Near the bottom of the page you will find prior authorization guidance from the Kentucky Department for Medicaid Services (KDMS). We strongly urge our providers to review KDMS guidance, which outlines changes to existing procedures as well as when such changes go into effect.

Network Notices

Provider requirement to report incarceration guidance from KDMS – Sept. 2, 2021, PDF opens new window

Kentucky Revised Statute: 205.6312 – June 29, 2021, PDF opens new window

Kentucky Medicaid Bypass List for Commercial Insurance Non-covered Codes – Jan. 1, 2020, PDF opens new window

Interim billing requirements for enrollee disenrollment after inpatient admission, PDF opens new window

State-supplied vaccines policy, PDF opens new window

No-show or cancellation fees for Medicaid members guidance from KDMS, PDF opens new window

Provider appeal time frame for medical necessity determination – Jan. 1, 2020 (posted Aug. 31, 2021), PDF opens new window

MedImpact single pharmacy benefit manager notice – July 1, 2021, PDF opens new window

Updated Retrospective Review Policy – March 1, 2021, PDF opens new window

Durable Medical Equipment (DME) Claims Payment Policy update – June 21, 2021, PDF opens new window

Required forms: Notice, completion, retention and claim submission, PDF opens new window

Kentucky Medicaid Regulation: 902 KAR 2:020 Reportable Disease Surveillance, PDF opens new window

Acupuncture value-added service notification , PDF opens new window

Doula value-added service notification , PDF opens new window

Claim dispute process network notification, PDF opens new window

Reminder: Claim submission requirements Update, PDF opens new window

Timely filing change – July 1, 2020 , PDF opens new window

Incontinent supply reimbursement, PDF opens new window

Introducing Humana Healthy Horizons™ in Kentucky, PDF opens new window

Out-of-Network Claims Payment Policy update – Jan. 1, 2021, PDF opens new window

Humana Urine Drug Testing (UDT) Policy – July 1, 2020, PDF opens new window

Updated Retrospective Review Policy – Aug. 7, 2020, PDF opens new window

Out-of-Network Claims Payment Policy update – Aug. 1, 2021, PDF opens new window

Medicaid and CHIP Provider Relief Fund application deadline extended to Aug. 3, 2020, PDF opens new window

Provider Relief Fund for Medicaid and CHIP distribution webinar – July 8, 2020, PDF opens new window

Urine Drug Testing Policy from KDMS – July 1, 2020, PDF opens new window

Medicaid Bypass List for Medicare non-covered codes – Dec. 15, 2020, PDF opens new window

New Horizon Kentucky Medicaid Provider Newsletter

New Horizon Kentucky Provider Newsletter, PDF opens new window

New Horizon Kentucky Provider Newsletter Archive, PDF opens new window

Prior Authorization Updates

Prior authorization guidance including Chiropractic Service Partnership –Oct. 1, 2021, PDF opens new window

Prior authorization guidance from KDMS – Aug. 12, 2021, PDF opens new window

Prior authorization guidance from KDMS – April 26, 2021, PDF opens new window

eviCore Partnership for Authorization Services, PDF opens new window

Prior authorization guidance from KDMS – Feb. 1, 2021, PDF opens new window

Prior authorization guidance from KDMS –Nov. 17, 2020, PDF opens new window

Reinstatement of prior authorization requirements – July 1, 2020, PDF opens new window

Targeted Case Management prior authorization notice - April 1, 2020, PDF opens new window