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December 4, 2024
Anthem Kentucky Managed Care Plan, Inc. will no longer be a Kentucky Medicaid Managed Care Organization starting Jan. 1, 2025, according to a court order in Anthem Kentucky Managed Care Plan, Inc. v Kentucky Finance and Administration Cabinet, et al., Franklin Circuit Court, Civil Action No. 20-CI-00719. This page assists members, providers, and other interested parties in understanding how this impacts the Kentucky Medicaid program.
This does not change an Anthem member’s Medicaid eligibility or coverage. Anthem Medicaid members are being automatically assigned to
Humana or UnitedHealthcare Community Plan.
Members may select another MCO by calling kynect at 1-855-459-6328.
Who to Call
Before Jan. 1, 2025
Anthem
855-690-7784 (members)
855-661-2028 (providers)
After Jan. 1, 2025
Humana
1-800-444-9137 (members & providers)
UnitedHealthCare
866-293-1796 (members)
866-633-4449 (providers)
May 3, 2024
Reinstated Coverage and Cost Assistance for Medicaid Members:
Guidance for Providers(PDF).
April 16, 2024
KY DMS has created a universal Notification of Pregnancy for Providers (PDF) to utilize for members with a positive pregnancy test.
October 25, 2023
UM Communication 4 - Fee for Service Providers (PDF)
September 1, 2023
UM Communication 3 - Fee for Service Providers (PDF)
August 2, 2023
UM Communication 2 - Fee-For-Service Provider (PDF)
June 30, 2023
UM Communication 1 - All providers requesting PA Services(PDF)
UM Communication 1 - Waiver Providers(PDF)
June 21, 2023
Fee for Service Utilization Management and Prior Authorization(PDF)
February 10, 2023
Beginning February 27th Gainwell will be utilizing a new CMS-1500 crossover coding sheet for paper submissions of CMS-1500 crossovers. A new field specific to Medicare Advantage Copay has been added. The new crossover coding sheet will be available on this site on February 24th.
Beginning February 27th providers submitting UB-04 crossovers may submit Medicare Advantage Copay using the appropriate “Copayment Payer” Value Codes and amounts.
June 24, 2022
Attention: Effective 7/1/2022, all Physician and CRNA Anesthesia providers must use additional modifiers. See the Physician Services and Advanced Registered Nurse Practitioner Billing Instructions for details.
April 30, 2021
Public Notification Revised
Notification Revised-alphabetical by last name (Excel)
Notification Revised-alphabetical by last name (PDF)
April 23, 2021
ATTENTION PROVIDERS / USERS:
KYHealthNet now has a panel for entering Missed and Cancelled Appointments. The commonwealth recognizes that when a member misses an appiontment or cancels with little notice this is a loss of revenue to your organization and delays another member access to quicker service. We are asking you to take a few seconds and provide us information about those missed or cancelled appointments so that we can act to reduce those cases. Thank you in advance for contributing to this effort.
This panel allows you to enter information when a patient either misses or cancels their scheduled appointment(s). If you have any questions about how to enter information on this new panel, please see the User Guide and Video at
kymmis/Provider%20Relations/trainingVideos.aspx
April 22, 2021
Effective date of service, June 1, 2021, prior authorization will be reinstated for inpatient hospital (provider type 01).
The following services will continue not to require an authorization: substance use and behavioral health services and services with a diagnosis of COVID.
February 26, 2021
Thank you to the nursing facility providers who attended the nursing facility ancillary webinar. We understand that not everyone was available to attend. Please take a moment to review the new guidelines (PDF) effective March 1, 2021 for requesting ancillary services. If you have any questions, please contact Carewise at 1-800-292-2392. Frequently Asked Questions(PDF)
January 4, 2021
Letter to Providers
DRG Audit Letter (PDF)
October 19, 2020
Each year Kentucky Medicaid is required to provide an Upper Payment Limit demonstration for CMS on DME codes covered by Kentucky Medicaid. This demonstration must reflect reimbursement rates for Kentucky Medicaid are set at or below the rates for the same codes listed by Medicare. Kentucky Medicaid was notified by CMS that we were out of compliance and must make adjustments to our fee schedule. To bring Kentucky Medicaid into compliance the Department for Medicaid Services immediately ordered a rate change adjustment to the 2020 DME fee schedule retroactive to 1/1/2020. This resulted in paid claims with any codes having rate decreases to automatically trigger a recoupment. The recoupment was in error. The recouped amounts will be reprocessed and repaid. Kentucky Medicaid apologizes for the late notice and any inconvenience that this has or may cause. The new effective date of the rates is 11/15/20.
June 19, 2020
Kentucky Level of Care System (KLOCS)
New Kentucky Level of Care System (KLOCS) is an electronic system which streamlines and automates the current Level of Care (LOC) paper process. Starting August 3, 2020, all Nursing facilities, ICF/IID facilities, and Institutionalized Hospice Service Providers will be required to use KLOCS in order to receive payment. Individuals who administratively handle LOC applications may attend a free 2-part webinar series on KLOCS system functionality. Attendees will be able to ask questions during the live webinars. To accommodate providers' schedules, the same 2-part series will be offered on multiple dates.
March 23, 2020
Provider Telehealth or Telephonic Health Services FAQs
November 6, 2019
Beginning January 1, 2020, beneficiaries and providers must use the new Medicare Beneficiary Identifier (MBI) to receive services and submit Medicare claims. With limited exceptions, CMS will reject claims submitted with the HICN and will reject all eligibility transactions submitted with the HICN.
Sister Agencies, Managed Care Organizations, and Fiscal Agents that use the HICN need to make sure they are able to receive and process the MBI before the end of the transition period on December 31, 2019. In addition, you should have updated anything with the HICN, such as ID cards, beneficiary letters, training materials, or call center scripts with the MBI.
June 28, 2019
Telehealth Message
On 7/1/2019, the Telehealth regulation expanding service locations and allowable providers becomes effective. By now you should have received a provider letter from Kentucky Medicaid that outlines the use of two letter modifiers that would capture the location of both the telehealth provider of service and the location of the recipient. It has been discovered that many of the modifier combinations we chose are not HIPAA compliant and/or are out of the Industry Standard. Because of the fact that claims could be denied due to this error, DMS is postponing the two-letter modifier requirement and will allow claims to be processed without them. Providers will still be required to place the “02” place of service modifier so that the claim will be adjudicated as a Telehealth claim. The Department for Medicaid Services apologizes for any confusion caused by this oversight and thanks you for your time and attention to this decision. When a viable solution is developed to address this data need, we will notify our partners and providers alike.
March 28, 2018
Please ONLY submit Map-24 forms to Carewise Health for Fee for Service members by faxing to the following numbers.
1-800-807-8843
1-800-807-7840
to discharge a member from a psychiatric facility or nursing facility.
In addition, if they are not sent this way they may not get reviewed or processed. Thank you
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