and Family Therapist
839 – Licensed Marriage and Family Therapist Group
84 – Licensed Psychological Practitioner
849 – Licensed Psychological Practitioner Group
97 – Behavioral Health Multi-Specialty Group
The QMB limitation will be removed from these provider types effective 1/1/2014 subject to CMS approval. If you are currently enrolled in this provider type you will automatically be transitioned:
82 – Licensed Clinical Social Worker
87 – Physical Therapist
879 – Physical Therapist Group
88 – Occupational Therapist
889 – Occupational Therapist Group
89- Licensed Psychologist
899 – Licensed Psychologist Group
September 10, 2013
Dear Medicaid Providers,
HP Enterprise Services, in conjunction with Kentucky Department for Medicaid Services, will be hosting educational workshops for Kentucky providers. These workshops will cover Annual Disclosure Agreements, ICD-10 Implementation and Medicaid Expansion. Workshops will be offered in all eight (8) Medicaid Regions.
Please be on the lookout for a letter in the mail with additional details and RSVP instructions. Because an RSVP is required, we encourage providers to respond quickly in order to have first choice at their desired locations. Note that providers are not required to attend the workshop in their region. Providers may attend workshops in any region convenient to them.
HP Enterprise Services & KY Department for Medicaid Services
April 23, 2013
All Medicaid Providers in Regions 7 and 8 “
Read the Medicaid Managed Care Educational Forums -
Save the Date Letter” regarding the Governor's enhanced educational efforts to improve the Medicaid managed care system.
April 11, 2013
If you are enrolling in KY Medicaid and will be participating with any of the MCO’s (Managed Care Organizations),
you will need to send your enrollment application to one of the MCO’s of your choice.
Do not submit enrollment applications directly to KY Medicaid unless you are
NOT participating with any of the MCO’s.
Coventry - 855-300-5528
Humana Caresource - 855-852-7005
KY Spirit - 866-643-3153
Passport - 800-578-0775
Wellcare - 877-389-9457
December 21, 2012
Attention Providers Kentucky Medicaid Enhanced Primary Care Payments Update
Effective January 1, 2013, healthcare providers who provide eligible primary care services to Medicaid clients are eligible to be paid the Medicare rates effective calendar years (CY) 2013 and 2014. The enhanced rate is available for fee for service providers who are fee for service providers with Kentucky Medicaid and eligible providers who are enrolled in the Kentucky managed care program. For more information, refer to the “What’s New” section of the DMS website at http://chfs.ky.gov/dms.
December 10, 2012
Attention Kentucky Medicaid Provider
Provider Letter#A-88 contains changes to the Medicaid (NON-Managed Care Organization) Claims Payment Cycle
November 13, 2012
The Cabinet for Health and Family Services, in collaboration with the Department for Medicaid Services (DMS), is hosting an on–site visit from the Centers for Medicare and Medicaid Services (CMS) to discuss processes for ICD-10 implementation on Nov. 15 and 16, 2012. This two day session will be aired via Webinar and is open to all organizations including providers of Medicaid services, trading partners, contractors, Managed Care Organizations, and other interested parties.
Information is available on the “What’s New” Section of the DMS ICD-10 website at http://chfs.ky.gov/dms/icd10.htm
January 10, 2012
ATTENTION ALL PROVIDERS:
As of 1/1/2012, all electronic claims submissions must be in the X12 5010 format. Please refer to your billing instructions for additional information required on the CMS1500 and UB04 paper claim forms due to 5010 implementation.
ATTENTION KY HEALTHNET Users:
All claims paid prior to 12/29/2011 will not have the (Copy Claim) or the (Adjust Claim) function through KY Health Net. Any adjustments to claims paid prior to 12/29/2011 will require paper adjustment submission to the following Address HP Enterprise Services P.O. Box 2108 Frankfort, KY 40602-2108 Attn: Financial Services
December 1, 2011
Providers shall begin using the revised HH prior authorization (PA) fax form, MAP-130 when requesting HH services. The revision date to the MAP-130 is September 2011.
SHPS will not process PA requests from previous versions beginning December 30, 2011. A copy of the revised fax form with instructions has replaced the previous form
October 24, 2011
Provider Rep Listing NOTE: Please notice the phone number and extensions have changed.
April 13, 2011
KYXIX will be migrating to a new data center on 4/17/2011. As a result this activity, transactions and online access will be suspended during the migration window from 11:00 p.m. on Saturday, April 16th to 02:00 p.m. on Sunday, April 17th. Once the migration effort has completed, there should be no impact to connectivity. In the event you should experience a connectivity post migration on 4/18/11, please contact the EDI Helpdesk immediately at 1-800-205-4696.
February 3, 2011
Provider types 64, 65, 85, 77, 31 and 35
If you are a Kentucky Physician, Kentucky Chiropractor, or Kentucky Optometrist, your license is set to expire 03/01/2011.
Please submit a current copy of your license to Kentucky Medicaid to avoid termination of your provider number.
Please submit your license to the following address and be sure to write your provider number or NPI number on the copy of your license.
P.O. Box 2110
Frankfort, KY 40602
September 10, 2010
ICD-10 Implementation in a 5010 Environment Follow-Up National Provider Call
The Centers for Medicare & Medicaid Services (CMS) will host a follow-up national provider conference call on "ICD-10 Implementation in a 5010 Environment". Subject matter experts will review basic information on both ICD-10 and 5010 and explain how they are interrelated.
A question and answer session will follow the presentations.
When: Monday, September 13, 2010
Time: 12:00 p.m. - 1:30 p.m. ET
Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers and all Medicare fee-for-service (FFS) providers
For more information and to register for this informative session, please go to http://www.cms.gov/ICD10/02c_CMS_Sponsored_Calls.asp on the CMS website. Registration will close at 12:00 p.m. ET on September 10, 2010, or when available space has been filled. No exceptions will be made.
Please register today.
September 7, 2010
ATTENTION DRG FACILITIES
This is a reminder that KY Medicaid will require all inpatient DRG facilities to submit a Present on Admission
(POA) indicator beginning September 1, 2010 on claims with a discharge date on or after July 1, 2010. The POA is required on all inpatient claims. Claims will be denied if the POA is missing. Admission and Emergency diagnoses are excluded.
If you should have any questions, please contact HP Provider Inquiry at 800-807-1232. The billing instructions are located at www.kymmis.com.
September 2, 2010
ATTENTION ALL PROVIDERS
Providers who serve or plan to serve Medicaid Lock-In Program members are encouraged to review a recent DMS Letter relating to changes in this program at http://chfs.ky.gov/dms/provider.htm.
The Lock-In Program was developed to identify, manage, and monitor Members who use Medicaid services at an amount or frequency that is not medically necessary in accordance with established utilization guidelines.
If you have any questions relating to the letter, you may contact (877) 298-6108 and select the lock-in option.
June 14, 2010
ATTENTION ALL PROVIDERS
The Commonwealth of Kentucky, in an effort to reduce costs, will be eliminating the production and mailing of PAPER remittance
advices (RAs) effective July 1, 2010. As already available to you today, you can currently view your RA each week by accessing
the KYHealthNET's RA Viewer or by retrieving your RA electronically. If you wish to view your RA through the KyHealthNet, you must
identify a specific user who will have RA VIEWER as their role and grant the user permission to retrieve the RA. If you are not already
signed up with KYHealthnet, refer to the DMS KYHealthNet page for assistance.
Another way to receive your RAS, would be to become a trading partner. This will allow you to retrieve the 835 file from the Bulletin Board.
You will need to complete the 835 enrollment form (MAP 380) which can be accessed on the KyHealthNet Provider Enrollment FORMS page.
If you have any questions please contact HP Billing Inquiry at 1-800-807-1232.
June 4, 2010
On June 15, 2010 The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on this important subject:
ATTENTION ALL PROVIDERS
"ICD-10 Implementation in a 5010 Environment".
It is very important that all providers be informed on this subject. You are strongly encouraged to access this link and learn how to register by June 14 to participate in this event.
June 18, 2009
Per CMS, current Medicaid policy does not allow providers to bill recipients for missed appointments. In no case may a provider
impose charges upon a Medicaid recipient for a missed appointment.
March 9, 2009
As you are aware, The American Reinvestment and Recovery Act (commonly referred to as the Economic Stimulus Bill), included some provisions that are meant to strengthen and increase the current Federal requirements for prompt pay
of clean claims (clean claims will be finalized no later than 30 days from date of receipt). Although the Kentucky Medicaid program was and continues to be in compliance with prompt pay requirements (clean claims), we have elected
to speed up claims payment timeframes to further ensure that we fully meet the new Prompt Pay requirements. Effective with the March 6, 2009 payment cycle, we are reducing the Prudent Pay (Cash Management) days from 19 to 15 days.
This means that any of your adjudicated (paid status) claims that are equal to or greater than 15 days old each Friday, based upon receipt date, will be released.
This speed up could result in a larger payment this week, but after the initial increase payments should return to normal levels in subsequent weeks based upon the 15 days. Kentucky Medicaid will continue to keep the provider community
informed of any other changes that may be necessary due to the American Reinvestment and Recovery Act (commonly referred to as the Economic Stimulus Bill).
January 26, 2009
If you are accessing KyHealthNET, there may be two remittance advices to select, 01/23/2009 and/or 01/26/2009.
Due to cycle issues, several claims were not completed and it was necessary to run another cycle. You may be receiving
this remittance advice as an addition to the RA from the Jan. 23, 2009 cycle.
January 6, 2009
Changes to KY Medicaid: Providers Should not be Impacted
Since 2005, First Health (FH) has served as the administrative agent for KY Medicaid, enrolling and credentialing providers, making updates and changes to already-enrolled provider files, hosting workshops for providers and more.
As of Jan. 1, 2009, the Department for Medicaid Services will assume provider enrollment and credentialing responsibilities.
View the new Web site.
September 24, 2008
On September 29, 2008, Providers will be able to submit Crossover claims through KYHealthnet without a Medicare EOMB. Providers will find
the new coding sheet for Professional Cross-overs by clicking on the Provider Relations link on the left, then click on Forms, then click
on Provider Relations, the CMS1500 Crossover Coding Form is at the top of the list of provider forms.
Important Information for Kentucky Medicaid Providers
Announcement: Policy Clarification for Tamper Resistant Prescription Pads (TRPPP)
May 9, 2008
May 14 is Legacy Free Day – an opportunity to check your National Provider Identifier (NPI) readiness.
The Department for Medicaid Services (DMS) is requesting providers and their billing vendors to participate in a one-day NPI preparation exercise on Wednesday, May 14, 2008.
Participating Kentucky Medicaid providers will send Medicaid claims with NPI-only in provider fields which originally contain NPI/legacy pairs from the provider. In other words, you or your billing vendor will strip the legacy identifiers when they are submitted as part of an NPI/legacy pair.
Over the past month, Kentucky Medicaid has asked providers to begin testing NPI-only by sending a group of claims with NPI alone in primary provider fields. This exercise will help Kentucky Medicaid providers evaluate their NPI readiness prior to the May 23, 2008 deadline.
The outcomes of this exercise are described below:
- Claims are processed and paid by Kentucky Medicaid. Under this scenario, the provider can feel confident that his or her cash flow will not be affected by the May 23 implementation date; or
- Claims are rejected or suspended. Under this scenario, the provider will know in advance that there are problems that must be resolved prior to May 23. Resolution might include changes to the NPESS data or to the Kentucky Medicaid provider enrollment record.
On May 15, participating providers and their billing vendors can revert back to billing claims with their NPI/legacy pairs. However, if you have the NPI and taxonomy on file with Kentucky Medicaid, continue to bill claims with the NPI.
Got Questions? Need More Information?
Still not sure what an NPI is and how you can get it, share it? Click to view the Frequently Asked questions regarding NPI registration. Providers may also contact First Health at (800) 639-5195.
Still not sure how to submit claims with your NPI? Providers may also refer to the Provider Billing Instructions or contact Provider Relations at (800) 807-1232 or the EDI helpdesk at (800) 205-4696
April 9, 2008
Announcement: Policy Clarification for Tamper Resistant Prescription Pads (TRPPP)
- The April 1, 2008 implementation of the tamper-resistant prescription pad requirements for written prescriptions
billed to Medicaid has been successful thus far. However, there are policy clarifications that seem appropriate
based on the questions received thus far. To view the clarifications, click the Policy Clarification for Tamper Resistant Prescription Pads.
Wednesday, October 11, 2006
- Starting in the Spring of 2007, all Medicaid members will receive a new card. For more information, click
October 2, 2006
- Information regarding the new CMS 1500 Claim Form to be accepted beginning
September 14, 2006
Prior authorization requirements for KyHealth Choices have changed. Please access the DMS website to view
the changes for radiology, speech therapy and physical therapy.