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Site Updates

May 15, 2013 Public Notification Revised Notification Revised (Excel) Notification Revised-alphabetical by last name (Excel) 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 March 29, 2013 Attention Providers Urgent Action Required before April 1, 2013! Please read the following letter "General Provider Letter #A-92 - Self Attestation - Adjusted Primary Care Payments(03/22/13) regarding the deadline to self attest. 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 September 18, 2012 Taxonomy Qualifier Letter 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 on line. October 24, 2011 Provider Rep Listing NOTE: Please notice the phone number and extensions have changed. August 17, 2011 Provider Letter A 84 July 25, 2011 Managed Care Organizations Notice April 13, 2011 Migration Notice 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. Kentucky Medicaid P.O. Box 2110 Frankfort, KY 40602 January 7, 2011 Dental Letters New Place of Serve Code for Mobile Units Letter(PDF) ADA Claim Form letter(PDF) November 22, 2010 5010 Implementation Letter (PDF) October 28, 2010 ATTENTION 5010 KY Medicaid News Splash (PDF) September 10, 2010 Final Reminder 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 ATTENTION ALL PROVIDERS On June 15, 2010 The Centers for Medicare & Medicaid Services (CMS) will host a national provider conference call on this important subject: "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. May 10, 2010 Revenue Intercept Letter (PDF) 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. May 26, 2009 Information regarding Excluded Providers On January 16, 2009, the Centers for Medicare and Medicaid Services issues a letter to state Medicaid Directors to reiterate a long standing policy. The letter clarifies the federal statutory and regulatory prohibitions regarding providers who have been excluded from participation in Federal Health Care programs. For more information please review the following letters. KY Medicaid General provider Letter regarding excluding providers CMS Letter regarding excluding Providers You may also visit the Office of the Inspector General Exclusions Program website for the List of Excluded Individuals/Entities DMS List of Excluded Providers Click the Excluded/termed provider list 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. Tuesday, October 17, 2006 Provider Enrollment information and forms may now be found on the KyHealth Choices Web site. Wednesday, October 11, 2006 Starting in the Spring of 2007, all Medicaid members will receive a new card. For more information, click here. October 4, 2006 Provider Letter # A-10 - KyHealth Choices - Prior Authorization Requirements for Chiropractic Services (10/03/06) Effective October 1, 2006, Prior Authorization will not be required for KyHealth Choices. Chiropractic services for both children and adults. October 2006. October 2, 2006 Information regarding the new CMS 1500 Claim Form to be accepted beginning October 2006. 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. August 11, 2006 KyHealth Choices - Prior Authorization Requirements A-70.doc ( 08/10/06) Frequently Asked Questions for the "Prior Authorization" Provider Letter Dated July 14, 2006 ( 07/31/06) To help expedite prior authorization requests, see KyHealth Choices - Prior Authorization Information ( 08/02/06) Includes: KyHealth Choices - Kentucky Medicaid Program Update (07/14/06) - Information on new prior authorization requirements and the DMS Communication Resource Guide; KyHealth Choices Prior Authorization Call Checklist (08/02/06) - Instructions and interactive response prompts about your prior authorization requests; and Radiology Services that Require Prior Authorization (08/01/06). Thank you for your attention to this announcement