Kentucky Medicaid 2015

❶ Helpful Links ❷ Billing Instruction Updates ❸ ICD-10 ❹ KYHealth Net ❺ Prior Authorizations ❻ Contacts ❼ Questions and Answers 2

3 School Based Health Services Programs and Services

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5 Provider Relations Site updates

6 Provider Billing Instructions Provider Rep. Contact Information

7 PT 21 School Based Health Services

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PHYSICAL THERAPY EVALUATION OCCUPATIONAL THERAPY EVALUATION Will be added soon Will be added soon for PT & OT: THERAPEUTIC PROCEDURES IN A GROUP SETTING

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11 Note: 1 unit equals 15 minutes except for the following procedure codes: E1399 = 1 Unit equals 1 item A0160 = 1 unit equals 1 mile All procedure codes require modifiers except A0160,E1399, T1002, T1003 and T1004

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13 In less than two months (1 month and 5 days) everyone will be switching from ICD-9 to ICD-10 coding for medical diagnoses

14 ICD-10 compliance means that HIPAA-covered entities must utilize ICD-10 codes for healthcare services rendered on or after the compliance date.  WHAT does ICD-10 compliance mean? Only ICD-9 codes 10/1/2015 Claims with date of service 10/1/2015 and after must use ICD-10 codes. Claims with date of service 9/30/2015 and before, use ICD-9 codes

The General Equivalence Mappings (GEMs) are a tool that can be used to convert data from ICD-9-CM to ICD-10-CM. The GEMs are a comprehensive translation dictionary that can be used to accurately and effectively translate any ICD-9-CM- based data. The GEMs are not a substitute for learning how to use the ICD- 10 codes. More information about GEMs and their use can be found on the CMS website at:

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There is a ICD indicator in the top right corner of the Diagnosis Code field box (box 21) to indicate if the code is ICD 9 or ICD 10. Acceptable codes are: 9 for ICD 9; or 0 for ICD 10 17

To obtain access to KYHealth Net: Complete a PIN Release form. The form and detailed instructions can be found at website.  Click on Electronic Claims, then  EDI Forms  Click on PIN Release Form 18

PIN # is assigned by helpdesk address Provider # Phone # 19 Fax to: Phone (800)

KYHealth Net website address: Your password must be reset every 30 days. An reminder will be sent to the address registered with KYHealth Net. 20

Account Management KYHealth Net Sign Out 21 Change Password

Clicking on Account Management will open a separate window allowing you to edit My Information, Change Password and the Administrator will have options to View Agent Roles and Add Agents. 22

Submit a Prior Authorization request as soon as an IEP is received. Prior Authorizations requested after services have been delivered could result in non-payment. Prior Authorizations are for current school year only. KYHealth Net Prior Authorization school year runs August through July. 23

24 KYHealth Net

Click on School Based Services 25

Click Cancel to go back to the Home Screen. 26

Request New Prior Authorization 27

28 Must be full name

Once you have clicked Submit, the Member Name and Authorization# will populate. Click New to Begin entering Another PA. 29

30 When putting your cursor over a subject, a drop down box appears with additional topics within that subject

31 Select “Eligibility Verification” Under Member 1.Select Lookup Type: In the drop down box, select how you would like to look up the member - Member ID# or SSN# 2.Service Type: Health Plan Coverage is Automatically selected 3.Member ID: Enter member ID# or SSN# 4.From and To Date of Service: Enter the dates you are checking eligibility 5.Click on Search Enter the From Date of Service and To Date of Service you would like to check Eligibility for

32 Words in blue and underlined are Hyperlinks. Clicking on a Hyperlink will open more details of that subject. Eligibility 5 Year History Benefit Plan

Claim Inquiry Place cursor over Claims in the Menu. Choose “Claims Inquiry” from the drop-down. 33

Search by: 1.Member ID# and dates of service or, 2.ICN# only - Remove dates of service 3.Claim status

35 The ICN# is a hyperlink. Click on the ICN# to view claim details, adjust or void

Submitting Professional Claim Place cursor over Claims in the Menu. Choose “Claims Submission (Professional)” from the drop-down. 36

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Enter the Diagnosis Code and Click Save Code Click Next 38

Place of Service Code School ID #: Employee ID# Number of Children = Enter the number of students when billing for a group service. Valid entry is Employee ID: Employee ID #

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RA Viewer Click RA Viewer on the menu. Click Search. 41

In the Run Date column, Click the date. RA Viewer holds six months of Remittance Advice statements displaying the most current at the top of the screen. Each RA can be viewed or downloaded. 42

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Thank you for attending Kentucky Medicaid School Based Presentation! 48