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Notices and newsletters

Stay up to date on the latest provider news and helpful info.

2024

Aetna and Quest Analytics Partnership (PDF)
 

Updated claim policy edits - genetic testing, TCM, drug and biological processing, Inebilizumab updated policy (PDF)

 

Reminder: ERA/EFT vendor change to ECHO (PDF)

 

Home infusion billing guidelines (PDF)

 

Updated claim policy edits - genetic testing (PDF)

 

MedImpact continuous glucose monitors - prior authorization criteria changes (PDF)

 

Updated claim policy edits - vaccine, lab, DME and vision (PDF)

 

Updated claim policy edits - DME (PDF)

 

Updated claim policy edits - 98960-98962 and H0038 (PDF)

 

Material change clarification on Fee Schedule updates (PDF)

 

Diagnosis-related grouping review program (PDF)

 

Tip Tuesday: Grievance and appeal (PDF)

 

PHP coverage and staffing requirements (PDF)

 

Tip Tuesday: Access and availability (PDF)

 

Aetna enhanced groupers (PDF)

 

INR monitor - new coverage update (PDF)

 

Q1 PUR clinical payment, coding and policy changes (PDF)

 

Payment policy: outpatient observation (PDF)

 

Recoupment time moving to 30 days (PDF)

 

New policy updates - venipuncture, NCCI, E&M, genetic testing (PDF)

 

Material contract change effective 8/1/2024 (PDF)

 

Aetna Provider Palooza (PDF)

 

Transition to MCG - Milliman guidelines (PDF)

 

Authorization changes for therapy providers - reminder (PDF)

 

CAHPS Survey (PDF)

 

Change Healthcare update (PDF)

 

Tip Tuesday: Prior Authorization /ProPat - February 6, 2024 (PDF)

 

IOP covered services and requirements (PDF)

 

Reporting newborn birth weights (PDF)

 

New policy updates: clinical payment, coding and policy changes - NDC and pilonidal cyst/sinus procedures (PDF)

 

DMS electronic visit verification (EW) for home health care services (PDF)

2023

Authorization changes for therapy providers (PDF)

 

TRP and PSS services billed on the same date of service (PDF)

 

Authorization changes for cardiac codes (PDF)

 

Authorization changes for transportation (PDF)

 

Credentialing changes and updates (PDF)

 

Chest wall oscillation system (E0483) (PDF)

 

Tip Tuesday - November 13, 2023 (PDF)

 

Individual peer support limits (PDF)

 

New policy updates: respiratory pathogen panels, Medicaid updates - NPI and modifier CR, drugs and pathologicals (PDF)

 

New policy updates: modifier CS, ICD-10 for gestational diabetes (PDF)

 

New policy updates: anatomical modifiers (PDF)

 

Behavioral health assessments billing and frequency– 90791, 90792, H0031, H0001 (PDF)

 

Tip Tuesday - July 27, 2023 (PDF)

 

Update - Monthly billing for Targeted Case Management services (PDF)

 

Coverage of IOP/PSS/CCSS services by individual BH practitioners (PDF)

 

Prior Authorization Guidance (PDF) 

 

Tip Tuesday - June 20, 2023 (PDF)

 

Incontinence supplies - coding update (PDF)

 

Targeted Case Management Care Plans - update (PDF)

 

Home Health PA guidance (PDF)

 

Mandatory modifiers for therapy (PDF)

 

Therapeutic Rehabilitation Services Program (PDF)

 

New Aetna Better Health® of Kentucky Medicaid claims and encounters front end edits (PDF)

 

OTC list update (PDF)

 

AvaiIabiIity Standards reminder (PDF)

 

Observation less than 8 hours (PDF)

 

CLIA (Clinical Laboratory Improvement Amendments) (PDF)

 

Targeted Case Management care plans (PDF)

 

Kentucky Medicaid Commercial Bypass List (PDF)

 

Change Healthcare EFT/ERA Registration Services (PDF)

 

Eviti Recommended Formulary Redirection (PDF)

 

Tip Tuesday: January 24, 2023 (PDF)

 

Introducing Dx Gap Advisor ™ (PDF)

 

New policy updates: clinical payment, coding and policy changes (PDF)

 

Billing expectations for Targeted Case Management Services (PDF)

 

 

2022

Claims Received report summary moving to Availity (PDF)

 

Urgent admission notification – change in timeframe (PDF)

 

New Aetna Better Health® of Kentucky Medicaid claims and encounters front end edits (PDF)

 

Tip Tuesday: November 8, 2022 (PDF)

 

New policy to apply Medically Unlikely Edits (MUE) (PDF)

 

Clinical Payment, coding and policy changes: OBGYN, smoking cessation counseling and Eversense® CGM (PDF)

 

Medicaid Precertification Optimization - ABHKY Updated Claim Policy Edit (PDF)

 

Tip Tuesday: Department IMD requirements and Aetna Better Health of Kentucky payment policy (PDF)

 

DME/drug code guidance (PDF)

 

Get Physical: Provider Education - Billing (PDF)

 

Neonatal Intensive Care Unit (NICU) (PDF)

 

Targeted case management - T2023 (PDF)

 

SUD residential billing requirement (PDF)

 

New policy updates - Clinical payment, coding and policy changes (PDF)

 

New policy updates – Drug and Biologicals and IUD (PDF)

 

Respiratory panel provider communication (PDF)

 

New policy updates – Drug and Biologicals and IUD (PDF)

 

Healthy home visits (PDF)

 

Update - SUD PA Resume (PDF)

 

Unbundling reminder (PDF)

 

Correspondence address update (PDF)

 

Claim edits platform enhancement (PDF)

 

Update – PA for inpatient and residential SUD services (PDF)

 

Update: Physician administered drug prior authorization criteria - Aduhelm (PDF)

 

Network Manager Staff Update (PDF)

 

April 18, 2022: Physician administered drug prior authorization criteria  (PDF)

 

Tip Tuesday: April 12, 2022 (PDF)

 

Volunteer opportunity:Mayfield Remote Area Medical (RAM) clinic (PDF)

 

Tip Tuesday: March 29, 2022 (PDF)

 

Updated state guidance for Covid diagnosis (PDF)

 

New policy updates: spinal surgery PA requirement (PDF)

 

New update for feeding supply kits (PDF)

 

Prior authorization changes effective 4/18/22 (PDF)

 

Method of claims payment - virtual credit cards (PDF)

 

EviCore for OB Ultrasounds -Update (PDF)

 

Providers affected by the storms - Resuming PA (PDF)

 

Introducing a new Behavioral Health Prior Authorization form (PDF)

 

Tip Tuesday: January 28, 2022 (PDF)

 

Introducing a new Behavioral Health Prior Authorization form (PDF)

 

Change - claims processing for respiratory panels (PDF)

 

PA removal extended - storm affected counties (PDF)

2021

PA Removal -Storm Affected Counties (PDF)

 

New P.O. Box Address and Vendor for Paper Claim and Claim Correspondence (PDF)

 

Tip Tuesday: November 30, 2021 (PDF)

 

Encounter Updates - Holiday check run schedule (PDF)

 

Current Network Listing: November 19, 2021 (PDF)

 

Virtual Training Opportunities - November 16 & December2, 2021 (PDF)

 

New Policy Updates - Clinical payment, coding and policy changes MedImpact Universal PA Form (PDF)

 

Tip Tuesday: November 2, 2021 (PDF)

 

Trauma Informed Care Training (PDF)

 

New policy updates: clinical payment, coding and policy changes (PDF)

 

Virtual Office Hours (PDF)

 

Tip Tuesday: October 19, 2021 (PDF)

 

Update to the communication platform (PDF)

 

Tip Tuesday: October 12, 2021 (PDF)

 

Changing Credentialing Verification Organization (CVO) (PDF) 

 

Virtual Office Hours (PDF)

 

Health Runs DEEP (PDF)

 

Q2 2021 HCPCP Updates (PDF)

 

Virtual Office Hours (PDF)

 

Genetic testing policy update; MedImpact Grandfathering notice (PDF)

 

Provider survey (IPRO) starting soon (PDF)

 

Update to Prior Authorization Policy (PDF)

 

Claims payer ID number & MedImpact PA notice (PDF)

 

Retraction of credit balances/clinical payment updates (PDF)

 

Credit balances/clinical payment updates (PDF)

 

Tip Tuesday: July 7, 2021  (PDF)

 

Pending clinical claim edits -BH (PDF)

 

New pharmacy benefit manager FAQ (PDF)

 

No-show or cancellation fees for Medicaid members (PDF)

 

Availity and Care Web QI are sunsetting (PDF)

 

Virtual office hours (PDF)

 

Summer webinar series - Availity (PDF)

 

Prior authorization resumes (PDF)

 

IPRO provider survey; multiplex nucleic acid amplified tests (PDF)

 

Health Runs DEEP sessions (PDF)

 

SKY Provider Information and Training (PDF)

 

Single preferred drug list formulary and Aetna supplemental formulary (PDF)

 

Tip Tuesday: February 23, 2021 (PDF)

 

Antepartum fetal surveillance; new remote patient monitoring program for high-risk pregnant women (PDF)

 

We are joining Availity (PDF)

 

Case management; high-risk pregnancies; reminder for SKY (PDF)

 

Better Health for high-risk pregnant moms (PDF)

 

Prior authorization guidelines (PDF)

 

SKY Provider Information and Training reminder (PDF)

2018

Kentucky provider manual letter (PDF)

 

Monthly collection letter to include supporting claims detail (PDF)

 

Centers for Disease Control and Prevention National Influenza Vaccination Week (PDF)

 

Year-end check run dates and new network relations consultant (PDF)

 

Approved policy edits for December 2 (PDF)

 

Discontinuing paper remits and refund or check address reminder (PDF) 

 

Kentucky Department of Medicaid Services (DMS) Medicaid Partner Portal Application (MPPA) provider newsletter (PDF)

 

PA changes effective November 15 and urine drug screen provider notice effective November 12 (PDF)

 

Editing changes and network relations listing (PDF)

 

Provider types 31 and 35 and network relations consultant list (Rural Health Clinic and Federally Qualified Health Center providers only) (PDF)

 

Duplicate remits (PDF)

 

Screening, Brief Intervention and Referral to Treatment (SBIRT) FAQ (PDF)

 

Policy edits for anesthesia effective September 25 (PDF)

 

Copay and network relations list (PDF)

 

Kentucky HEALTH updated webinars and network relations list (PDF)

 

Medically frail attestation policy updates; clinical payment, coding and policy changes; and Kentucky HEALTH WebEx reminder (PDF)

 

Kentucky HEALTH webinars reminder (PDF)

 

Kentucky HEALTH webinars and network relations list update (PDF)

 

DMS survey for value-based payments for providers (PDF)

 

Kentucky HEALTH provider education webinars (PDF)

 

Hepatitis A vaccine and lock box address (PDF)

 

DMS provider forum notice (PDF)

 

ePA Kentucky provider notice (PDF)

 

Provider changes and improvements to provider processes (PDF)

 

Network relations representative list update (PDF)

 

Provider Portal trainings — January (PDF)

2017

Provider process change for PA requirements (PDF)

 

Hepatitis C policy updates and holiday check runs reminder (PDF)

 

Early elective delivery and Aetna Better Health of Kentucky provider forum reminder (PDF)

 

Change to check run date and updated Provider Relations representative listing (PDF)

 

Reminder unlisted and non-specific CPT and HCPCS codes (PDF)

 

Change unlisted and non-specific codes (PDF)

 

After-hours and weekend care codes and updated PR representative listing (PDF)

 

Correction to PR representative listing (PDF)

 

Updated PR representative listing (PDF)

 

After hours and weekend care codes and prenatal cytogenetic codes 99050-99051 (PDF)

 

Updated appeal PR listing ordering, referring and prescribing (ORP) reminder revision (PDF)

 

ORP reminder (PDF)

 

Behavioral health T2023 code (PDF)

 

Updated PR representative listing (PDF)

 

Updated clinical practice guidelines and ORP reminder (PDF)

 

Behavioral health applied behavioral analysis OTR form added to website (PDF)

 

Ordering referring prescribing behavioral health T2023 code 831 PR representative listing (PDF)

 

Claim reconsideration process discontinued reminder (PDF)

 

Claim reconsideration process discontinued (PDF)

 

Cross claim provider policy change PR representative listing  (PDF)

 

Cotiviti PR representative listing (PDF)

 

Medical record claims review notice letter (PDF)

 

Medicare crossover claim edit (PDF)

 

Behavioral health CPT T2023 (PDF)

 

Prescription PA forms fall newsletter (PDF)

2016

Clinical payment changes and modifiers for occupational therapy, physical therapy and speech therapy (PDF)

 

Duplicative coding check runs (PDF)

 

Policy updates Medicaid web portal updates check runs bill 131 clinical practice preventive health guidelines (PDF)

 

Check runs behavioral health telephone reminder (PDF)

 

Community Mental Health Centers update only (PDF)

 

Check runs and no policy change for in-person claims (PDF)

 

Bill 131, inpatient costs policy check runs map 811 flu shot (PDF)

 

Draft check run map 811 policy claims hepatitis C (PDF)

 

Policy changes observation stays open enrollment service in 2017 (PDF)

 

Open enrollment here to stay Coventry account do not bill map 811 forum flu (PDF)

 

Open enrollment here to stay Coventry account do not bill map 811 forum flu (PDF)

 

Open enrollment here to stay provider forums flu (PDF)

 

Provider forums (PDF)

 

Provider forums eviCore update (PDF)

 

Provider forums eviCore update attending doctor to bill (PDF)

 

Provider forums eviCore attending doctor to bill (PDF)

 

eviCore update Provider Relations representative listing (PDF) 

 

Pain cardiology portal updates provider newsletter (PDF)

 

Aetna public exchange (PDF)

 

Zika virus provider requirement flu prevention (PDF)

 

Void requests claims inquiries (PDF)

 

Behavioral health National Correct Coding Initiative claims edits (PDF)

 

Behavioral health contract Zika virus crib program (PDF)

 

Zika virus crib program (PDF) 

 

Claims reconsideration reminder and provider reference guide update (PDF)

 

Behavioral health (PDF)

 

Clinic coding and policy communication under Affordable Care Act (PDF)

 

HCPCS/NDC code claim recon clearinghouse taxonomy (PDF)

 

eviCore MedSolutions portal hospital observation stays (PDF)

 

Formulary change portal enhancements prior authorization update (PDF)

 

Provider Relations updated list provider newsletter (PDF)

 

Location code 99 vaccines concurrent review fax inpatient ICD-10 code (PDF)

 

Check run update (PDF)

 

DMS updates concurrent review fax address form (PDF)

 

The Department of Community Based Services (DCBS) Benefind taxonomy NPI claims PR list (PDF)

 

iHealth edits claims denial review PR list (PDF)

 

ChangeHealth taxonomy (PDF)

 

High dollar claim check run primary care physician change WRAP payments pharmacy (PDF)

 

CICR taxonomy (PDF)

 

Lockbox PA ultrasound taxonomy member incentives (PDF)

 

eviCore member ID number (PDF)

 

Pharmacy PA update portal HEDIS (PDF)

 

Pharmacy requests ultrasound OB codes (PDF)

 

Portal claims tobacco cessation PR representative list (PDF)

 

Portal registration provider payment reminder (PDF)

 

Provider payment reminder PR representative list (PDF)

 

Portal registration DMS universal PA form (PDF)

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