Requirements for Testing Electronic Claims with
Kentucky Medicaid
| Requirement |
Provider Type |
| At least 20 claims of regular Medicaid billing. They
can be old claims that have already been paid, or they can be new claims. |
All |
| The claims must have real KY Medicaid provider numbers,
recipient numbers, diagnosis codes, and procedure codes. |
All |
| Current Service Dates (within the last 12
months) |
All |
| All alpha characters must be in capital letters. |
All |
| Kenpac example. |
01, 20, 22, 31, 34, 35, 36, 37, 64, 65, 74, 78, 80,
86, 90 |
| Prior-Authorization |
22, 29, 31, 35, 36, 43, 45, 52, 54, 60, 77, 85, 90 |
| Treatment Authorization |
01, 02, 04, 11, 12, 41, 42, 46, 47 |
| Tooth Number |
60, 61 |
We will accept the test file on Async phone lines or
on diskette. Asynchronous transfer (modem to modem) is preferred. The
file must follow the specifications and record layouts that have been approved
by the Department for Medicaid Services. The software that is used to create
the file, if it is not our software, must be tested by the vendor prior to
the provider testing. A list of approved software vendors and billing agencies
will be supplied upon request.
Any claim that requires an attachment cannot be billed
electronically. Claims crossing over from Medicare can be set up to come to us
automatically through Provider Enrollment. You must have a MAP 380
and/or MAP 246 on file with Provider Enrollment to bill
electronically. You can contact enrollment at: (877)838-5085.
Whenever a change has been made in your computer system,
or if you change software, you must retest. This will assure that there
will be no problems with your transmission, the claim format, or the billing.
Please call the EDI Help Desk for further information
regarding electronic transmission: (800)205-4696
For all billing questions, contact Provider Relations at:
(800)807-1232.
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kymmis > Electronic Claims > documents : Testing
