Kentucky medicaid provider manual 2020. In such cases, the most recently .
Kentucky medicaid provider manual 2020 Providers can access the more current Provider Manual at On July 1, 2020, Humana Healthy Horizons implemented the Kentucky Department for Medicaid Services’ updated urine drug testing (UDT) policy. Access Humana publications made for providers. Providers can access the more current Provider Manual at I. Department of Health and Human Services. This Manual serves as a guide to the policies and procedures governing the administration of WellCare’s Medicaid plans and is an extension of and supplements the Provider CABINET FOR HEALTH SERVICES DEPARTMENT FOR MEDICAID SERVICES ,p TITLE V SERVICES PROVIDED BY DSS SECTION I - INTRODUCTION A. 3 What is a Provider Administrator? A Provider Administrator has control of a Provider’s account and can grant access to Billing Agents. We recognize the importance of developing resources and training for our provider partners as we embark on this collaborative mission. Welcome to the Aetna Better Health® SKY network Our Supporting Kentucky Youth (SKY) program is committed to improving outcomes for children and families involved in the foster care and juvenile justice systems. The updates include various regulatory policy changes implemented by the Department of Medical Services since 2016. 1, 2013. In such cases, the most recently Description Reimbursement Reimbursement Modifiers Modifiers Providers should refer to their provider manual and state and federal guidelines for guidance on modifiers affecting reimbursement or modifiers reimbursed specific to state and federal payment methodologies. 2020) DMS awarded the MCO PBM contract to MedImpact to administer pharmacy benefits and services to Kentucky Medicaid members enrolled in the managed care delivery system. It communicates policies and programs, and outlines key information such as claim submission and reimbursement processes, authorizations, member benefits, and more to make it easier for you to do business with us. The area consists of trained, skilled staff who respond to both written and telephonic inquiries. 4, 2019, network notification. This guide explains the services that WellCare offers to help with those routine tasks. Care Model The Care Model helps to empower UnitedHealthcare Community Plan of Kentucky members enrolled in Medicaid, care providers and our community to improve care coordination and elevate outcomes targeting Kentucky members with complex medical, behavioral and social needs and multiple chronic health conditions. This manual will provide you with information about Passport and will describe how we will work together as you care for your patients’ health care needs. Jan 2, 2025 · The primary identification for Medicaid-eligible members is the Kentucky Medicaid card. Here’s Your Provider Manual To read the Provider Manual hover your mouse over the lower left corner of each page. See Billing Manual Instructions The Texas Medicaid Provider Procedures Manualis divided into two volumes as follows: • Volume I: General Information Volume 1 applies to all health-care providers who are enrolled in Texas Medicaid and provide services to Texas Medicaid fee-for-service clients. Humana and CareSource jointly managed the plan through Dec. CABINET FOR HEALTH SERVICES DEPARTMENT FOR MEDICAID SERVICES ,p TITLE V SERVICES PROVIDED BY DSS SECTION I - INTRODUCTION A. In other words, the Billing Agent may submit claims on behalf of the Provider, but only if the Provider Administrator has granted access to the Billing Agent. A Personal Identification Number (PIN) is required to set up a Provider Administrator account, and only one Provider Administrator account can exist for each Kentucky Medicaid provider number. Providers are expected to periodically review the manual to ensure accurate claims processing and reimbursement. This manual explains the Medicaid school-based health If there is an inconsistency between information contained in this manual and the agreement between you or your facility and Anthem, the agreement governs. 256b). In Kentucky, MSEA service providers must This first part of this manual will address coding and documentation information and compliance for a variety of provider types in the state of Kentucky. To enroll and bill Kentucky Medicaid, Preventative Services providers must be: Enrolled with the Kentucky Department of Public Health be enrolled as a Kentucky Medicaid Provider Enrolled as an active Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary served. We also will archive each issue online. INTRODUCTION This manual provides for Title V Services Provided by Department for Social Services. 2 Don't forget to Subscribe to provider enrollment email notices. 1 Program or policy inquiries - ext. Enrollees are eligible to receive Medicaid assistance under one of the following aid categories: Temporary Assistance to Needy Humana implemented the Kentucky Department for Medicaid Services’ Urine Drug Testing (UDT) Policy, effective July 1, 2020. To enroll or bill Kentucky Medicaid, dental service providers must be: Out-of-state providers must be licensed by the Kentucky Board of Dentistry. The Medical Policy Manual has been developed to ensure the success of the IHCP. Humana Healthy Horizons in Kentucky maintains the same submission time frame outlined in the Humana – CareSource® Kentucky Medicaid plan provider manual, as detailed in a Jan. We constantly strive to provide an optimal provider experience for every provider in our network. To download the Provider Manual, click Download. Once the enrollee exceeds the benefit limit as established by the department, Humana Provider manual for physicians, hospitals and healthcare providers – delegation – effective Aug. Find documents and resources for Humana’s Managed Medical Assistance (MMA) program specific to Humana Healthy Horizons Medicaid coverage in Kentucky. Sep 30, 2024 · Provider resources from prior authorization, manuals, forms, recent news, and more for UnitedHealthcare Community Plan of Kentucky Health (Medicaid) Plans. 4 May 12, 2025 Commonwealth of Kentucky - MMIS KYHealthNet Institutional User Manual DMS Approved: 06/30/2020 Page ii Revision History Document Version Jul 25, 2023 · Manuals, payer specs, and more!Manuals, payer specs, and more! << Back to Client Home Commonwealth of Kentucky - MMIS KYHealthNet Professional User Manual DMS Approved: 06/30/2020 Page ii Medicaid 2024 Capitalized words or phrases used in this Provider Manual shall have the meaning set forth in your Agreement with Passport by Molina Healthcare, Inc. Please refer back Nov 10, 2025 · WellCare has updated the Kentucky Medicaid Provider Manual, effective July 12, 2019. May 15, 2019 · Provider Billing Instructions Contact Information If you need assistance, contact us by sending an e-mail to the following address: KY EDI HelpDesk Purpose of this Manual This Provider Manual is intended for Medicaid Providers that are contracted with WellCare and provide healthcare service(s) to WellCare Members enrolled in a WellCare Medicaid managed care plan. May 15, 2019 · Provider Billing Instructions Contact Information If you need assistance, contact us by sending an e-mail to the following address: KY EDI HelpDesk This Provider Manual is a resource for working with our health plan. , contracted with the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services (the Department) to provide Medicaid and Kentucky Children’s Health Insurance Program (KCHIP) managed care services in seven of the state’s eight regions beginning Nov. It has been User Manual Version 5. Humana allows 60 calendar days from the date of the original medical necessity denial for a provider to appeal the determination. The transaction under HIPAA is the standard electronic exchange of information between two parties to carry out financial activities related to health care. To read the Provider Manual hover your mouse over the lower left corner of each page. If you are interested in enrolling as a new Kentucky Medicaid provider or are a current Kentucky Medicaid provider who needs to perform maintenance or revalidate, please select the button below. Reg. Sess. The Kentucky Medicaid Program appreciates your interest and welcomes the opportunity to work with you to provide health care services to Kentucky Medicaid members. This is a permanent plastic card issued when the Member becomes eligible for Medicaid coverage. Who We Are The Department for Medicaid Services (DMS) contracts with managed care organizations (MCOs) to provide coverage for most Kentucky Medicaid recipients. May 15, 2019 · Provider billing instructions are displayed in Adobe Acrobat formats. Medicaid 2025 Capitalized words or phrases used in this Provider Manual shall have the meaning set forth in your Agreement with Passport by Molina Healthcare, Inc. Jul 25, 2023 · Manuals, payer specs, newsletters and more!Manuals, payer specs, newsletters and more! May 15, 2019 · Prior Authorization Forms Contact Information 2025 Provider Manual HUMANA HEALTHY HORIZONS IN KENTUCKY Humana Healthy Horizons in Kentucky is a Medicaid product of Humana Health Plan, Inc. A comprehensive waiver-redesign project, including needed Kentucky Administrative Regulation (KAR) updates and provider manual updates, was temporarily paused in February 2020 after a change in state administration. If a Provider has not had a Medicaid number assigned, the Provider must apply for enrollment with the Department for Medicaid Services (DMS) and meet the Medicaid Provider enrollment requirements set forth in the Kentucky Administrative Regulations and in the Medicaid policy and procedures manual for fee-for-service Providers of the appropriate This Provider Manual (the “Manual”) is designed as a comprehensive reference guide for the dental plans in your area, primarily UnitedHealthcare Community Plan Medicaid and Medicare plans. Kentucky Medicaid identifies Behavioral Health Multi-Specialty Group (BHMSG) services as Provider Type (66). We’ll give you valuable tools to help you work . In response to S. The Department for Medicaid Services (DMS) only contracts with providers or entities qualified under 907 KAR 1:671 and 907 KAR 1:672 and approved by DMS to participate. INTRODUCTION The Kentucky Medicaid Program Behavioral Health Services Manual for Community Mental Health Centers (CMHC) is intended to provide individuals associated with CMHCs with a useful tool for interpreting the procedures and policies of the Kentucky Medicaid program. In Kentucky, BHSO service providers must contact the Office of Inspector General Division of Health Care and Long Term Care for a survey/license Enrolled This Provider Manual is intended for Medicaid Providers that are contracted with WellCare and provide healthcare service(s) to WellCare Enrollees enrolled in a WellCare Medicaid managed care plan. WellCare of Kentucky Attn: Claim Payment Appeals P. Kentucky Medicaid identifies physician service providers as Provider Type (64) individual or (65) group. The Medicaid Program, identified as Title XIX of the Social Security Act, was enacted in 1965, and operates according to a State Plan approved by the U. Kentucky Medicaid Fee-For-Service (FFS) Pharmacy Benefit Manager (PBM) Pharmacy Provider Point-of-Sale (POS) Billing Manual 01/01/2024 This manual is intended to provide pharmacy claims submission guidelines to providers enrolled with Kentucky Medicaid when processing claims for members enrolled with any of the contracted Kentucky Medicaid contracted MCOs. If a provider does not agree with the decision on a processed claim, the provider has 60 calendar days from the date of the original claim denial to file an appeal. The Care Model examines Medicaid 2025 Capitalized words or phrases used in this Provider Manual shall have the meaning set forth in your Agreement with Passport by Molina Healthcare, Inc. Once the enrollee exceeds Kentucky Medicaid identifies Medical Supplies, Equipment, and Appliances (MSEA) suppliers as Provider Type (90). On Jan. In such cases, the most recently Kentucky Medicaid and the Children’s Health Insurance Program (CHIP) provide healthcare coverage to low-income children, pregnant women, adults, seniors and people with disabilities in the commonwealth of Kentucky. To enroll in or bill Kentucky Medicaid, BHSO service providers must be: Licensed per 902 KAR 20:430 for Tier 1 908 KAR 1:374 for Tier 2, 908 KAR 1:372 for Tier 3. KRS 205. For Assistance with KY MPPA KY MPPA Contact Center: (877) 838-5085 Technical support - ext. Review the Provider Manual 2025 for detailed billing and documentation guidance. Covered To establish and maintain a strong provider network, Passport has developed and adheres to a Network Development and Management Plan that aligns with the Kentucky Department for Medicaid Services’ (DMS) goals and supports the needs of its Medicaid Program Membership. Introduction Under the Medicaid school-based health services program, local education agencies in Kentucky are eligible to enroll as a Medicaid health service provider for all Medicaid eligible children including children who qualify under the Medicaid program and under the Individuals with Disabilities Education Improvement Act (IDEA). Thank you for being a Humana Kentucky Medicaid enrollee and for letting us partner with you on your health and well-being journey. 2024 Provider Manual HUMANA HEALTHY HORIZONS IN KENTUCKY Humana Healthy Horizons in Kentucky is a Medicaid product of Humana Health Plan, Inc. 4 Welcome to your provider manual Welcome to Aetna Better Health® of Kentucky. B. The program helps address their needs holistically. Within this manual, you will find information and direction to resources that we hope you will find helpful. The federal public health emergency subsequently led to an extended pause on redesign activities while the state dealt with the impact of COVID-19 on 1915(c) HCBS waiver programs Provider Relations is the first line contact for medical provider's questions. To enroll and bill Kentucky Medicaid, CMHC service providers must be: Licensed in the state in which they operate. 1. Dear Providers and Staff, Thank you for your continued partnership in serving WellCare of Kentucky Medicaid members. The department has Provider Services representatives who serve all of Passport’s Provider network. 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 manual is updated at least annually, and more often if required due to regulatory or operational changes. Providers can access the more current Provider Manual at Kentucky Medicaid identifies Community Mental Health Centers (CMHC) Provider Type (30). This manual applies to prescription drugs billed at pharmacy point-of-sale or on the Dec 4, 2020 · Manuals The Alabama Medicaid Provider Billing Manual is a practical guide to assist Medicaid-enrolled providers in receiving reimbursement. Here you will find the tools and information needed to successfully administer UnitedHealthcare plans. The health care claim or equivalent encounter information transaction is the transmission of either of the following: A request to Provider Services Department The Network and Provider Services department handles inquiries from Providers regarding address and Tax-ID changes, contracting, and training. The Provider Manual is customarily updated annually but may be updated more frequently as needed. The provider is responsible for checking identification and verifying eligibility before providing services. Box 31370 Tampa, FL 33631-3370 Note: Any appeals related to a claim denial for lack of prior authorization, services exceeding the authorization, insufficient supporting documentation or late notification must be sent to the Appeals (Medical) address in the section below. In Kentucky, BHMSG service providers must contact the Office of Inspector General (OIG). Purpose This document contains the Kentucky Medicaid policies and procedures for Managed Care Organization (MCO) and Fee-for-Service (FFS) providers who participate in the 340B Drug Pricing Program. KY Medicaid classifies behavioral health services (BHSO) as provider type (03). 6, 2020 Humana Healthy Horizons in Kentucky identified that the current provider manual does not detail provider retrospective review request submission time frames. 520 (3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed, or opportunity presented, by federal law to qualify for federal Medicaid funds. The manual was formulated to provide Medicaid providers with a useful tool for interpreting the procedures and policies of the Kentucky Medicaid Program. An individual may obtain a Billing Monday – Friday, 7 a. Covered Plan payment Plan payment data Medical loss ratio Coverage Gap Discount Program Medicare Advantage application Medical Savings Account (MSA) Health Care Prepayment Plans (HCPPs) Cost plans Network adequacy Medicare Prescription Payment Plan Kentucky Medicaid identifies Preventative Services as Provider Type (20). Enrolling New Kentucky Medicaid Providers Before enrolling: Review the provider type summary for your provider type to understand the documentation required to enroll. This guidance is issued to comply with federal law regarding the 340B Drug Pricing Program (42 U. An appeal of a department decision regarding a Medicaid provider based upon an application of this administrative regulation shall be in accordance with 907 KAR 1:671. Review the trainin g resources to A Personal Identification Number (PIN) is required to set up a Provider Administrator account, and only one Provider Administrator account can exist for each Kentucky Medicaid provider number. Read our Humana physician newsletter, review provider manuals, and more. Providers can access the more current Provider Manual at The Kentucky Information Exchange (KHIE) allows providers to access, locate and share patient health information with other providers at the point of care using a secure, electronic network. Welcome to Passport by Molina Healthcare! We are glad you made the decision to become a part of our network. In the event of a material change to the information contained in this manual, we will make all reasonable efforts to notify you through web-posted newsletters, provider bulletins and other communications. C. Welcome to the Kentucky Cabinet for Health and Family Services, Department for Medicaid Services Fee-For Service and Managed Care provider portal, administered and maintained in conjunction with MedImpact. To enroll and bill Kentucky Medicaid MSEA, suppliers must be: active Medicare MSEA providers Out-of-state providers may enroll but must be licensed by the state where they practice. Find the Kentucky Department for Medicaid Services (KDMS) updated fee schedule for existing published codes and modifiers allowable for Kentucky Medicaid enrollees. Provider manuals, policies and guidelines for Anthem Blue Cross and Blue Shield Medicaid providers in Kentucky Together, we serve more than 217,000 Kentuckians, and your patients are at the forefront of everything we do. To enroll or bill Kentucky Medicaid, independent laboratory providers must be: Enrolled with Medicare Licensed in the state in which it is located. The second part of this manual outlines a formal compliance program that may serve as the template to set up or improve current compliance program efforts. S. m. Be enrolled as active Medicaid providers and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary served. The federal public health emergency subsequently led to an extended pause on redesign activities while the state dealt with the impact of COVID-19 on 1915(c) HCBS waiver programs A Personal Identification Number (PIN) is required to set up a Provider Administrator account, and only one Provider Administrator account can exist for each Kentucky Medicaid provider number. WellCare of Kentucky, Inc. O. A single Billing Agent may work on behalf of multiple providers. The Cabinet for Health and Family Services, Department for Medicaid Services, has responsibility to administer the Medicaid program. Purpose of this Manual This Provider Manual is intended for Medicaid Providers that are contracted with WellCare and provide healthcare service(s) to WellCare Enrollees enrolled in a WellCare Medicaid managed care plan. We have some important information to share with you related to recently passed legislation – House Bill (HB) 695. – 7 p. Billing Instructions are for Fee For Service (FFS) providers only. In such cases, the most recently Humana Healthy Horizons in Kentucky maintains the same submission time frame outlined in the Humana – CareSource® Kentucky Medicaid plan provider manual, as detailed in a Jan. If there is an inconsistency between information contained in this manual and the agreement between you or your facility and Anthem, the agreement governs. We are pleased that you are part of our network of providers. Kentucky Medicaid enrolls providers based on their provider type. Dental services are recognized by Kentucky Medicaid as Provider Type (60) individual or (61) group. “Passport” has the same meaning as “Health Plan” in your Agreement. In Kentucky, physician service providers must be licensed with the Kentucky Board of Medical Licensure Enrolled as a Medicaid active provider and, if applicable, enrolled 2024 Provider Manual HUMANA HEALTHY HORIZONS IN KENTUCKY Humana Healthy Horizons in Kentucky is a Medicaid product of Humana Health Plan, Inc. In Kentucky, CMHC service providers must contact the Office of Inspector General Division of Health Care for a survey/license Enrolled as a Medicaid active provider, and if applicable, enrolled Aug 15, 2025 · CHFS offers resources for diagnosis/treatment of 2019-nCoV (Novel Coronavirus) Claims & Payment Policy (#150): 340B Drug Payment Reduction Policy Dialysis Claims Payment Policy Notice of Kentucky Medicaid Legislative Changes Impacting DME Providers New Urine Drug Testing Guidelines Updates to Prior Authorization Requirements Medicaid 2025 Capitalized words or phrases used in this Provider Manual shall have the meaning set forth in your Agreement with Passport by Molina Healthcare, Inc. Humana’s Kentucky Medicaid Managed Care Plan Humana was awarded a Managed Care Organization (MCO) contract to administer a Kentucky Medicaid plan, effective Jan. About us For the commonwealth of Kentucky’s Medicaid MCO, Humana — the nation’s premier health benefits innovator with its roots in Kentucky — has aligned with CareSource, an Ohio-based Medicaid health plan, to create a team that leverages deep Medicaid experience and capitalizes on proven expertise, strong resources and capabilities, established relationships and infrastructure. Annual QI Evaluation Report (MCO Report #85) HEDIS Final Audit Report and IDSS rates (MCO Report #96) Healthy Kentuckians Outcomes Measures Report CAHPS Report (MCO Report #94) Provider Satisfaction Survey Report (MCO Report #95) NCQA Accreditation Certificate and ISS Survey Report or status of accreditation Evaluation, analysis and follow-up Kentucky Medicaid identifies independent lab services as Provider Type (37). Examples include Explanation of Payment Codes DN001, DN004, DN0038 Sept. General Information The Kentucky Medicaid Program is administered by the Cabinet for Health and Family Services, Department for Medicaid Services. Kentucky Medicaid was notified by CMS that we were out of compliance and must make adjustments to our fee schedule. The name of the member and the member's Medicaid identification (ID) number are displayed on the card. For providers who are not in our network but have Humana-covered patients, please review the important information below regarding the Humana Kentucky Medicaid plan requirements related to Kentucky Department for Medicaid Services (DMS) enrollment, Humana out-of-network claims payment policy and contracting contacts. For more information on appeals, please refer to the Kentucky Medicaid Provider Manual. (Ky. Humana Healthy Horizons and the Kentucky Cabinet for Health and Family Services’ Department for Medicaid Services (Kentucky DMS) reminds all providers to check a patient’s eligibility in KYHealthNet before providing services. Feb 1, 2020 · State & Federal | Medicaid | February 1, 2020 New! Provider manual now available This Provider Manual is intended for WellCare-contracted (participating) Medicaid providers providing health care service(s) to WellCare members enrolled in a WellCare Medicaid Managed Care plan. It Visit our ProPAT CPT Code Lookup : Aetna Better Health of Kentucky to confirm which services require approval. This guide gives you information related to: The Kentucky Medicaid Partner Portal Application (KY MPPA) is a web-based application that streamlines and expedites Kentucky Medicaid’s process of applying to become a new Medicaid Service Provider as well as allows the user to perform maintenance and revalidations on existing Kentucky Medicaid IDs. Kentucky Medicaid Provider Resource Guide WellCare understands that having access to the right tools can help you and your staff streamline day-to-day administrative tasks. 4, 2019, network notification, with This manual is intended to provide pharmacy claims submission guidelines to providers enrolled with Kentucky Medicaid when processing claims for members enrolled with any of the contracted Kentucky Medicaid contracted MCOs. 4 What is a Billing Agent? A Billing Agent is an accountholder who works on behalf of a Provider but is not the Provider Administrator. Commonwealth of Kentucky - MMIS KYHealthNet LTC User Manual Save Date: 6/9/2025 Page ii A. 1, 2020 Provider manual for physicians, hospitals and healthcare providers – July 9, 2019 Provider manual forphysicians, hospitalsand healthcareproviders –delegation – July 9, 2019 Find provider information and materials for Humana’s Managed Medical Assistance (MMA) program specific to Kentucky Medicaid coverage. This manual will be used as a reference handbook for the Family and Social Services Administration’s (FSSA) Office of Medicaid Policy and Planning (OMPP), Health Care Excel (HCE), and other State contractors and partners. , Eastern time. Humana now processes these claims for payment as indicated by the department’s policy, per the provider’s Humana contract agreement and/or the Humana out-of-network payment policy. We are committed to providing accessible, high-quality service to our members in Kentucky, and we realize this can only happen with your partnership. 31, 2019. To establish and maintain a strong provider network, Passport has developed and adheres to a Network Development and Management Plan that aligns with the Kentucky Department for Medicaid Services’ (DMS) goals and supports the needs of its Medicaid Program Membership. Please refer back to this page for the most current version of the Provider Manual and contact us at (800) 578-0775 should you have any questions. Provider Type (PT) - The first two digits of the KY Medicaid provider number. Enrollees are eligible to receive Medicaid assistance under one of the following aid categories: Temporary Assistance to Needy If there is an inconsistency between information contained in this manual and the agreement between you or your facility and Anthem, the agreement governs. Jul 30, 2025 · The primary identification for Medicaid-eligible members is the Kentucky Medicaid card. Enrolled as a Medicaid active provider and, if applicable, enrolled with the Apr 1, 2020 · I. 1, 2013, WellCare began providing managed care services statewide. This Manual serves as a guide to the policies and procedures governing the administration of WellCare’s Medicaid plans and is an extension of and supplements the Provider Medicaid prior authorization list Humana requires prior authorization for certain services to facilitate care coordination as well as to confirm that the services are provided according to Kentucky Department of Medicaid Services coverage policies. DMS oversees the Medicaid program including the MCOs which process claims and provide disease management, prior authorization and other services for their recipients. To determine if prior authorization is required for a patient with Humana Health Plan (Kentucky Medicaid) coverage, physicians and other healthcare Kentucky Statutes and Regulations KAR 907 - Department for Medicaid Services Regulations KRS Chapter 205 - Public and Medical Assistance Statutes Federal Laws and Regulations Social Security Act Title XIX - Grants to States for Medical Assistance Programs Social Security Title XIX - State Children's Health Insurance Program Stay informed about updates to the Aetna Better Health of Kentucky plan by checking on these provider notices and newsletters. This manual serves as a guide to the policies and procedures governing the administration of WellCare’s Medicaid plans and is an extension of and supplements the Provider Participation Agreement May 15, 2019 · Kentucky Medicaid Companion Guides Companion Guide instructions are displayed in Adobe Acrobat formats. The primary identification for Medicaid-eligible members is the Kentucky Medicaid card. It has been Jun 21, 2024 · For providers who are not in our network but have Humana-covered patients, please review the important information below regarding the Humana Kentucky Medicaid plan requirements related to Kentucky Department for Medicaid Services (DMS) enrollment, Humana out-of-network claims payment policy and contracting contacts. Humana Healthy Horizons in Kentucky identified an omission in the Kentucky Provider Manual that requires clarification. As a reminder, Humana Healthy Horizons now processes these claims for payment as indicated by the department’s policy, per the provider’s Humana Healthy Horizons contract agreement and/or the out-of-network payment policy. To enroll or bill Kentucky Medicaid, BHMSG service providers must be: Licensed in the state in which they operate. 1, 2011. HB 695, enacted by the 2025 General Assembly, restores utilization management requirements for behavioral health services that were suspended by the Department Access Humana publications made for providers. The Kentucky Medicaid Program Behavioral Health Services Manual for Community Mental Health Centers (CMHC) is intended to provide individuals associated with CMHCs with a useful tool for interpreting the procedures and policies of the Kentucky Medicaid program. WellCare This Provider Manual is intended for Medicaid Providers that are contracted with WellCare and provide healthcare service(s) to WellCare members enrolled in a WellCare Medicaid managed care plan. In Kentucky, independent lab service providers must contact the Office of Inspector General, Division of Health Care for a survey/license Clinical Laboratory Improvement A Personal Identification Number (PIN) is required to set up a Provider Administrator account, and only one Provider Administrator account can exist for each Kentucky Medicaid provider number. To enroll and bill Kentucky Medicaid, physician service providers must be: Licensed in the state in which they operate. MSEA was formerly known as Durable Medical Equipment or DME. Need to Find a Medicaid Provider? To find a Medicaid-enrolled provider, please visit here to be taken to the Kentucky Medicaid Provider Directory. 50, 2020 Leg. wdgnxoziieuqzklihupoypaelqimdlqwirhptiawsrgrmyrzcmwubwgwauendncllnprqrhamcqrgymeeylc