Kentucky Medicaid utilizes the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Gainwelll Technologies to process FFS claims. Kentucky Medicaid currently contracts with This form allows the member to opt out of receiving the item with no financial responsibility or receive the item and be responsible for paying for the item or service. MAP-1001 advance member notice must be completed and signed by the member if an item or service was denied for failing to meet medical necessity or the supplier failed to obtain a prior authorization in a timely manner and the item(s) and/or service(s) were already provided to the member. Most items that require FFS prior authorization also require a certificate of medical necessity, MAP-1000 for durable medical equipment and MAP-1000B for metabolic formulas and food. Each MCO processes its own prior authorizations. Prior AuthorizationsĬareWise processes prior authorizations (MAP-9) for any fee-for-service (FFS) beneficiaries. The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period. Reimbursement for DME services is in accordance with the Kentucky Medicaid DME Fee Schedule and defined in Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net System. All services must be medically necessary. Providers must follow Kentucky Medicaid regulations. Listing of a service in an administrative regulation is not a guarantee of payment. Any services performed must fall within the scope of practice for the provider. Medicaid covers DME such as wheelchairs hospital beds orthotic appliances (foot/leg braces) and prosthetic devices (artificial limbs), etc., and disposable medical equipment ordered by an accepted prescriber that is medically necessary and suitable for use in the home.ĭMEs must meet the coverage provisions and requirements set forth inĩ07 KAR 1:479 to provide covered services. It is generally not useful to a person in the absence of an illness or injury. Enrolled as an active Medicaid provider and, if applicable, enrolled with the managed care organization (MCO) of any beneficiary it serves.ĭME is equipment that withstands repeated use and is used primarily to serve a definite medical purpose.In Kentucky, DME service providers must be licensed with the Out-of-state providers may enroll but must be licensed by the state where they practice.To enroll and bill Kentucky Medicaid DME suppliers must be: Kentucky Medicaid identifies durable medical equipment (DME) suppliers as Provider Type (90). Office of the Ombudsman and Administrative Review.Office of Application Technology Services.DPH Division of Maternal and Child Health.Office for Children with Special Health Care Needs.Division of Prevention and Quality Improvement.Division of Epidemiology and Health Planning.Program of All-Inclusive Care for the Elderly (PACE).Division of Program Quality and Outcomes.Division of Long-Term Services and Supports.Advisory Council for Medical Assistance.Division of Family Resource and Youth Services Centers.Department for Family Resource Centers and Volunteer Services.Division of Administration and Financial Management.Department for Community Based Services.Department for Behavioral Health, Developmental and Intellectual Disabilities.Department for Aging and Independent Living.
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