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LTC Roster User Manual

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1. DMS Approved 10 6 2015 Page 79 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selections 6 Save Code Saves the diagnosis information on the claim Must save to continue 7 Add Code Allows the user to add an additional diagnosis code to the claim Save code after each additional code added 8 Delete Code Allows the user to remove a diagnosis code previously entered on the claim 9 Next Advance to the next screen 10 Print Allows user to print this screen DMS Approved 10 6 2015 Page 80 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 8 1 Billing Codes Procedure KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 17 am Header gt Billing Codes Billing Codes Diagnosis Procedure Condition Value Occurrence Span Paver Sequence Number O Procedure Code Date Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selection 1 Sequence Number The sequence number of the procedure codes This field is auto populated 2 Procedu
2. 7 Anesthesia Cardiac Rehabilitation Last Updated 8 11 2014 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved When the search criteria is selected the screen will expand to include fields for dates of service and Service Type The Service Type will display all 12 of the CORE ACA required service types the page will automatically default to Health Plan Coverage The current date will automatically be plugged in the date s fields The user may change the dates to the desired dates of service 2 Enter the search criteria 3 Click search DMS Approved 10 6 2015 Page 26 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The Member Eligibility Verification page will appear This screen will display the most current eligibility information available KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Member Eligibility Verification Wednesday 23 September 2015 10 22 am Emergency Services A Family Planning Health Plan Coverage e Service Type Member ID Lookup Ei From Date of Service 09 23 2015 To Date of Service 09 23 2015 7 Verification No 3ecb59972f 9 23 2015 Status Active Current ID First Name Last Name Date of Birth Old ID Check
3. Field Number Definition of Field Description Menu Selection 1 Sequence Number The sequence number of the Occurrence This field is auto populated 2 Occurrence Span Code drop down Select the appropriate code 3 From Enter the corresponding From date 4 Thru Enter the corresponding Through date DMS Approved 10 6 2015 Page 86 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 Save Code Saves the occurrence code information on the claim Must save code to continue 6 Add Code Allows the user to add an additional occurrence code to the claim Save code after each additional code entered 7 Delete Code Allows the user to remove an occurrence code previously entered on the claim 8 Next Advance to the next screen 9 Print Allows user to print this screen DMS Approved 10 6 2015 Page 87 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 8 5 Billing Codes Payer KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 22 am Header gt Billing Codes gt Detail gt Summary Billing Codes Diagnosis Procedure Condition Value Occurrence Span Payer Sequence Number O Payer Code Prior Paymen
4. KentucRy UNBRIDLED SPIRIT Commonwealth of Kentucky KY Medicaid KyHealth Net Long Term Care LTC Companion Guide Version 3 0 September 24 2015 Revision History Version 1 3 10 12 2010 Martha Senn Remove PHI Number graphics and Ron Chandler ormat document 1 4 10 14 2010 Martha Senn DMS Approved Ron Chandler E EECH 1 Ge ase corrections and changes 02 05 2013 Martha Senn CO 19321 Updated Member Eligibility Keri Hicks Verification screen and the Managed Care 5 year History screen CO 19280 Inserted Adjusted Primary Care Attestation screens 02 14 2013 Keri Hicks Finalized Tech Writer Updates DMS Approved 02 14 2013 02 26 2013 Martha Senn Removal of Adjusted Primary Care Attestation screens 03 04 2013 Keri Hicks Finalized Tech Writer Updates DMS Approved 03 01 2013 2 6 8 28 2014 Martha Senn CO 22265 and 22673 Provider Status Information screen shots S pum o D ue Name 2 7 13 2015 Martha Senn Updates to screenshots removed EADO and EFT examples DMS approved 31 2015 Gu icuaa 5 Martha Senn Updates to screenshots 2 9 8 28 2015 Martha Senn Update screen shots for Suspension Disenrollment status pages 3 and 34 3 0 9 24 2015 Martha Senn Updated eligibility verification screenshots or CO 25433 DMS approved 10 6 2015 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 10 11 Table of Contents uge e UE 1 dad Whattit is MEUPS EE 1 EC ele Ree MEET EE 1
5. Last Name First Name County Code Case Name Displayed Member Geographic Information is Members Current Information KenPAC History Provider Name Site Phone Begin Date End Date Last Updated 1 22 2013 dividuals with Disabilities Copyright 2005 Commonwealth of Kentucky CE MSL MOE Se A at All rights reserved DMS Approved 10 6 2015 Page 31 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Lockin 5 Year History Monday 4 February 2013 10 20 am LD Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information Lockin History No Rows Found Last Updated 1 22 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky ge A All rights reserved KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Lockin 5 Year History Tuesday 11 June 2013 1 54 pm lf member is enrolled in Managed Care please refer to MCO Member Information panel LD Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geograp
6. 8 Provides NPI Provides Taxonomy ID Trading Partner C J ID Username hpinst g Password eeeceeee Password 2 HO Sgggggeeg Select a security question from the list below and provide an answer that you will remember This question will help the Help Desk verify your identity if you need assistance Question in what city were you born Enter ful name of city ority Answer frankfort Potes requred fei Next KyHealth Net LTC Companion Guide DMS Approved 10 6 2015 Page 4 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The Your account was successfully created window will display Kentucky go KENTUCKY i CABINET FOR HEALTH AND FAMILY SERVICES Create New Account KyHealth Choices Your account was successfully created Kentucky Medicaid Web You can now log into KyHealth Choices using your new username and password you just created by clicking on the Sign In button below Or assistance email us at Sign In ommonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 5 KyHealth Net LTC Companion Guide Commonwealth of Kentucky MMIS 2 Signing into KyHealth Choices 2 1 Sign into KyHealth Choices 1 Access https home kymmis com 2 Enter the username and password KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR MEDICAID SERVICES iim Sign into the KyHealth Choices e Manage your contact information e Chang
7. E a 03 20 2014 0401 2014 O ocean rains xo 0s212012 Lena ss Lens bascecei No 2202 Lamm _ 05 012012Regular KISS se DMS Approved 10 6 2015 Page 24 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 2 Member Eligibility Verification 1 Select Member from the Menu 2 Choose Eligibility Verification from the drop down The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance S Eligibility Verification MCO Member Information Pharmacy History Member Links Last Updated 8 11 2014 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 25 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 2 1 Searching for a Member 1 Click the arrow to the right in the Select Lookup Type box and select the criteria to be used in the search KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Member Eligibility Verification Friday 30 January 2015 11 53 am Provider Select Lookup Type Service Type Ambulatory Service Center Facility Select
8. Kentucky Medicaid Web you want to view or modify the Agent s access Site or assistance emai usat a Successful adding role of Eligibility Venfication for system KYHeathNer Kr EI HelpDeck Php com A Details Soar eee Name edi test edi test Account Status Actwe B00 pm Monday Email Address nday EST Address Telephone 800 205 4595 Account Owner hp insta KYHeathnet hpinst Remove All Roles D Select the system to modify access 2 Modify the permissions for KYHealthNet System r Roles Lo GE Management i l Card Issuance DR a a I Claims Inquiry CA I Claes Submission Dergah DI T Cisis Suberiesion institutional I Claims Submission Professional DI DMS Approved 10 6 2015 Page 18 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 3 Accessing KY Health Net KyHealth Net allows users to access Member eligibility and related functions submit claims adjust or void claims check claim status check Prior Authorization requests print Prior Authorization letters view or download remittance advice statements and access other valuable information 1 On the KyHealth Choices Home page click on the KYHealth Net link KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR MEDICAID SERVICES KyHealth Choices Home Friday 23 January 2015 11 29 am Sign Out Jane Doe Welcome to KyHealth Choices Applications Application Description Account Management Manages conta
9. eg proton imaging orbit face and neck with contrast material s 70543 Magnetic resonance eg proton imaging orbit face and neck without contrast material s followed by contrast material s and further sequences 70544 Magnetic resonance angiography head without contrast materials Effective 03 01 2007 70545 Magnetic resonance angiography head with contrast materials Effective 03 01 2007 70546 Magnetic resonance angiography head without contrast materials followed by contrast materials and further sequences Effective 03 01 2007 70547 Magnetic resonance angiography neck without contract material s 70548 Magnetic resonance angiography neck with contrast material s 70549 Magnetic resonance angiography neck without contrast material s followed by contrast material s and further sequences 70551 Magnetic resonance eg Proton imaging brain including brain stem without contrast material 70552 Magnetic resonance eg Proton imaging brain including brain stem with contrast material 70553 Magnetic resonance eg Proton imaging brain including brain stem without contrast material followed by contrast material and further sequences 70557 Magnetic resonance eg Proton imaging brain including brain stem and skull base during open intracranial procedures eg To assess for residual tumor or residual vascular malformation without contrast material 70558 Magnetic resonance eg Proton imaging brain in
10. 1 45 21 PM Last Password Change 1 15 2010 1 45 21 PM Your password will expire in 30 days snimonwealth of Kentucky All rights reserved Click on the My Information button the following screen displays Scroll to the Security Question amp Answer section Select the security question Enter the answer oo Em e O Click on Save DMS Approved 10 6 2015 Page 8 Commonwealth of Kentucky MMIS For assistance email us at K _EDI_HelpDeskihp com or call 800 205 4696 during normal business hours 7 00 am 6 00 pm Monday Friday EST Contact Us wor First Name hp instit Middle Name Last Name KYHeatthnet Contact Address Line 1 Chamberin Ave Address Line 2 jedi City frankton State kK Zip Code ren Phone Number f00 205 4696 E Mail Address r Security Question amp Answer Select a security question from the list below and provide an answer that you will remember This question wil help the Help Desk verify your identity f you need assistance Question in what city were you bom Enter full name of r onty Answer frankfort o Geen Sne KyHealth Net LTC Companion Guide DMS Approved 10 6 2015 Page 9 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 2 1 How to Change the Password The account password expires every 30 days A pink banner will display on the Home page showing the days remaining to password expiration beginning
11. Approved 10 6 2015 Page 47 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout CareWise Prior Authorization Letters Monday 21 July 2014 1 28 pm Search Criteria Case Number Member Last Name Ce To Date Cl Click the Search button below to find Carewise Prior Authorization Letters associated with your provider number When the Letter listing displays click the Letter to view the details Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Last Updated 12 14 2013 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Searches may be conducted by Provider or by using a specific Member ID DMS Approved 10 6 2015 Page 48 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 8 3 1 PA Letter List Select Member letter under letter type KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout CareWise Prior Authorization Letters Tuesday 29 July 2014 1 30 pm Search Criteria Case Numbe
12. FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS i Provider Home Member Claims PA Provider References RA Viewer Logout TPL 5 Year History Monday 4 February 2013 10 18 am I D Last Name First Name Date of Birth SSN County Code Case Name Displayed Member Geographic Information is Members Current Information TPL History No Rows Found Last Updated 1 22 2013 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 30 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Managed Care 5 Year History Tuesday 29 January 2013 5 53 pm LD Last Name First Name SSN County Code 015 Case Number Case Name Displayed Member Geographic Information is Members Current Information Managed Care History MCO Name PMP ID Region Date Added Effective Date End Date Disclaimer individuals with Disabilities Copyright KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Ry MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMESJ Provider Home Member Claims PA Provider References RA Viewer Logout KenPAC 5 Year Histo Monday 4 February 2013 10 20 am
13. Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear 2 Select the provider NPI Taxonomy from the Drop Down menu if the user works on behalf of multiple providers 3 Click Search KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES EV HEOICAL MANAGUMENT EE Provider Home Member Claims PA Provider References RA Viewer Logout RA Viewer Friday 20 August 2010 1 08 pm Provider v Click the Search button below to find RA reports associated with your provider number When the RA listing displays click the Run Date link beside a specific RA to view or download RA report details Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Last Updated 7 1 2010 Contest Us Privacy Disclaimer individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All nights reserved 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 DMS Approved 10 6 2015 Page 63 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 4 Select the applicable Run Date KENTUCKY k CABINET FOR HEALTH AND FAMILY SERVICES TY MEDICAL MANAGEMENT INFORMATION SYSTEM KVMMIS Provider Home Member Claims PA Provider References RA Viewer Logout RA Viewer Thursday 29 January 2015 4 24 pm Provider Y Click the
14. KyHealth Net LTC Companion Guide Field Description Definition of Field Description 2 Adjust To adjust a paid claim make the correction and click save when a save button is available 3 Void Claim To reverse a paid claim click on Void 4 Print Allows user to print this screen DMS Approved 10 6 2015 Page 96 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 12 Medicare crossover 1 Follow the regular billing instructions for Institutional claim submission a Under Claim Type select either Crossover inpatient or Long Term Care or Crossover Outpatient 2 Continue with the regular instructions a Under Medicare Information enter the following Medicare information from the Medicare EOMB e Date Paid e Amount Paid and e Amount Allowed Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Tuesday 24 August 2010 1 23 pm Header Biling Information Service Information Claim Type Type of Bill From Date Last Name Thru Date First Name Covered Days Patient Acct Non Covered Days Patient Status Admit Source Admission Type Admission Date Admission Hour Member ID Discharge Time Co insurance Days Lifetime Reserve Days EPSDT No e Medicare Information Date Paid CG cs Date Requres Amount Paid Amount Requred Amount Allowed 4 amount Requr
15. KyHealth Net LTC Companion Guide e Contracts panel displays the current contract effective and end dates e Licenses panel displays the provider s license number state issued effective date and end date e Revalidation panel displays when the revalidation application is due Annual Disclosure ADO ADO Date Received 04 01 2014 Note Your ADO Must be received within one Year from the ADO Date Recieved Date Contract Effective Date End Date 01 01 1978 12 31 2299 01 01 1978 12 31 2299 01 01 1978 12 31 2299 Licenses License Number State Issued Effective Date End Date KY 01 01 1978 12 31 2299 Revalidation 60 Day Letter Date 30 Day Letter Date Note If no dates are indicated for 60 Day Letter Date and 30 Day Letter Date you are not due for revalidation at this time DMS Approved 10 6 2015 Page 101 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide e Location Address panel displays the provider physical pay to and correspondence addresses Location Address Last Updated 8 20 2014 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 102 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 13 Appendix A 13 1 Forms Web site link for blank PIN Release form www kymmis com 1 Click on electronic claims 2 Click on EDI Forms 3 Click on link for PIN Release F
16. Member Claims PA Provider References RA Viewer Logout Pharmacy Claims History Friday 17 December 2010 10 01 am Note Pharmacy information is updated every two weeks Disclaimer Claims shown are paid claims only Denied suspended or waiting to be paid claims will not be listed Member ID Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Last Updated 9 15 2010 3 Enter the Member s ID and click Search 4 The Pharmacy Claims History screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Pharmacy Claims History Thursday 15 January 2015 4 48 pm Note Pharmacy information is updated every two weeks Disclaimer Claims shown are paid claims only Denied suspended or waiting to be paid claims will not be listed Prescription Name Date Filled Supply Days NITROFURANTOIN NABUMETONE NITROFURANTOIN ABUMETONE Last Updated 8 28 2014 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 37 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 6 Patient Liability 1 Select Member from the Menu 2 Choose Patient Liability from the drop down KEN
17. by all providers today excluding orthodontics and school based providers Training materials can be found at http Awww kymmis com kymmis Provider 20Relations KYHealthNetManuals aspx The Electronic Prior Authorization link has been automatically loaded to all administrator accounts and the system administrator will need to delegate the EMAX role for agents wanting to utilize the new system Last Updated 6 8 2009 Privacy Disclaimer Individuals with Disabilities Copyright 2007 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 7 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Account Management screen displays The functionality available is Account Home Click and return to home page Admin and Agent My Information Allows user to update address phone number and security question Admin and Agent View Agent Roles Allows the provider administrator to view the roles granted to an agent Change Password Allows user to change the current password Admin and Agent Add Agent Allows the provider administrator to add agents Kentucky KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Chose Application eens eer Account Home KyHealth Choices Good afternoon hp instit KYHealthnet Please select a button above to view or edit your account ho ment KYHealthinet 656 Chamberlin Ave O frankfort KY 40601 800 205 4696 LastAccessed 1 15 2010
18. claim 1 2 3 4 Select Claim Inquiry Enter Member information and dates of service or enter the claim Internal Control Number Click the Next button to advance Click the VOID button If the claim does not show an Adjust or Void Claim button the claim was previously adjusted or voided DMS Approved 10 6 2015 Page 94 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Detail EOB Description 1 9945 PRICING ADJUSTMENT PROVIDER UNIT RATE PRICING APPLIED Detail EOB Description 2 4975 THIS REVENUE CODE IS NOT COVERED FOR THIS MEMBER Billing Information Service Information Claim Type Type of Bill 673 Intermediate Care From Date 06 01 2008 J Thru Date 06 30 2008 C Covered Days Non Covered Days Patient Status 30 STILL PATIENT OR EXPECTED TO RETURN FOR C wi Admit Source Emergency room v Admission Type 1 EMERGENCY v Admission Date fos o4 2004 7 Admission Hour 0001 Discharge Time 2359 Co insurance Days Lifetime Reserve Days EPSDT No Last Updated 9 29 2010 Copyright 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities All rights reserved Field Description Definition of Field Description d Next Will navigate the user through the claim DMS Approved 10 6 2015 Page 95 Commonwealth of Kentucky MMIS
19. had a new Medicaid enterprise user account created on your behalf Your new account username is hptesti To establish your password please visit the following URL and follow the on screen instructions hitps public kymmis conviwirk hievkid 43887 f1 9785 4ac5 aQ0 1395 1ct3e3a Please contact the EDS helpdesk at KY_EDLHelpDeckfMhp com er call G00 205 4696 between 7 00 am 6 00 pm Monday Friday EST should you have questions regarding this notiication Medicaid Enterprise Users Provisioning System H 5 When user clicks the link in the email example above the Terms of Service User Agreement window appears as shown below DMS Approved 10 6 2015 Page 14 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 6 User must click I agree in order to proceed kentucky Terms of Service KyHealth Choices You must agree to the terms below before delegating permissions Kentucky Medicaid Web USER AGREEMENT Or assistance email us at KY_EDI_HelpDeeki gt np com is User Account Agreement hereinafter Agreement effective today ts made by and or call 900 205 4696 dunng etween the Commonwealth of Kentucky Cabinet for Health and Family Services CHFS ormal business hours 7 00 epartmment of Medicaid Services COMS and users who sign up for an account on this bsie hereinafter Liser the aforementioned being a bcensed health care provider or an intily who acts on behalf of a licensed health ca
20. holder who works on behalf of a Provider but isn t the Provider Administrator In other words the Billing Agent may submit claims on behalf of the Provider but only as long as the Provider Administrator has granted access to the Billing Agent A single Billing Agent may work on behalf of multiple providers An individual may set up his or her own Billing Agent account but may not access claims submission eligibility etc until a Provider Administrator grants access DMS Approved 10 6 2015 Page 1 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 1 5 What is a PIN Number Each Kentucky Medicaid Provider has been issued a Personal Identification Number which can be used to set up an account This PIN is the key that unlocks the account initially Instructions for obtaining the PIN are in the next section of this document Creating a New Provider User Account for KYHealthnet The user creating the KYHealth Net account should be the office manager or someone deemed responsible for accessing provider information A PIN number is required to create a user account The Electronic Data Interchange EDI Helpdesk will assign a PIN number to each KY Medicaid provider ID 1 5 1 How to obtain a PIN number 1 Go to the KY Medicaid Website www kymmis com 2 Click on Electronic Claims 3 Click on EDI Forms 4 Click on PIN Release Form 5 Complete the attached PIN Release form and return to the EDI Helpdesk along w
21. in order for that Agent to act on the Provider s behalf To add roles for KyHealth Net claims eligibility etc follow the instructions below 1 Click on the KYHealth Net link Kentuckygo KENTUCKY CABINET FOR HEALTH ANO FAMILY SERVICES Close Applicaton NIUCR Manage Agent Roles KyHealth Choices This page allows you to add and remove roles from the agent Begin by selecting the system in which Kentucky Medicaid Web you want to view or modify the Agent s access Site Agent Detais or assistance ema vz at Name edi test edi test Account Status Email Address ormal business hours 7 00 Address Telephone 800 205 4696 Account Owner hp instit KY Healthnet hpinst Remove All Roles Bi Select the system to modify access 2 Modify the permissions for selected system System P Select Account Management Select KYHealthNet DMS Approved 10 6 2015 Page 16 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 Notice section B Modify the permissions for KYHealthNet section opens 3 Roles are granted or removed in this section Ri Account Home My Information Change Password View Agent Roles Add Agent ee Manage Agent Roles KyHealth Choices This page allows you to add and remove roles from the agent Begin by selecting the system in which Kentucky Medicaid Web you want to view or modify the Agent s access Agent Details or assistance email us at Name edi test edi test Acc
22. on the next button to view the Summary page DMS Approved 10 6 2015 Page 52 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES RY MEDICAL MANAGEMENT INFORMATION BYSTEN KYHMIN Provider Home Member Claims PA Provider References RA Viewer Logout PA Summary Friday 20 August 2010 12 29 pm Header gt Diagnosis gt Details gt Summary Header Requesting Provider Number PA Category Inpatient Hospital Servicing Provider Number Nursing Facility Type Member ID Diagnosis Code 1490 Last Name First Name Emergency N Admission Date 07 07 2009 Accident N Discharge Date Special Consideration N Case Management Disease Management DMS Approved 10 6 2015 Page 53 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 9 Provider References 9 1 Provider Reference Search 1 Select Provider References from the Menu 2 Choose Reference Search from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout lain Page Monday 13 December 2010 11 30am 17t r er Documentation Welcome to the Kentucky Medicaid Website The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents Provider e Claim Inquiry e Eligibi
23. sequence number of the diagnosis This field is auto populated 2 Condition Code drop down Select the appropriate condition 3 Save Code Saves the condition information on the claim Must save code to continue 4 Add Code Allows the user to add an additional condition code to the claim Save code after each additional code entered 5 Delete Code Allows the user to remove a condition code previously entered on the claim DMS Approved 10 6 2015 Page 83 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 6 Next Advance to the next screen 7 Print Allows user to print this screen 11 4 8 3 Billing Codes Value KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 15 am Header gt Billing Codes Billing Codes Diagnosis Procedure Condition Value Occurrence Span Paver Sequence Number H Ee Value Code Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selection 1 Sequence Number The sequence number of the diagnosis T
24. with 10 The user will receive an email notification from MEUPS prior to the expiration on the 20 day 1 Click on the Change Password button 2 Complete form 3 Click the Change Password button Kentucky go KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Close Applicaton Kentucky AccoumtHome Myintommtion Change Password View Agent Roles Add Agent eee eer Change Password KyHealth Choices Fill out the form below to change your password Your new password must Kentucky Medicaid Web e Have a length of at least 8 characters Contain at least one number or assistance email us at e EDI HelpDeskgpnp com Contain both lower and uppercase letters or call 800 205 4696 during ormal business hours 7 00 Old Password 4 SP pm Monday New Password riday EST New Password verity 2 2 2 Email examples of password reminder and account change notification From MEUPS Automated Mailer mailto MEUPS_DoNotReply email kymmis com Sent Friday July 16 2010 1 30 PM To Doe Jane Subject PASSWORD EXPIRATION REMINDER 10 days left Sensitivity Confidential Kentucky user Jane Doe Your Medicaid system account password will expire in 10 days on Monday July 26 2010 Please change your password before then to ensure uninterrupted system access Please contact the EDS helpdesk at KY_EDI HelpDesk hp com or call 800 205 4696 between 7 00 am 6 00 pm Monday Friday EST should you have
25. 0 No PA Required Age Restriction 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Not a Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 40 000 Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 No PA Required Age Restriction 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Not a Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 22 000 o 31 000 o 35 000 o 64 000 o 65 000 o 77 000 o 78 000 Privacy Disclaimer Individuals with Disabilities Last Updated 12 14 201 Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 57 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 9 2 TPL Carriers 1 Select Provider References from the Menu 2 Choose TPL Carrier from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Reference Search lain Page Monday 13 December 2010 11 32am Documentation Welcome to the Kentucky Medicaid Website The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents Provider v e Claim Inquiry e Eligi
26. 015 Page 21 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 Member Information 5 1 Member Card Issuance KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICER KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Eligibility Verification MCO Member Information Pharmacy History Provider Main Page Welcome to ti z ree 2 The Kentucky Department of Medicaid Services secure website is intended for Patient Liability gt aa Soe 3 providers clerks and billing agents he Electronic Annual Disclosure of Ownership EADO process has been disabled This functionality may be available in the future If you have an EADO currently in process you may be contacted for further information if additional information is needed to process your EADO We apologize for any inconvenience Provider X Switch Working Provider Claim Inquiry Submit Professional Claim Submit Institutional Claim Fabi Vaaia ibility Verificati Provider Status Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in 1 Select Member from the Menu 2 Choose Card Issuance from the drop down DMS Approved 10 6 2015 Page 22 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 3 Enter the Member ID or SSN and click the Search button to find the Medic
27. 1 3 What is a Provider Administrator AA 1 1 4 Whats a Billing AQ EE 1 125 2 Whatis a PIN Number ver ticccdrettsaterenssadessersleetanssccathel adibeasdcccsavtsleeteas cteelastna Edge eege 2 1 5 1 How to obtain a PIN MUMDON ser Aetia anaa EA SEE AEN EAAS E TA RETAS 2 1 5 2 Using the PIN to Create a New Account 3 Signing into KyHealth ChoiCeS sssesussesnsnsennnnnnnnnnnnnnnnnnnnnnnnunnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnn nennen 6 2 1 Sign into KyHealth Choices 0 00 cece eccceceecceeseceeeeaeeeeeceseeeeecaaesseaaesseaaesaeeeeaaeseeeaesseeeeeaaeseeaaeeeeeaeees 6 2 2 ACCessing USer ee ee EE 7 2 2 1 How to Change the Password 10 2 2 2 Email examples of password reminder and account change notification 0 10 2 3 Viewing Agent ROIS ooir nna Eiee EEE SERENA NENE ERRELEA ENEE TA NE deele EEGEN 12 24 Add an Agent or New Employee cccccccesccceceseceeeeeeeeeceeneeeeeeeeceeeeaeceeesneeeeseeseeaeeesnneaeenennnaes 12 2 4 1 No Email Address Found Create LUsemame 13 25 Manage Agent ROES na eivesctis n ARA ea EEEE A SEREANTE TA E AENOR A EA 16 Accessing KY Health Net E 19 F nctionality sessin iar r N NENN ON A iE eedbbe ce ANTE KANOER VENKAN VOA KUENE evvenceeeveedecreys 21 M mber Informati n Nepred aranea aniei Se apase E a ania a Tana REESEN EENS EE 22 5 1 Member Card Issuance ccccceeeteeeeececeeeeeeeaeeeeaaeeaeeeceaeeecaaesaaeecaeeecaaesseaaeseaneeseaeeesaeeeeaaeeeenees 22 5 2 Member El
28. 1 302015 EED EE EAIA UC Urgent Care 01302015 soos y o o o wt ect Ht vi rt fo D Accurate information regarding KY Medicaid member copay coinsurance for MCO plans should be ained directly from the appropriate MCO or Medicaid members not enrolled in Managed Care please refer back to the Copay Coinsurance Cost Share 5 year history section under member eligibility verification for urrent information Last Updated 8 11 2014 Contact Us DMS Approved 10 6 2015 Page 29 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide If the member eligibility has end dated the following message will display KENTUCKY s CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Member Eligibility Verification Monday 21 September 2015 4 05 pm Provider y Select Lookup Type Service Type Emergency Services A Member ID Lookup N Family Planning Health Plan Coverage v Member ID From Date of Service 09 21 2015 CF To Date of Service 09 21 2015 J Verification No cc940dfa06 9 21 2015 Status Non Active Print Error code 78 Subscriber Insured Not in Group Plan Identified Last Updated 8 28 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved KENTUCKY E CABINET
29. 10 6 2015 Page 59 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 9 3 Provider References Documentation 1 Select Provider References from the Menu 2 Choose Documentation from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Reference Search lain Page Monday 13 December 2010 11 32 am Welcome to the Kentucky Medicaid Website The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 60 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear Kentucky gov Search advanced Search KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS kymmis gt Provider Relations Index Kentucky d Provider Resources d Provider Relations is the first line contact for medical provider s F A Q lt q ie questions The area consists of trained skilled staff who respond a to both written and telephonic inquiries FAQ A Please refer to the DMS Provider Enrollment website for specific forms and
30. D KY Medicaid Provider ID or Group ID and 2 Enter the PIN number assigned KyHealth Choices Enter your Provider ID and temporary PIN provided to you in the letter Kentucky Medicaid Web Provider ID Site PIN or assistance or call 800 205 4696 during Kyltealth Choices o Account Migs ation User Agreement to Terms of Service window will display 3 Click the Yes agree or No do not agree button Create New Account You must agree to the terms below before creating an account USER AGREEMENT is User Account Agreement hereinafter Agreement effective today is made by and etween the Commonwealth of Kentucky Cabinet for Health and Family Serices CHFS epartment of Medicaid Senices OMS and users who sign up for an account on this bsite hereinafter User the aforementioned being a licensed health care provider or an ntity who acts on behalf of a licensed health care provider EREAS User renders certain professional health care sermces Services to members f employer groups and indmiduals and submits documentation of those Semices to DMS nd REAS DMS in its implementation of the Medicaid program in Kentucky provides to ealth care companies such as User a System of operational and informational support to espond to provider inquines to exchange Certain claims and billing information through fectronic Communications and through the intemet hereinafier the System REA
31. Digit Gender Date of Death Other IDs Phone Number SSN County Code County Name View Member s Mailing Address Physical Address here City Hospice Election Date Medicare A Medicare B Case Number Eligibility Eligibility 5 Year History Program Pov From Date of To Date of Eligibility Group Code Program Status ind TEAT Ger KY Managed Care XC P1 Child at least 6 and under Organization without Co Pay Child 19 Attending School if 18 Se TUNO e Link on the hyper link to view member mailing address DMS Approved 10 6 2015 Page 27 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide e The member mail address information KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer EFT Logout Member Mail Address Wednesday 23 September 2015 10 24 am LD Last Name First Name Address1 Address2 Address3 City State KY ZipCode 40213 3060 Displayed Member Geographic Information is Members Current Information Last Updated 8 20 201 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved e Ifthe member is not eligible an error code is returned KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Me
32. LY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Member Eligibility Verification Thursday 27 August 2015 11 28 am Provider iv Select Lookup Type Service Type Emergency Services A Member ID Lookup E GE Pianning S Member ID From Date of Service 06 01 2015 Es To Date of Service 08 31 2015 rs Verification No 3ecb59972f 9 23 2015 Status Active Member Last Name First Name Date of Birth Check Digit Gender M Date of Death Other IDs Phone Number SSN County Code County Name Address City State KY ZipCode Hospice Election Date Medicare A Medicare B Case Number Case Name Service Limitation Service Limitation 5 Year History No current coverage for date of service entered Copay Coinsurance Cost Share Copay Coinsurance Cost Share 5 Year History No current coverage for date of service entered No current coverage for date of service entered Managed Care Managed Care 5 Year History Ae gt Ae J MCO Name PMP ID Region Dateadaea from Date of To Date of Service Service Oe 08 21 2014 06 01 2015 08 26 2015 KenPAC KenPAC 5 Year History No current coverage for date of service entered Lockin 5 Year History No current coverage for date of service entered H member is enrolled in Managed Care please refer to MCO Member Information panel Last Upcatec 8 20 201 Privacy Di
33. LY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 17 am Header gt Billing Codes gt Detail gt Summary Billing Information Service Information Provider Number Member ID 287 Last Name 11 01 2010 First Name 11 30 2010 Patient Acct Covered Days 30 Date of Birth Non Covered Days 0 Gender Patient Status 30 Attending Phys Admit Source 4 Referring Phys Admission Type 2 Facility Number Admission Date 11 01 2010 Other Physician Admission Hour 0200 Insurance Denied No Discharge Time Prior Authorization Co insurance Days Lifetime Reserve Days EPSDT No Charges roa Charges 1000 00 Diagnosis Codes Item Diagnosis Code Details Date Of Service Revenue Code Amt Billed Amount TPL 11 01 2010 120 1000 00 0 00 Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 93 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 11 Adjust or Void Claim Screen To ADJUST a paid claim 1 Select Claim Inquiry 2 Enter Member information and dates of service or enter the claim Internal Control Number 3 Click the Next button to advance 4 Correct the information on the claim 5 Save the updated information 6 Click the Adjust button To VOID a paid
34. NAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Friday 17 December 2010 2 32 pm Provider Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 68 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 Long Term Care Roster The Long Term Care Roster is a unique application designed for Nursing Facilities to submit a monthly batch of claims Please follow Billing Instructions for applicable claim type when completing fields Appendix A Web site link for all Medicaid Billing Instructions 11 4 1 LTC Roster of Members The Previously Submitted Claims includes members previously submitted claims detailing e Member name e ID number e Claim ICN e Revenue code and e Date of last submission The members may be edited deleted and or copied KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout LTC Roster Thursday 6 January 2011 09 06 am Provider s Previously Submitted Claims Click on name to view claim or 5 REV 6 sate Last CODE Submitted 2 MemberName 3 MAID 4 ICN 120 120 11 30 2006 11 30 2006 11 30 2006 DM
35. Page 20 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 4 Functionality Provider Administrators have access to all applicable functions on KyHealth Net Billing Agents and Agents have access to only those functions granted them by the Provider Administrator A Billing Agent or Agent may only perform the functions granted them by a given Provider Administrator while logged in under that provider s account For example if an Agent works on behalf of Dr Smith and Dr Jones but the Agent doesn t have claim submission access for Dr Jones the claim submission function will not appear unless the Agent has selected Dr Smith s NPI Taxonomy from the drop down when logging in KyHealth Net offers the following functions Menu Selection Functions Member Check eligibility card issuance spend down patient liability pharmacy history and enroll a Member in Presumptive Eligibility PE providers only Claims Check claim status submit claims adjust paid claims or void paid claims Prior Authorization PA iri PA information download a PA letter or lookup a PA number Provider References Check coverage on a procedure code lookup commercial insurance carrier information and access other references on the DMS website RA Viewer View and or download your Remittance Advice The hyperlinks on the Home Page also offer quick access to commonly used functions DMS Approved 10 6 2
36. RVICES a e ee e eee aa a e a e e eme e KY MEOICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Inquiry Wednesday 18 August 2010 4 03 pm Provider v Transaction Member Dem PA eg ID Category x SSN Last Name First Name Start Date Si Type Submitted v Last Updated 7 1 2010 Privacy Disdaimer Individuals with Disabilities CPN se COE OR All rights reserve A PA search is completed by entering e Transaction ID is the PA number or e Member ID or e SSN or e Name of member and e Start date is required with all search criteria DMS Approved 10 6 2015 Page 51 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Fv MEDICAL MANAGEMENT KR Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Inqui Friday 20 August 2010 12 27 pm Provider Transaction KH Member PA ID ID Category SSN Last Name irst Name Start Date 07 07 2008 Wil Type Submitted v Transaction ID Momber ID Last Name tirst Name PA Category Inpatient Hospital Last Updated 7 1 2010 Copyright 2005 Commonwealth of Kentucky All rights reserved Privacy Disclaimer Individuals with Disabilities 1 Selecting Search returns the Transaction ID 2 Click to open the PA 3 Click
37. S while perforrning gz semces User may be gwen access to or may be exposed o Certain confidential or Indeidually Identifiable Health Information or Protected Health information PHIM as defined under the Health Insurance Portabilay and Accountability Act f 1996 HIPAA 45 Code of Federal Regulations Parts 160 164 and applicable guiations that implement Title V of the Gramm Leach Bliley Act 15 U S C 6801 ef seg the GLB Regulations REAS User desires to utilize the System provided by DMS and OMS desires to Ovide the System and related seraces and support to User as defined and according to Ei Do you agree to the terms of service as stated above Yes agree No I do not agree DMS Approved 10 6 2015 Page 3 Commonwealth of Kentucky MMIS 4 Enter the data On the Create New Account Form Men KyHealth Choices Kentucky Medicaid Web Site For assistance email us at KY_EDI_HelpDesk hp com jor call G00 205 4696 during pormal business hours 7 00 po 6 00 pm Monday riday EST Contact Us Create New Account First Name hp instit Midde Name Last Name KYHealthnet Address Line 1 Chamberlin Ave Address Line 2 jedi City rankon E State ky Zip Code Joen Phone Number fe00 205 4696 E Mail Address Je E Mail Address r verity Provider ID Provider NPI Provider IT Taxonomy ID Trading Partner C 1D E Mail Address H E Mail Address reen gan Provides ID
38. S Approved 10 6 2015 Page 69 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Description Menu Selections 1 Add New Member Click box to add new member to the Roster 2 Member Name The members name is shown after entry of information on a previously submitted claim 3 Maid The member s KY Medicaid ID number 4 ICN The unique 13 digit internal control number for previously submitted claim 5 Rev Code The revenue code previously submitted for member 6 Date Last Submitted The date the claim was previously submitted 7 Edit To edit a claim 8 Delete Copy For deleting a claim 9 Copy For copying a claim DMS Approved 10 6 2015 Page 70 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 2 Current Month Submitted Claims Screen Print Previously Submitted 12 31 2010 12 31 2010 12 31 2010 12 31 2010 1231 2010 12 25 2010 12 23 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 12 31 2010 Print Current Month 6 Submit Billing From Date 12 01 2010 J Through Date 1231 2010 J Submitted Amount Code 110 148 00 Code 120 148 00 Code 130 148 00 Code 140 148 00 Code 150 148 00 Code 160 148 00 Code 180 bag 00 Code 185 148 00 Submit All Claims 11 4 3 Current Month Submitted C
39. Search button below to find RA reports associated with your provider number When the RA listing displays click the Run Date link beside a specific RA to view or download RA report details Run Date Load Date Provider Report N S gehier Number 01 23 2015 RA Payee ID RA 13323870 NPI SEQ 01 16 2015 RA Payee ID _ RA 13317888 NPI SEQ 01 09 2015 RA PayeeID BA 13311781 NPL SEQ 01 02 2015 RA Payee ID RA 13306059 NPI 12 26 2014 RA Payee ID RA 13300107 NPI SEQ 1 23 2015 1 26 2015 1 16 2015 1 19 2015 1 10 2015 1 3 2015 12 26 2014 12 27 2014 12 19 2014 RA Payee ID RA 13293811 NPI SEQ 12 19 2014 12 22 2014 12 12 2014 RA PayeeID RA 13287423 NPI SEQ 12 05 2014 RA Payee ID RA 13281242 NPI SEQ 11 28 2014 RA Payee ID RA 13274846 NPI SEQ 11 21 2014 RA Payee ID RA 13268460 NPI SEQ 12 12 2014 12 14 2014 12 5 2014 12 6 2014 11 28 2014 11 29 2014 11 21 2014 11 23 2014 DMS Approved 10 6 2015 Page 64 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 Claims 11 1 Claim Inquiry 1 Select Claims from the Menu 2 Choose Claims Inquiry from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout C
40. TUCKY b CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMISJ Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Provider Main Page J Eligibility Verification d Pharmacy History x Sana site The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents Provider e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 DMS Approved 10 6 2015 Page 38 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Patient Liability Friday 17 December 2010 10 10 am Member ID SSN Last Updated 9 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved 3 Enter the Member ID or SSN and click the Search button to find the patient liability 4 Click on the View button to populate the MAP 552 Liability Begin Date End Date Type of Liabiility 01 01 2006 12 31 2299 32 00 LTC Long Term Care View 02 01 2005 12 31 2005 13 00 LTC Long Term Care View Last Updated 11 24 2009 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwe
41. aid card issue date KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Friday 30 January 2015 11 47 am Member ID SSN Last Updated 8 11 2014 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky Ge EE EE EE e EE All rights reserved The card issuance dates include eligibility begin and end dates along with card type An R in the retroactive column indicates the segment was issued retroactively DMS Approved 10 6 2015 Page 23 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Friday 30 January 2015 11 50 am MemberID SSN o Search Issue Date Retroactive Beginning Date End Date Type Source Currently Billable 24 12012014 01 01 2015 Regular KMIDC e 1 1 4 Y 20 ER es EE Beer Ze SE E 05 20 2014 06012014 07 01 2014 Regular KMIDC e 12014 Leen een RegularKMIDC Yes 02 19 2014 TAX ease bsorzonsReesad emod wo rg 9 Paak ET o jivis2oi3 12012013 d KISS pomos iver pees xe josi72013 1001 2013 11 01 2013 Regular KISS No 05212013 06 01 2013 _ 07 01 2013 Regular KISS No EE Saal ener hosoro No 12172012 Loo 0201 2013 Regular KISS No EE ere ES No
42. alth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 39 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 7 Spend Down 1 Select Member from the Menu 2 Choose Spend Down from the drop down KENTUCKY y CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Provider Main Page Monday 13 Dec Eligibility Serioa Pharmacy History site The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 DMS Approved 10 6 2015 Page 40 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear 3 Enter the Member ID or SSN and click the Search button to find the spend down data KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Spend Down Thursday 19 November 2009 08 08 am Member ID SSN Last Updated 4 30 2009 Contact Us Privacy Disclaimer Individuals with Disabilities Consign S 2009 Commonwealth afke All rights reserved KENTUCKY CABINET FOR HEALTH AND FAMILY SEAVICES EY MECICAL MAMAGEMONT INFORMATION NTs TOs EES Provi
43. arch Eligibility listed does not guarantee payment of a claim Wednesday 8 January 2014 3 41 pm Provider Choose Search Type Procedure Code Procedure Code 99213 Eligibility Group CCEBA Compr Chces Exp Pop Bas ABI X Date Of Service 08 01 2010 Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 No PA Required Age Restriction 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Not a Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 85 000 Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 No PA Required Age Restriction 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Not a Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 80 000 DMS Approved 10 6 2015 Page 56 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 No PA Required Age Restriction 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Not a Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 01 000 Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 201
44. atient Account Patient s account number Optional 6 Date of Birth Members date of birth auto populated 7 Gender Members gender auto populated 8 Attending Physician Enter Attending physician s NPI number if applicable 9 Referring Physician Enter Referring physician NPI number This is the KenPac provider otherwise leave blank 10 Facility Number Enter Billing NPI number 11 Other Physician Enter Other treating physician NPI number 12 Insurance Denied Indicates a denial from commercial insurance If yes is selected the claim must be billed paper with the insurance denial 13 Prior Authorization Enter Prior Authorization number or Treatment Authorization Number if applicable DMS Approved 10 6 2015 Page 75 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 14 Claim Type Select the appropriate claim type in drop down box 15 Type of Bill Select the applicable type of bill 16 From Date Enter the first date of service 17 Thru Date Enter the through date of service 18 Covered Days Enter number of days billed on claim 19 Patient Status Enter Patient s status on through date 20 Admit Source Select the admission source 21 Admission Type Select the admission type ER Admission Date Enter the patient s date of admissio
45. bility Verification Last Updated 9 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 58 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout TPL Carriers Friday 20 August 2010 12 47 pm Business Name Last Updated 7 1 2010 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved 3 Enter the TPL Carrier name 4 Click Search The response will return all carrier information on file KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout TPL Carriers Friday 20 August 2010 12 50 pm Business Name MEDICARE Code Business Name Address Telephone ee FIRST HEALTH CARRIER idea geen FRANKFORT KY 40601 RST HEALTH CARRIER RANKFORT KY 40601 FIRST HEALTH CARRIER FRANKFORT KY 40601 ANYTOWN KY 99999 9999 Last Updated 7 1 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved
46. cluding brain stem and skull base during open intracranial procedures eg To assess for residual tumor or residual vascular malformation with contrast material 70559 Magnetic resonance eg Proton imaging brain including brain stem and skull base during open intracranial procedures eg To assess for residual tumor or residual vascular malformation without contrast material followed by contrast DMS Approved 10 6 2015 Page 46 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 8 3 PA Letters 1 Select PA from the Menu 2 Choose CareWise Prior Authorization Letter from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Checklist Monday 21 July 2014 1 26 pm Jor MMIS Prior Authorization Letter PAL i elcome to the Kentucky Medicaid page ea EES Services secure website is intended for providers Provider hg Switch Working Provider You currently receive paper and electronic PA Letters in an effort to go green would you like to discontinue Paper PA Letters The following provider id s require renewal of their Annual Disclosure of Ownership Provider ID Provider Name Due Date Claim Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Claim Bee Verification bility Verificati DMS
47. count It s the same thing as your KyHealth Choices account 1 2 How do l use this system When you log in you ll see the KyHealth Choices Home Page and any applications available to you will appear on your menu including Account Management Authorization Request KyHealth Net and EMAX KyHealth Net LTC Companion Guide information change your security question answer and reset your password Link Functions for All Users Functions for Provider Functions for Billing Admin Only Agents Only Account Allows you to manage Allows you to view None Management your personal agents with access to your account and add an agent to your account KyHealth Net Allows user to submit claims PA requests check eligibility etc Functions are limited to those that are applicable to the Provider type Functions are limited to those authorized by the Provider Administrators EMAX None Functions are limited to those that are applicable to the Provider type Functions are limited to those authorized by the Provider Administrators 1 3 What is a Provider Administrator A Provider Administrator has control of a Provider s account and can grant access to Billing Agents A PIN is required to set up a Provider Administrator account and only one Provider Administrator account can exist for each Kentucky Medicaid provider number 1 4 What is a Billing Agent A Billing Agent is an account
48. ct information password and authorizations for applications KYHealthNet Eligibility Verification Claims submission and inquiry Presumptive Eligibility RA Viewer Messages Message Providers are now able to view Confirmation notices Lack of Information and Denial letters online via KYHealth Net through https home kymmis com home Select PA from the top menu and then select the option titled Carewise Prior Authorization Letter This will allow you to search for save or print a copy of the letter You must be the provider the letter was issued to in order to view and print the letter 11 17 2014 Effective December 1 2014 Licensed Professional Art Therapists and Applied Behavior Analysts applications will be accepted However these two new provider types will not be allowed to enroll until January 1 2015 The enrollment requirements can be found on the Provider Enrollment website located at http www chfs ky gov dms provEnr Important KYHealthNet Announcement Providers who are already enrolled in KY Medicaid are now able to access their provider enrollment file online through https home kymmis com home If you already have access to KYHealthNet you are now able to view your contract dates licensure information physical correspondence and pay to address phone number fax number taxonomy NPI group practice provider is affiliated with providers that participate in group practice annual disclosure of ownership ADO and
49. der Home Member Claims PA Provider Relerences RA Viewer Logout Spend Down Friday 20 August 2010 12 21 pm Alember ID l SSN i Member DOB 07 04 1966 Member ID BboOD 09 04 2009 Name SpendDown e End Date Amoun Baana 03 10 2009 04 30 2009 396 52 5396 52 03 01 2009 07 31 2009 3 914 00 50 00 08 01 2009 10 31 2009 3 915 00 0 00 Last Updated 7 2010 Privacy Disclaimer Individuals with Disabilities Kachen EA a Cea rea O a All nights resend DMS Approved 10 6 2015 Page 41 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 8 PA Prior Authorization 8 1 Prior Authorization Check list 1 Select PA from the Menu 2 Choose Prior Authorization from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Prior Authorization Checklist z s Radiology Prior Auth Proc Code List Friday 16 January 2015 11 25 am ane ES DEE CareWise Prior Authorization Letter Welcome to the Kentucky Medicaid Medicaid Services secure website is intended for gents Provider M Switch Working Provider You currently receive paper and electronic PA Letters in an effort to go green would you like to discontinue Paper PA Letters The following provider id s require renewal of their Annual Disclosure of Ownership Provider ID NPI Provider Name Du
50. documentation required for enrollment The Provider Relations area is available for service 8 00 a m until 6 00 p m ET Monday through Friday Provider Workshop Provider Billing Instructions Page Updates KY Health Net user manuals Department for Medicaid Services Provider Directory Provider Relations Electronic Claims HIPAA Companion Guides and EDI Guides Medicaid Preferred Drug List Selected documentation for additional provider resources available at www kymmis com DMS Approved 10 6 2015 Page 61 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 10 RA Viewer 1 Click RA Viewer on the menu KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Provider Main Page Thursday 29 January 2015 4 20 pm Welcome to the Kentucky Medicaid Website The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents Provider v Switch Working Provider You currently receive paper and electronic PA Letters in an effort to go green would you like to discontinue Paper PA Letters e Claim Ingui e Submit Dental Claim e Submit Professional Claim e Submit Institutional Claim p Eligibility Verification Verificati e Provider Status Last Updated 8 11 2014 DMS Approved 10 6 2015 Page 62 Commonwealth of
51. e Date Claim Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Claim Elisibility Verification e Provider Status DMS Approved 10 6 2015 Page 42 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following dialogue box will appear File Download 3 Select Open or Save DMS Approved 10 6 2015 Page 43 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide An example of the checklist follows XyHealth Prior Authorization Call Checklist Prior to calling or faxing this request to prior authorize services please complete the following information for each Medicaid member when requesting services By completing this form our representatives will be able to process your request more quickly We thank vou for your assistance Clinical staff should make the Prior Authorization request Review the attached list to see if service requires prior authorization which would be the letter and add below All fields are required to process the Prior Authorization request This request does not guarantee these services will be authorized Member Last Name Member First Name Member Middle Member Medicaid Initial P ID Number Member Address Zip Code Responsible Party for Member Under Age of18 Ordering Provider Name Ordering Provider s Medicaid Number non Medicaid providers should enter license number and state Ordering Provider Contact Per
52. e your password e Providers Manage your agent s access For assistance email us at KY_EDI_HelpDesk hp com I 600 205 4696 duri am s lee Reg al If you are a billing agent or you wish to complete a am 6 00 pm Monday provider application you may register here Friday EST Privacy Disclaimer Individuals with Disabilities Sign in to KyHealth Choices Username Ir n Password l KyHealth Choices Reset your password Copyright 2006 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 6 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 2 Accessing User Applications 1 Click on Account Management under Application The Administrator to the provider account can view or add Agents An agent has limited access to change password or update security questions KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR MEDICAL SERVICES KyHealth Choices Home Thursday 16 December 2010 1 58 pm Jane Doe Welcome to KyHealth Choices Applications Application Description Account Management Modify your account information Providers can also use this application to give application permissions to their agents KyHealth Choices This is the KyHealth Choices portal application Model Office KYHealthNet For Eligibility Claims PA PE Transactions to the Model office environment Messages Reminder Electronic Prior Authorization is available for use
53. ed DMS Approved 10 6 2015 Page 97 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 1 Claim Type Choose the applicable crossover claim type 2 Date Paid Enter Medicare s paid date 3 Amount Paid Enter the Medicare paid amount on the services being billed 4 Amount Allowed Enter Medicare s allowed amount on the services being billed DMS Approved 10 6 2015 Page 98 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 12 1 Billing Codes Medicare KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Friday 15 January 2010 2 30 pm Header gt Biling Codes Billing Codes Diagnosis Procedure Condition Value Occurrence Span Payer Sequence Number fi elete Code COINSURANCE PAYER E COINSURANCE PAYER F COVERED DAYS COVERED SELF ADMIN DRUGS DIAG STUDY Last Updated 1 1 24 2009 Copyright 2005 Commonwealth of Kentucky Field Number Definition of Field Description Menu Selection 1 Value Code drop down list Medicare crossover claim click on Billing Codes Choose if it s a coinsurance or deductible claim and list amount and save DMS Approved 10 6 2015 Page 99 Co
54. ence caeeesaaeseeaaeseneeseaeeesaeeeeaaeesenees 73 11 4 5 Add New Member 73 Revised 10 6 2015 Page i Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 6 Completing the Cam 74 11 4 7 Billing Code Screens 00 ceeecececcceceneeeeeeceeeeeceaeeesaaeeseaeeseeeeesaaeseseaeseeeeeseaeeessaeeseaeseeeees 77 11 4 8 Billing Codes Diagnosis cccceeceeeeeeceeceeceeeeeeeaeeeeneeceeeeecaaeeeeaaeseceeeseaeeesaeeeeaaeseenees 78 11 4 9 Detail et EEN 90 11 4 10 Summary Screen eeteeeececeee ee ceeeeeeee cence ceaeeeeaaesaaaeeceaeeesaaeseeaaeseneeseaeeeeaeseenaeesenees 93 11 4 11 Adjust or Void Claim Gereen 94 11 4 12 Medicare Crossomver cece cece cece cece cece eeeeEEEEEEEEEEEEEEEEEEEEEEEEEEEEESEEEEEEEEEEEEEEEEEEEEEES 97 12 e DT 100 12 1 The Provider Status Information 100 br WE TT i WEE 103 EE Da FOM EE 103 13 2 Billing Instructions gt accn etea a ita aaa tes Since nia niin oa hice ida ie 103 DMS Approved 10 6 2015 Page ii Commonwealth of Kentucky MMIS 1 Introduction 1 1 What it is MEUPS MEUPS is an acronym for the Medicaid Enterprise User Provisioning System It s a single sign on system that allows users to access multiple applications via a single user name and password What that means to Kentucky Medicaid Providers is that you can manage your own account and others access to it You won t see the word MEUPS on your screen but you may hear someone refer to your MEUPS ac
55. gent is found the screen below will appear allowing the user to create an Agent account and associate that agent with the Provider account 1 Complete the fields boxed in red below 2 Click Add amp Manage Agent button Choe Aetiu tan aanne wg Add Agent KyHealth Choices Use this screen to add access to an agent for your application Kentucky Medicaid Web Enter the email address of the agent you are adding access to your application and click search D Gomm omal busmess haws 700 An agent with the email address you specified was not found in the system Please verify that the i oe Za Monday address is correct Fill out the fields below with the agent s information to create a new agent account in the system Email Address Email Address wartty Fira Name Last Name Uhermame hptestt u Phone zoeae D Ad amp Manage Agent DMS Approved 10 6 2015 Page 13 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 3 The Agent Account Created window appears Agent Account Created You have successfully created a new agent account Your agent wil receive instructions via emai on how to set their password 4 User will receive an email as shown below Automated MEUPS email Example E PASSWORD SETUP Message HTML A ech Foward dR al 3 AR ss sl Ep Edt View Feet Format Tools actions Hep Kentucky user hptestt You have been sent thes message because you have
56. gents Found will appear Kentucky go KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Close Applicaton Ey View Agent Roles KyHealth Choices Use this screen to manage the roles for your agents Kentucky Medicaid Web Site To edit the user s permissions select the user by browsing below Or assistance email us at No agents found You are not sharing permissions to any agents To begin the process of giving access to your agents click on the Add Agent button above 2 4 Add an Agent or New Employee Provider Administrators and Billing Agents have the ability to add agents to an account giving them access to submit claims check claim status check eligibility or perform other functions on behalf of the provider Clicking Add Agent allows a Provider Administrator or Billing Agent to add an Agent to the account Cleae Applicaton nee eer Add Agent KyHealth Choices Use this screen to add access to an agent for your application Kentucky Medicaid Web Enter the email address of the agent you are adding access to your application and click search or assistance email us at simer Individuals wth Disa DMS Approved 10 6 2015 Page 12 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 4 1 No Email Address Found Create Username The Provider Administrator or Billing Agent may search for an existing agent by entering the email address of the agent and clicking search If no a
57. hic Information is Members Current Information Provider Name Provider Phone Service Type Effective LOCK IN MEDICAL 02 01 2009 05 31 2009 LOCK IN PHARMACY 05 01 2005 05 31 2009 Last Updated 6 10 201 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky GE All rights reserved DMS Approved 10 6 2015 Page 32 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEOICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Waiver 5 Year History Monday 4 February 2013 10 21 am LD Last Name SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information No Rows Found Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 33 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 2 2 Member Eligibility Suspension Disenrollment The new indicators for member who have the following status at the time of member inquiry if the member does not have one of these indicators on file this panel will not display e Suspended Incarcerated e A Eligible but dis enrolled due to address mismatch e W Address Mismatch warning KENTUCKY L CABINET FOR HEALTH AND FAMI
58. his field is auto populated 2 Value Code drop down Select the appropriate value code DMS Approved 10 6 2015 Page 84 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 3 Amount Enter the corresponding dollar amount 4 Save Code Saves the value code information on the claim Must save to continue 5 Add Code Allows the user to add an additional value code to the claim Save code after each additional code entered 6 Delete Code Allows the user to remove a value code previously entered on the claim 7 Next Advance to the next screen 8 Print Allows user to print this screen DMS Approved 10 6 2015 Page 85 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 8 4 Billing Codes Occurrence Span KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 15 am Header gt Billing Codes Billing Codes Diagnosis Procedure Condition Value Occurrence Span Paver Sequence Number fi Occurrence Span Code Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky Al rights reserved
59. igibility Verification 22 2 cece ceeeeeeeeeeeeeeeeeeeaeeeeeeeaeeeeeeaaeeeseeaaeeeseeaaeeeeeeaaeeeeeenaeeeeneaaes 25 5 2 1 Searching for a Member 26 5 2 2 Member Eligibility Suspension Disenrollment sesseesseessessseeseeesisenssnnsnnsnnsrenneennee 34 5 3 View Pharmacy Claim History cccccccceececeeeeeeeeeeeeeeceaeeeseaeeeeneeseaeeecaaeeesaaeseeeeeseaeeesaeeeeaeeeeeees 36 Patient Liability EE 38 POM RN ae EE A0 PA Prior A thorizati n 2 eege EEN Edge 42 8 1 Prior Authorization Check Wert 42 8 2 Radiology Prior Authorization Procedure Code Let 45 8 3 PA Letters aa aerea aea dace dE ACEN eda eg ee hee eit ee d 47 8 3 1 PA Letter bist meaa aaa aa aaa i aaaea dee Eesen 49 CR PA Me Un EE 50 Provid r Refere COS sust aeecedda ce EENS EE EES EE 54 9 1 Provider Reference Search 0 cccccccecceceeeceeeeeeeeaaeeeeeeeceaeeeeaaeseeaeeceaeeesaaeeseaaesseneeseaeeesaesteaaeesenees 54 9 2 EREM heet EE 58 9 3 Provider References Documentation 60 FRA VIC WOM cece A Ree TT ey avereevechteausenvie A 62 EU 65 VAS Gla le lte EE 65 11 2 Submitting LTC Roster cccccccccceeeeeeseeeeeeeeceaeeeeaaeegeneeceaeeeeaaeseaeeseaeeeceaeeseaaesgeceeseaeeesaeeseneeesaes 67 TES Venty te Mie EE 68 11 4 Long Term Care Hoster 69 11 4 1 LTC Roster of Members 69 11 4 2 Current Month Submitted Claims Green 71 11 4 3 Current Month Submitted Claims Table 71 11 4 4 Successful Submission 2 0 0 eee ceeeceenee cece ee ceeeeeeaae c
60. ith a copy of a valid driver s license via e mail or fax Include your phone number and e mail address and someone will contact you with your PIN and website information a Fax your PIN Release form to 502 209 3242 or 502 209 3200 b E mail your form to KY_EDI_Helpdesk hpe com The HP EDI department will respond within 2 business days via email The PIN release email example is below From Jane doe hp com Sent Monday August 9 2010 10 30 AM To Daisy Duck anywhere com Subject KY Medicaid PIN release request To create a KY Health Net account user the following information Provider ID XXXXXXXXXX PIN XXXXXXXXX To create a KYHealth Net account access https public kymmis com pinletter To access the user account http home kymmis com The password expires every 30 days A reminder is sent on the 20th day to update the password To change your password click on Account Management Change my password In the future you can do the following If the account user password is expired click on Forgot my password button on the sign in page under password to complete a password update This function only works if a security question is linked to the account If you have questions contact the EDI Helpdesk at 800 205 4696 or KY_EDI_Helpdesk hpe com DMS Approved 10 6 2015 Page 2 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 1 5 2 Using the PIN to Create a New Account 1 Enter the provider I
61. laims Inquiry Main Page Deem Claims Submission Dental Friday 17 December 2010 Claims Submission Professional Claims Submission Institutional LTC Roster Submittal Welcome to the Kentucky ae TE Se epartment of Medicaid Services secure website is intended for and billing agents Provider Claim Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Claim Eligibility Verification Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 65 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Claim Inquiry Friday 17 December 2010 2 25 pm Search Criteria Member ID Claim Status Any Status v Date Of Servi Patient Acc Date Type Date ervice Warrant Date ICN or TCN From Date 12710 2010 Cl Thru Date 12 17 2010 e 3 Select the applicable NPI and Taxonomy if using an agent or billing agent account Enter Member ID and From Date Thru Date or Patient Acct Claim Status Any Status Paid Denied and Suspended Warrant Date Warrant Date should read as RA date ICN Enter ICN and remove From Date Thru Da
62. laims Table Field Number Description Menu Selection 1 Member name Name of Patient from most recent month s billing 2 MAID Member s KY Medicaid ID number 3 ICN Internal control number of this month s claims 4 REV CODES Revenue codes for this month s claims 5 DATE LAST SUBMITTED Date of last month s submission 6 SUBMIT BILLING Fill in the current month s from and through dates DMS Approved 10 6 2015 Page 71 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 7 SUBMITTED AMOUNT Enter amounts of each Rev codes for the month 8 SUBMIT ALL CLAIMS When you are done click this button to submit your claims for the month DMS Approved 10 6 2015 Page 72 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 4 Successful Submission 23 Submission successful Tracking number w paper 500005448 180705 xml Current Month Submitted Claims Member Name MAID ICN REV CODE Date Last Submitted Add New Member Roster response returns a tracking number 11 4 5 Add New Member 1 Click the Add New Member button Previougly Submitted Claims Click on name to vie claim or Add New Member 2 Complete the claim with the applicable information required for Long Term Care DMS Approved 10 6 2015 Page 73 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 6 Comp
63. leting the Claim Follow the field by field instructions for completing the claim KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 09 42 am Header Billing Information Service Information Provider oOo Claim Type Long Term Care Number Type of Bill 15 v From Date Thru Date Member ID Fei Last Name Covered Days e Non Covered Days Patient Status Admit Source Admission Type Admission Date Admission Hour Discharge Time Co insurance Days Attending Phys Referring Phys o mp ae Lifetime Reserve Days EPSDT Last Updated 9 29 2010 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 74 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 1 Provider Number NPI Number of billing provider auto populated 2 Member ID Enter 10 digit Membere KY MEDICAID ID number 3 Last Name Members last name auto populated 4 First Name Membere first name auto populated 5 P
64. lity Verification Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Last Updated 9 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky ett All rights reserved DMS Approved 10 6 2015 Page 54 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Reference Search Eligibility listed does not guarantee payment of a claim Wednesday 8 January 2014 1 53 pm Provider Choose Search Type Procedure Code Procedure Code Eligibility Group CCEBA Compr Chces Exp Pop Bas ABI Date Of Service m Search Last Updated 12 14 201 Copyright 2005 Commonwealth of Kentucky All rights reserved 3 Enter the procedure code and date of service 4 Select the Benefit Plan click Search The response will return the Limitation for the date of service DMS Approved 10 6 2015 Page 55 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Reference Se
65. mber Claims PA Provider References Trade Files RA Viewer Logout Member Eligibility Verification Monday 21 September 2015 4 05 pm Provider v Select Lookup Type Member ID Lookup v Health Plan Coverage Member ID From Date of Service 09 21 2015 CF To Date of Service 09 21 2015 7 Verification No cc940dfa06 9 21 2015 Status Non Active Error code 05 Recipient ID missing or not on file Last Updated 8 28 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 28 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide When the link under Eligibility Group is selected a new window displays the service types Provider Home Member Claims PA Provider References RA Viewer Logout Service Type Coverage Friday 30 January 2015 12 10 pm I D Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information Service Type Coverage for Eligibility Group Opt Chc Exp pop Tgt no Copay Date Co Co Base Deductible pe i SL Effective a Sorted Pay Insurance Deductible Remaining 1 Medical Care 01302015 aal Y e LE oa St Ge 01 30 2015 01 30 2015 Ge 01302015 baal Y Hepa aga semi yo 01 30 2015 PETE CS 01 30 2015 01 30 2015 98 EES 01 30 2015 01 30 2015 sa Gp 0
66. mmonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 12 Provider Status 12 1 The Provider Status Information The Provider Status Information panel allows a user to view active provider status items from the provider file Select the provider NPI and Taxonomy combination or the KY Medicaid ID from the dropdown selection to view provider status information covered in this section e Identification panel is the provider s NPI and KY Medicaid provider number e Taxonomy panel is the effective and end date of each taxonomy associate to the provider e Group Practice panel is each individual provider effective and end dates linked to the group name if applicable KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Provider Status Information Wednesday 27 August 2014 08 09 am Provider e Switch Working Provider Identification Provider Number I Effective Date End Date 01 01 1978 12 31 2299 01 01 1978 12 31 2299 Taxonomy Taxonomy Effective Date End Date 01 01 1978 12 31 2299 Group Practice Group Name Effective Date End Date 11 01 1997 12 31 2299 05 01 1998 12 31 2299 11 01 2011 12 31 2299 03 01 2013 12 31 2299 e Annual Disclosure ADO panel displays the last ADO received by Provider Enrollment DMS Approved 10 6 2015 Page 100 Commonwealth of Kentucky MMIS
67. n to the facility 23 Admission Hour Enter the patient s hour of admission 24 Discharge Time Enter the time of patient s discharge 25 Co insurance Days Number of co insurance days Medicare Only 26 Lifetime Reserve Days Number of lifetime reserve days Medicare Only 27 EPSDT Indicates an EPSDT related service if applicable 28 Next Advance to the diagnosis screen DMS Approved 10 6 2015 Page 76 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 29 Print Allows user to print this screen 11 4 7 Billing Code Screens This portion includes separate screens accessed by clicking the appropriate links Diagnosis Procedure Condition Value Occurrence Span and Payer Be sure and click the save code button after entering the information on each screen Field by field instructions follow DMS Approved 10 6 2015 Page 77 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 8 Billing Codes Diagnosis KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 09 42 am Header Billing Information Service Information Claim Type Long Term Care Type of Bill 15 v From Date Thru Date Cove
68. odifier s which further describes the service performed 7 Units Enter number of units 8 Units of Measurement Enter units of measurement i e days 9 Charges Amount charged by the provider 10 Co pay The co payment deducted from reimbursement No information should be entered into this field 11 TPL Amount Enter amount paid by other insurance 12 Status Status of claim 13 Allowed Amount The amount allowed by Kentucky Medicaid paid claims only 14 Non Covered Charges Amount of charges not covered by Kentucky Medicaid 15 Units Allowed Number of units allowed 16 Paid Amount Amount paid by Kentucky Medicaid 17 Add NDC Enter the 11 digit NDC code This is currently only used by hospitals for outpatient services DMS Approved 10 6 2015 Page 91 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 18 Save Detail Saves the detail line on the claim 19 Add Detail Allows user to add an additional detail line 20 Delete Detail Allows user to remove the detail line previously entered 21 Next Advance to the next screen 22 Print Allows user to print this screen DMS Approved 10 6 2015 Page 92 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 10 Summary Screen The summary screen allows the user to verify the data entered KENTUCKY CABINET FOR HEALTH AND FAMI
69. orm 13 2 Billing Instructions www kymmis com 1 Click on Provider Relations 2 Click on Billing Instructions 3 Click on Provider Type DMS Approved 10 6 2015 Page 103
70. ount Status Active ap call e en Email Address ormal business hours 7 00 Address m 6 00 pm Monday Telephone 600 205 4696 niday EST Account Owner hp instit KYHealthnet hpinst Remove All Roles CA Select the system to modify access B Modify the permissions for KYHealthNet System Roles Select Account Management K I Card Issuance ble KYHealthNet a I Claims Inquiry I Claims Submission Dental IF Claims Submission institutional I Claims Submission Professional I KenPAC Referral Confidential Message Inquiry IF KenPAC Referral Confidential Message Submit IF KenPAC Referral Inquiry IF KenPAC Referral Submit W Eligibility Verification IT LTC Claims M PA Inquiry IT PA Submission I Pharmacy History I Presumptive Eligibility I Pricing M Ra Viewer TPL Carrier ECSCCCCECECECCCECCECEEEE Save Changes Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2007 Commonwealth of All rights re 4 Check the roles you wish to grant agent 5 Click the Save Changes button to save modifications DMS Approved 10 6 2015 Page 17 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The screen returns Successful adding role of Kentucky gov KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Ae om Manage Agent Roles KyHtealth Choices This page allows you to add and remove roles from the agent Begin by selecting the system in which
71. questions regarding this notification Medicaid Enterprise Users Provisioning System MO DMS Approved 10 6 2015 Page 10 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide From MEUPS Automated Mailer mailto MEUPS_DoNotReply email kymmis com Sent Wednesday August 18 2010 2 00 PM To Doe Jane Subject ACCOUNT CHANGE NOTIFICATION Sensitivity Confidential Kentucky user Jane Doe KyHealth Choices sends you this account change notification for your information No action on your part is required The following changes have been made recently against your systems account Date of Change Description Aug 18 2010 4 30PM Account access has been reinstated Aug 18 2010 1 32PM Password changed Please contact the EDI helpdesk at KY EDI HelpDesk hp com or call 800 205 4696 between 7 00 am 6 00 pm Monday Friday EST if you have questions about any of these changes KyHealth Choices DMS Approved 10 6 2015 Page 11 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 3 Viewing Agent Roles Provider Administrators and Billing Agents have the ability to add agents to an account giving them access to submit claims check claim status check eligibility or perform other functions on behalf of the provider Clicking View Agent Roles will allow a Provider Administrator or Billing Agent to see the Agents associated with an account If no Agents have been added No A
72. r Member Last Name To Date Ce Click the Search button below to find Carewise Prior Authorization Letters associated with your provider number When the Letter listing displays click the Letter to view the details 7 23 2014 PA SHPS Mem ID Name Prov ID Rev Type WAIVER Searches may be conducted by Provider or by using a specific Member ID DMS Approved 10 6 2015 Page 49 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 8 4 PA Inquiry 1 Select PA from the Menu 2 Choose PA Inquiry from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Checklist Radiol Prior Auth P Code List Monday 13 December 2010 11 19 d 0 09 Prior Auth roc S Prior Authorization Letter IPA Inquiry DME PA Smart Sheets Welcome to the Kentucky Medicaid s f Medicaid Services secure website is intended for providers clerks and billing agents Provider e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 50 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SE
73. re Code Enter the ICD CM procedure code 3 Date Enter the DOS that the procedure was done 4 Save Code Saves the procedure information on the claim Must save code to continue DMS Approved 10 6 2015 Page 81 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 Add Code Allows the user to add an additional procedure code to the claim Save code after each additional code entered 6 Delete Code Allows the user to remove a procedure code previously entered on the claim 7 Next Advance to the next screen 8 Print Allows user to print this screen DMS Approved 10 6 2015 Page 82 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 8 2 Billing Codes Condition KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institutional Claim Thursday 6 January 2011 10 14 am Header gt Billing Codes gt Detail gt Summary Billing Codes Diagnosis Procedure Condition Value Occurrence Span Paver Sequence Number 1 Condition Code Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selection 1 Sequence Number The
74. re proveder EREAS User renders certain professional health care services Services to members d employer groups and indmiduals and submits documentation af those Services to DMS nd EREAS OMS in its implementation of the Medicaid program in Kentucky provides to ealih care companies such as User a System of operational and informational support to espond to provider inquires to exchange Certain claims and billing information through lectronic communications and through the Internet hereinafer the System IEREAS while performing its semmces User may be given access to or may be exposed o Certain confidential or Indeidually Identifiable Health Information or Protected Health formation PHI as defined under the Health Insurance Portabilay and Accountability Act f 1996 HIPAA 45 Code of Federal Regulations Parts 160 164 and applicable egulations that implement Title V of the GrammLeach Bliley Act 15 U S C 6801 et seg he GLB Regulations IEREAS User desires to utilize the System provided by OMS and OMS desires to rovide the System and related services and support to User as defined and according to z Do vou aaree to the Terms of Service as stated above eem SE gaere ee es DMS Approved 10 6 2015 Page 15 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 5 Manage Agent Roles After an Agent is associated with a Provider account permissions or roles must be granted
75. red Days Discharge Time Co insurance Days Lifetime Reserve Days EPSDT Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 78 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMISJ Provider Home Member Claims PA Provider References Trade Files RA Viewer Institutional Claim Friday 25 July 2014 3 46 pm Header gt Billing Codes Billing Codes EE EEN Sequence Number 1 Feature available with ICD 10 implementation Diagnosis Diagnosis Code Principal e Present on Admission Indicator Last Updated 12 14 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selections 1 Sequence Number The sequence number of the diagnosis This field is auto populated 2 ICD CM Select the appropriate option 3 Diagnosis drop down Select the type of diagnosis i e Principle Admitting 4 Diagnosis Code Enter the appropriate code for the member s diagnosis Do not enter Decimal in Diagnosis code 5 POA Choose the appropriate POA indicator
76. revalidation dates Once you log on to KYHealthNet click on the Provider Status tab to access your file If you do not have access to KYHealthNet please visit http www chfs ky gov dms kyhealth htm for instructions on how to sign up for this feature If you have questions please contact the EDI Department at HP by email KY_EDI_HelpDesk hp com or by phone at 800 205 4696 DMS Approved 10 6 2015 Page 19 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 2 Select verify the Providers NPI Taxonomy in the drop down box KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Provider Main Page Thursday 29 January 2015 4 33 pm Welcome to the Kentucky Medicaid Website The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents Provider e e Claim Inquiry e Submit Professional Claim e Submit Institutional Claim e Eligibility Verification e Provider Status Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Would you like to start receiving paper PA Letters also NOTE The drop down only appears if the user is an agent for multiple providers otherwise the agent will see only one provider s NPl taxonomy in the box DMS Approved 10 6 2015
77. sclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 34 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Suspensions Disenrollments Address Mismatch Warning Please have the member call the Department for Community Based Services DCBS at 855 306 8959 or kynect at 1 855 4kynect 459 6328 to update their address Suspension Disenroliment Type Date Effective Date End I Suspended Incarcerated 08 15 2015 08 31 2015 A Eligible but Disenrolled Address Mismatch 07 01 2015 08 31 2015 W Address Mismatch Warning 06 01 2015 06 30 2015 Alert Individuals with an incarceration suspension Ind I or an address hold Ind A will not be eligible for claims payment or MCO enrollment If this information is incorrect have member call DCBS at 855 306 8959 or kynect at 1 855 4kynect 459 6328 Eligibility Eligibility 5 Year History Program Pov From Date of To Date of Eligibility Group Code Program Status ind Saran Sarnia KY Managed Care Organization P3 Newborn Child ett Bim XC Child be Be N 06 01 2015 08 31 2015 Copay Indicator From Date To Date N 06 01 2015 08 31 2015 Note POV_IND An N in this field indicates that the member is at or below 100 of the federal poverty level If the indicator is N you may not refuse to provide services for no payment of co pays If the indicator is Y you may refuse to provide
78. services for non payment of co pays if this is the current business practice for all patients Please note that the Medicare Savings benefit package which includes QMB program code Z SLMB program code ZL and QI1 Program code ZJ is not full Medicaid coverage This benefit package is for members who have Medicare and KY Medicaid pays their Medicare premiums Of this group those with Program Code Z or QMB are also eligible for co pays and deductibles DMS Approved 10 6 2015 Page 35 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 5 3 View Pharmacy Claim History 1 Select Member from the Menu 2 Choose Pharmacy History from the drop down KENTUCKY K CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issuance Provider Main Page Mond y 13 ceed Eligibility Lee 4 Pharmacy History Patient Liabili Rina Tees site The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 DMS Approved 10 6 2015 Page 36 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home
79. son Name Ordering Provider Contact Person Phone E J Facility Name Facility s Medicaid Number Facility Contact Person Name Facility Contact Person Phone Ss ll Clinical Criteria Procedure Codes po e DMS Approved 10 6 2015 Page 44 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 8 2 Radiology Prior Authorization Procedure Code List 1 Select PA from the Menu 2 Choose Radiology Prior Auth Proc Code List from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Checklist Monday 13 December 2010 11 16 qa Prior Authorization Letter PA Inquiry DME PA Smart Sheets Welcome to the Kentucky Medicaid f Medicaid Services secure website is intended for providers clerks and billing agents Provider e Claim Inquiry e Eligibility Verification Last Updated 9 15 2010 A PDF version of the Radiology Prior Authorization Procedure Code List will appear DMS Approved 10 6 2015 Page 45 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Revised KyHealth Choices Radiology Codes Requiring Prior Authorization Effective September 15 2006 70540 Magnetic resonance eg proton imaging orbit face and neck without contrast material s 70542 Magnetic resonance
80. t Oe sinatea Due v Medicare TPL aE Medicaid Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selection 1 Sequence Number The sequence number of the Payer This field is auto populated 2 Payer Code drop down Select the appropriate code Medicare TPL or Medicaid 3 Prior Payment TPL private insurance payment not Medicaid not Medicare 4 Estimated Due Enter the estimated amount due 5 Save Code Saves the occurrence code information on the claim DMS Approved 10 6 2015 Page 88 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 6 Add Code Allows the user to add an additional occurrence code to the claim 7 Delete Code Allows the user to remove an occurrence code previously entered on the claim 8 Next Advance to the next screen 9 Print Allows user to print this screen DMS Approved 10 6 2015 Page 89 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 4 9 Detail Screen KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Institu
81. te Date of Service A search for claim using the dates of service entered or Unfinished claims A claim not completed but saved for future submission DMS Approved 10 6 2015 Page 66 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 2 Submitting LTC Roster 1 Select Claims from the Menu 2 Choose LTC Roster Submittal from the drop down KENTUCKY L CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Claims Inquiry Main Page Sao ary 201 ee a ae S 4 Claims Submission Professional Claims Submission Institutional Welcome to the Kentucky DRG Letter epartment of Medicaid Services secure website is intended for and billing agents Claim Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Claim Eligibility Verification Non activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Last Updated 9 29 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 67 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide 11 3 Verify Provider Box 3 Verify the correct NPI and taxonomy display 4 Click Next KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MA
82. tional Claim Tuesday 24 August 2010 12 28 pm Header gt Billing Codes gt Detail gt Summary Detail Information Ttem fi From DOS c3 To DOS O rs Revenue HCPCS rQ Fan feat begeger Code Ji Rates RE rO SE Units of F 8 Units 0 00 Me SE DA Day ao TPL 0 00 Co Pay biet Amount Non Allowed Km Se Q pce 0 01 Covered 0 00 Charges Last Updated 7 1 2010 Contact Us Privacy Disdaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Field Number Definition of Field Description Menu Selection 1 Item Line number of the detail This field is auto populated 2 From DOS Enter the first date the services were provided The indicates that this field is required 3 To DOS Enter the last date the services were provided The indicates that this field is required 4 Revenue Code Enter the four digit revenue code which identifies the service provided the first digit will be a zero DMS Approved 10 6 2015 Page 90 Commonwealth of Kentucky MMIS KyHealth Net LTC Companion Guide Field Number Definition of Field Description Menu Selection 5 HCPCS Rates Enter the procedure code which further identifies the service provided For all out patient claims 6 Modifiers Enter the appropriate two digit m

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