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Professional User Manual

1. Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Auto populated from detail line charges TPL Amount Enter any amount paid by private insurance not Medicare Total Amount Paid This is auto populated after claim is adjudicated Carrier Denied Drop down for yes or no Co pay Amount Will auto populate after claim is adjudicated Advance to the diagnosis screen Allows user to print this screen DMS Approved 10 6 2015 Page 76 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 3 Billing Code Screens Diagnosis Diagnosis codes for all claim services will be entered on this screen 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 A Professional Claim Friday 25 July 2014 3 46 pm Header gt Billing Codes gt Diagnosis Codes Diagnosis Anesthesia Condition he Feature available with ICD 10 Sequence Number Q implementation Principal 5 Add Code Last Updated 12 14201 Copyright amp 2005 Commonwealth of Kentucky Wacy Disclaime dividuals with Disabilities Pri Disclaimer Individuals with Di ilitie All rights reserved 11 2 3 1 Professional Claim Diagnosis Screen Field Descriptions 2 Sequence Number The sequence number of the diagnosis This field is auto populated IC
2. Provider Status LTC Claims PA Inquiry PA Submission Pharmacy History DMS Approved 10 6 2015 Page 18 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Jane Doe Welcome to KyHealth Choices Applications Application Description agement Manages contact information password and authorizations for applications KY HealthNet 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 ia KY Health Net through https home_kymmis com home Select PA fram 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
3. KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout 4 DME Prior Authorization Smart Sheets Monday 13 December 2010 11 29 am Above Knee Prosthetics Microprocessor Controlled Knee General Above Knee Prosthetics General Above Knee Prosthetics Senior Aerosol Delvery Devices General Aerosol Delivery Devices Senior Ausmentative and Alternatrve Communication Devices General Auementatrve and Alternate Communication Devices Senor Below Knee Prosthetics General Below Knee Prosthetics Senior Bone Growth Stimulators Noninvasive General Bone Growth Stimulators Morninvasive Senior Continuous Passive Motion Device CPM Knee General Continuous Passive Motion Device CPM Knee Senior Continuous Passive Motion Device CPM Upper Extremity General Cramal Remodeling Orthosis General Diabetic Shoes Orthosis General Diabetic Shoes Orthesis Senior Hearing Aids General lome Oxygen Therapy General lome Oxygen Therapy Senior ospital Beds General ospital Beds Senior nsulin Pump Ambulatory General asuln Pump Ambulatory Senior ower Extremity Orthotic Devices Ankde Foot Orthoses General ower Extremity Orthotic Devices Ankle Foot Orthoses Senior ower Extremity Orthotic Devices Knee Braces General ower Extremity Orthotic Devices Knee Braces Senior vmphedema Compression Devices General vmphedema Compression Devices Senior Manual Wheelchairs General Manual Whee
4. 2005 Commonwealth of Kentucky Ali noms reserved Privacy Disclaimer indmiduals wit Disabiities 11 3 1 Adjust Void Field Descriptions To adjust a paid claim make the correction and click save when a save button is available To reverse a paid claim click on Void Allows user to print this screen DMS Approved 10 6 2015 Page 94 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 12 Supplemental Claims 12 1 The Supplemental Claims display of encounter data The Supplemental Claims page allows Primary Care Center provider type 31 and Rural Health Center provider type 35 providers to view additional supplemental claim data The page will display the encounter or encounters that generated the supplemental claim along with the MCO Paid Amount Calculated Medicaid Allowed Amount and TPL Amount for the encounter s Users can click on the ICN of the encounter s to view additional information for that encounter KENTUCKY 1 CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member ETE PA Provider References RA Viewer Logout Claims Inquiry Main Page Monday 1 July 2013 1 28 f Claims Submission Professional Supplemental Claims epartment of Medicaid Services secure website is intended for and billing agents Welcome to the Kentuck A a came Provider Switch Working Provider You currently receive paper and electr
5. Copyright 2005 Commonwealth of Kentucky All rights reserved 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 or e Start date is required with all search criteria DMS Approved 10 6 2015 Page 54 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Ry MEDICAL MANAGEMENT INFORMATION BYSTEN KYNAN Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Inqui Friday 20 August 2010 12 27 pm Provider Transaction Member __ PA ID ID Category SSN Last Name rst Name Start Date 07 07 2009 73 Type Submitted v Lransection iD Member MD Last Nome Hrs Nome PA Category Inpatient Hospital Last Updated 7 1 2010 Copyright 2005 Commonwealth of Kentucky All nights reserved Privacy Dinclaimer Indmidvals with Disabilities 1 Selecting Search returns the Transaction ID 2 Click to open the PA 3 Click on the next button to view the Summary page DMS Approved 10 6 2015 Page 55 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES OY MECCA MANAGEMENT ENFOMMA TION SYETOH EYHMHES PA Provider References RA Viewer Logout PA Summary Provider Home Member Chim Friday 20 August 2010 12 29 pm Head
6. KENTUCKY k 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 FEET a a5 11 Radiology Prior Auth Proc Code List Friday 16 January 2015 11 25 am naa EA CareWise Prior Authorization Letter PA Inquiry Welcome to the Kentucky Medicaid on cmart Sheets Medicaid Services secure website is intended for gents Provider 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 ld s require renewal of their Annual Disclosure of Ownership Provider ID Provider Name Due Date Submit Dental Claim Submit Professional Claim Submit Institutional Claim Eli it ili cali Provider Status DMS Approved 10 6 2015 Page 53 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Prior Authorization Inquiry Wednesday 18 August 2010 4 03 pm Provider v Transaction Member E PA ID ID Category SSN Last Name First Name Start Date a Type Submitted v Last Updated 7 1 2010 Contact Us
7. Provider Home Member Claims PA Provider References 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 I D Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information Lockin History Provider Name Provider Phone Service Type Effective LOCK IN MEDICAL 02 01 2009 05 3 07 LOCK IN PHARMACY 05 01 2005 05 31 2009 Last Updated 6 10 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 34 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY 7 CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL 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 1 D Last Name First Name SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information No Rows Found Last Updated 1 22 2013 yu a Onn Y rv o nba lion Privacy Disclaimer Indmduals with Disabilities Copyright 2005 Commonwealth of Kentucky f All rights reserved DMS Approved 10 6 2015 Page 35 Commonwealth of Kentucky MMIS KyHealth Net Professiona
8. CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 9 December 2011 08 49 am gt Billing Codes gt Detail gt Summar Service Information From Date 10 01 2011 To Date 10 01 2011 Accident Accident WN Date EPSDT N Claim Charges Total Charges 0 00 9999999999 Member ID 0000000000 Last Name DOE First Name JIM Date of Birth 05 13 1998 TPL Amount 0 00 Gender M Total Amount Paid Patient Acct Carrier Denied N Co Pay Amount 0 00 Diagnosis Codes Medicare Paid Date 10 30 2011 Net Amount 0 item Diagnosis Code 1 V222 5 Details item From DOS TO DOS Procedure Code Units Balled Charges 10 01 2011 10 01 2011 99213 1 00 0 00 Medicare Details WY Allowed Amount Comsurance 0 00 0 00 Submit Claim Last Updated 11 4 2011 11 2 9 1 Summary Screen Field Descriptions A ii this as the Summary screen DMS Approved 10 6 2015 Page 91 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 2 filling Information Identifies this section as the Billing Information section of the Summary screen Service Information Identifies this section as the Service Information section of the Summary screen Claim Charges Identifies this section as the Claim Charges section of the Summary screen Identifies this sec
9. 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 aa 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 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 15 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 Professional Companion Guide The following screen will appear Kentucky gov rch Advanced Search KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS kymimis gt Provider Relations Index Kentucky de Provider Resources Provider Relations is the first line contact for medical provider s ee questions The area consists of trained skilled staff who respond to both written and telephonic inquiries MS Please refer to the DM5 Provider Enrollment website for Presumptive Eligibility Li 2 specific forms and documentation required for enrollment Provider Letters The Provider Relations area is
10. Claims Click on Frequently Asked Questions 2 3 Read What is KYHealthnet 4 Click on link for PIN Release Form 13 2 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 KyHealth Net Professional Companion Guide Page 102
11. 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 fanww chfs ky gowdms provEnr 10 30 2014 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 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 govw dms kyhealth htm or instructions on how to sign up for this feature If you have questions please contact the EDI Department at HP by email K Y EDI HelpDesk hp com or by phone at 600 205 4696 DMS Approved 10 6 2015 Page 19 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 2 Select verify the Provider s NPI Taxonomy in the drop down box KENTUCKY CABINET FOR HEALTH AND FA
12. MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 6 February 2015 1 30 pm Last Updated 2 3 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 73 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 2 Professional Claim Header The claim Header information appears on this screen divided in sections The section on the left is the Billing Information the top right contains the Service Information and the section on the bottom right has the Claim Charges Please follow the provider type Billing Instructions for detailed field by field instructions Appendix A includes a website link for all Medicaid Billing Instructions 11 2 2 1 Professional Claim Header Screen Field Descriptions KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 9 December 2011 08 30 am Header Billing Information Service Information Provider TO Clai Number v pe erica ma Member ID 6 Ol a To i ate E Date 0 Last Name O atch e Accident First Name uE MEA Date Da Date of Birth EPSDT v y Gender ra Claim Charges Ph
13. MMIS KyHealth Net Professional Companion Guide 11 2 7 Detail Screen Ambulance Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 9 December 2011 08 44 am Header gt Billing Codes gt Ambulance gt Detail gt Summary Ambulatory Logistics Specifications Pick Up Information Time of Pick Up TO Pick Up Address 1 BY Pick Up Address 2 BY ci OO State Zip Code O Drop Of Information Drop Off Address 1 O Drop Off Address 2 oOo City State Zip Code Last Updated 11 4 2011 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved 11 2 7 1 Professional Claim Ambulance Detail Screen Field Descriptions Time of Pick Up O oe the military time of pick up PE ter the physical address where the member was picked up DMS Approved 10 6 2015 Page 87 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Enter the physical address where the member was picked up City Enter the city where the member was picked up Enter the state where the member was picked up Zip Code Enter the zip code where the member was picked up Drop Off Address 1 Enter the physical address where the member was dropped off Drop Off Address 2 Enter the physical address where the member was dropped off City Enter the city where the member
14. PERLAPICAL FIRST 0110712010 Vision Ultra Sound No Rows Found EPSDT Procedure Code Description Date of Service PREY VISIT EST AGE 5 11 06 28 2011 EYE EXAM ESTABLISH PATIENT 02 01 2011 DENTAL PROPHYLAXIS CHILD 10 07 2010 DENTAL PROPHYLAXIS CHILD 0329 2010 EYE EXAM ESTABLISH PATIENT 01 29 2010 PREV VISIT EST AGE 5 11 01 25 2010 DENTAL PROPHYLAXIS CHILD 07 50 2009 PREY VISIT EST AGE 5 11 01 22 2009 EYE EXAM ESTABLISH PATIENT 10 06 2008 DENTAL PROPHYLAXIS CHILD 0710 2008 Outpatient Rehab Therapy Corman amp 2005 Camnranwealin of Kaiti ha i All rights reserved DMS Approved 10 6 2015 Page 32 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES A KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout TPL 5 Year History Monday 4 February 2013 10 18 am 1 D Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information TPL History No Rows Found Last Updated 1 22 2013 Contact Us Privacy Disclaimer indmwiduals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Prov
15. 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 print or save RA report details Report Name Provider Run Date Load Date Number 01 30 2015 RA Payee ID RA 13330073 NPL SEQ 01 23 2015 RA Payee ID RA 13323871 NPL SEQ 01 16 2015 RA Payee ID RA 13317889 NPL SEQ 01 092015 RA Payee ID RA 13311782 NPL SEQ 01 02 2015 RA Payee ID RA 13306060 NPL SEQ 12 26 2014 RA Payee ID RA 13300108 NPL SEQ 12 19 2014 RA Payee ID ma 13293812 NPL 12 19 2014112 22 2014 12 12 2014 RA Payee ID RA amp 13287424 NPL SEQ 12 05 2014 RA Payee ID RA 13281243 NPL SEQ 11 28 2014 RA Payee ID RA 13274847 NPE SEQ 1 30 2015 2 2 2015 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 12 2014 12 14 2014 12 5 2014 12 6 2014 DMS Approved 10 6 2015 Page 69 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 Claims 11 1 Claim Inquiry 1 Select Claims from the Menu 2 Choose Claims Inquiry from the drop down KENTUCKY s 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
16. Services secure website is intended for providers clerks and billing agents Patient Liability Spend Down Provider v Switch Working Provider Claim Inquiry Submit Professional Claim Submit Institutional Claim Diba Verificalioa 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 Professional Companion Guide 3 Enter the Member ID or SSN and click the Search button to find the Medicaid 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 MemberID SSN Search Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky 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 Professional Companion Guide Provider Home Member Claims PA Provider References RA Viewer Logo
17. available for service 8 00 a m until UU a wt h Fridav 6 00 p m ET Monday through Friday ee A EELE Provider Billing Instructions i ugu st 16 201 KY Health Net user manuals New Provider Rep Department for Medicaid Services Phone Directory Provider Directory Provider Relations Electronic Claims sala H a 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 66 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Provider oy 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 Claim Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Claim Eligibility 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 Last Updated 8 11 2014 DMS Approved 10 6 2015 Page 67 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guid
18. b 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 Ca Search Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved 3 Enter the procedure code and date of service 4 Select the Eligibility Group and click Search The response will return the Limitation for the date of service DMS Approved 10 6 2015 Page 60 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Search Eligibility listed does not guarantee payment of a claim Wednesday 8 January 2014 341 pm Provider Choose Search Type Procedure Code Procedure Code 99213 Eligibility Group CCEBA Compr Chces Exp Pop Bas ABI Date Of Service 08 01 2010 Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 N
19. date of service 08 01 2010 No PA Required Age Restriction 0 999 Maximum Units 999 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 Last Updated 12 14 201 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright amp 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 62 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 EEN Monday 13 December 2010 11 32 am 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 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 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DM
20. e Eligibility Verification Last Updated 9 15 2010 DMS Approved 10 6 2015 Page 42 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 a 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 Copyright 2005 Commonwealth of Kentucky i All rights reserved KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES A PEE DAT PLA PLU GYE TEE ae Provider Home Member Claim PA Provider Relerenosa RA Viewer Logout Spend Down Friday 20 August 2010 12 21 pm Member ID SSN DOB 07 04 1966 Member ID D0D 09 04 2009 Same Spend Down End Date Around Balance 04 30 2009 396 52 3376 52 07 31 2009 53 915 00 50 00 10 31 2009 53 915 00 50 00 Last Updated 7 1 2010 Privacy Disclaimer indhiduals with Disabilities Copyright 2005 Commonwealth of Kentucky Al nights rin 0rnvod DMS Approved 10 6 2015 Page 43 Commonwealth of Kentucky MMIS KyHealth Net Professional C
21. or Unfinished claims A claim not completed but saved for future submission DMS Approved 10 6 2015 Page 71 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 Submitting Professional Claim 1 Select Claims from the Menu 2 Choose Claims Submission Professional 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 Claims Inquiry Main Page mAn i December 2010 Claims Submission Dental Claims Submission Institutional LTC Roster Submittal Welcome to the Kentuck a aE epartment of Medicaid Services secure website is intended for DRG Letter wr and billing agents Provider v 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 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 72 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 1 Verify Provider Box 3 Verify the correct NPI and taxonomy display 4 Click Next KENTUCKY b CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL
22. 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 hp com DMS Approved 10 6 2015 Page 2 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 1 5 2 Using the PIN to Create a New Account 1 Enter the provider ID 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 email us at K _EDi HelpDeski gt hp com or call 800 205 4595 dunng Kytteai
23. 012 a ate ET 10 222012 11012012 12 01 2012 Regular KISS No 09 19 2012 10012012 11 012012Regular KISS No osa 09012012 100102 KISS No van oa oa Reg KISS No 06202012 07012012 08 01 2012 Regala KISS No 052120 06012012 07 01 2012fRegular KISS No 04 19 2012 05012012 06 01 2012 fRegular KISS No 03212012 04012012 _ 05 012012Regular KISS No DMS Approved 10 6 2015 Page 24 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Card Issuance Eligibility Verification MCO Member Information Logout Member Links Last Updated 8 11 2014 Copyright 2005 Ci Commonwea alth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 25 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Provi
24. 459 6328 Eligibility Eligibility 5 Year History Program Pov From Date of To Date of Eligibility Group Code Program Status ind Service Service KY Managed Care Organization P3 Newborn Child m1 viinat Co De XC Child S ae 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 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 37 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 5 3 View Pharmacy Claim History 1 Select Member from the Menu 2 Choose Pharmacy History from the drop down KENTUCKY 3 CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Card Issu
25. A Ee Tt Select a security question from the list below and provide an answer that you will remember This Question ill help the Help Desk verify your identity if you need assistance Chine Ei oth In what city wer you born Enter fal name of city grily Answer Hartat r iiae pepe feed Peri Contact Ls DMS Approved 10 6 2015 Page 4 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The Your account was successfully created window will display Kentucky gov KENTUCKY l CABINET FOR HEALTH AND FAMILY SERVICES Kentucky 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 Of assistance ema us a Sign In KY_EDI_HelipDeskibhp com 5 2006 Commonweatyr af ent ch y All nghts reserved DMS Approved 10 6 2015 Page 5 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 2 Signing into KyHealth Choices 2 1 Sign into KyHealth Choices 1 Access https nome kymmis com 2 Enter the username and password KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES DEPARTMENT FOR MEDICAID SERVICES eee Sign in to the KyHealth Choices Sign in to KyHealth Choices e Manage your contact information e Change your password e Providers Manage your agents access Password Username For assi
26. A pink banner will display on the Home page showing the days remaining to password expiration beginning 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 ge KENTUCKY CABINET FOR HEALTH ANO FAMILY SERVICES Close Applicaton ee eet Change Password KyHealth Choices Fill out the form below to change your password Your new password must Kentucky Medicaid Web Site Have a length of at least 8 characters Contain at least one number or assistance email us at Contain both lower and uppercase letters KY_EDI_HelpDeskiBhp com or call 800 205 4696 during senal business hours 7 00 Old Password m 6 00 pm Monday New Password nday EST New Password vary Cancel Change Password 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
27. D Version Feature available with ICD 10 implementation Diagnosis drop down Select the type of diagnosis i e Principle Other 1 MO the appropriate ICD version DMS Approved 10 6 2015 Page 77 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Enter the appropriate code for the member s diagnosis Do not enter Decimal in Diagnosis code Save Code Saves the diagnosis information on the claim Must save to continue Add Code Allows the user to add an additional diagnosis code to the claim Save code after each additional code added Delete Code Allows the user to remove a diagnosis code previously entered on the claim Advance to the next screen Allows user to print this screen DMS Approved 10 6 2015 Page 78 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 4 Billing Code Screens Anesthesia KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout i Professional Claim Friday 9 December 2011 08 33 am Header gt Billing Codes gt Detail gt Summary Anesthesia Related Procedure Codes Diagnosis Anesthesia Condition Sequence Number FO Anesthesia Code FO Add Code Delete Code Last Updated 11 4 2011 _ Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth o
28. EDI_HelpDeekibhp com or call 800 205 4696 dunng ormal business hours 7 00 6 00 pm Monday nday EST Kentucky Terms of Service You must agree to the terms below before delegating permissions USER AGREEMENT is User Account Agreement hereinafter Agreement effective today ts made by and etween the Commonwealth of Kentucky Cabinet for Health and Family Sernces CCHFS epartmem of Medicaid Semces DMS and users who sign up for an account on this bette hereinafter User the aforementioned being a bcensed health care provider or an ntty who acts on behalf of a licensed health care pronder EREAS User renders certain professional health care services Serices to members f employer groups and indmduals and submits documentation of those Sermces to DMS nd EREAS DMS in fs implementation of the Medicaid program in Kentucky prowdes to esih care companies such as User a System of operational and mformational support to espond to prowder inquines to exchange certain clans and bling information through lectronic Communications and through the Internet nereinafer the System EREAS while performing Rs semces User may be given access to or may be exposed o Certain Confidential or indendually Identifiable Health Information or Protected Health formation PHI as defined under the Health Insurance Portability and Accountability Act f 1995 CHIPAA 45 Code of Federal Regulations Parts 160 164 and appli
29. 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 Select Lookup Type _ Service Type Emergency Services Member ID Lookup Family Planning Health Plan Coverage bo Member ID From Date of Service 09 21 2015 Cal To Date of Service 09 21 2015 Taj Verification No cc940dfa06 9 21 2015 Status Non Active Print Error code 05 Recipient ID missing or not on file Last Updated 3 28 20158 Contact Us Copyright 2005 Commonwealth of Kentucky All nghts reserved Privacy Disclaimer Individuals with Disabilities DMS Approved 10 6 2015 Page 28 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide When the link under Eligibility Group is selected a new window displays the service types KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Service Type Coverage Wednesday 8 January 2014 334 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 KY Managed Care Organization Program with no copay Date Co Co Base Deducti
30. GEMENT 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 915 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 Amount Type of Liablility 01 01 2006 12 31 2299 LTC Long Term Care View 02 01 2005 12 31 2005 LTC Long Term Care View Last Updated 11 24 2009 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 41 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 7 Spend Down 1 Select Member from the Menu 2 Choose Spend Down 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 Card Issuance Provider Main Page Monday 13 Decs Eligibility rover Pharmacy History Patient Liabili Welcome to rre ny site The Kentucky Department of Medicaid Services secure website is intended for providers clerks and billing agents e Claim In iry
31. Kentucky UNBRIDLED SPIRIT rm Commonwealth of Kentucky KY Medicaid KyHealth Net Professional Companion Guide Version 3 9 September 24 2015 Revision History 04 27 2010 Created 06 09 2010 Suzanne Willson Revised per request Ron Chandler 06 10 2010 Suzanne Wilson Removed PHI from images Ron Chandler 10 8 2010 Stayce Towles Updated 10 5 2010 Stayce Towles Revised Ron Chandler 10 14 2010 Stayce Towles Revised Ron Chandler 10 18 2010 Martha Senn DMS approved 10 18 2010 Ron Chandler 12 08 2010 AS aeea corrections and changes 12 09 2011 Brenda Orberson Updated screen shots Ann Murray 12 15 2011 Pg 90 field 14 changed EPSDT Family Planning to EPSDT 02 14 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 Update to Adjusted Primary Care Attestation information by provider type 03 04 2013 Keri Hicks Finalized Tech Writer Updates DMS Approved 03 01 2013 6 20 2013 Martha Senn CO 19925 Update to Adjusted Primary Care Attestation screen shot eligibility period for adjusted rates CO 20055 Lockin comment If member has MCO eligibility jeanne vam Fal DMS approved 7 1 2013 2 4 7 3 2013 Martha Senn CO 19849 Supplemental cl
32. MILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer EFT Logout Provider Main Page Wednesday 24 June 2015 2 56 pm Notice to all providers The electronic funds transfer EFT update function via KYHealth Net will be disabled on March 6 2015 In order to update your EFT please contact provider enrollment at 1 877 838 3085 for further instructions We apologize for any inconvenience 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 Clam Inquiry Submit Dental Claim Submit Professional Claim Submit Institutional Clam SE dhe Verificati e Provider Status Last Updated 4 30 201 NOTE The drop down only appears if the user is an agent for multiple providers otherwise the agent will see only one provider s NPI taxonomy in the box DMS Approved 10 6 2015 Page 20 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 wo
33. Monday Friday EST Po _ Search Contact Us Privacy Disdalmer Individual Ah Disabilaias Copyright SOT Commonwealth of Fa tudo 20 night rarerced DMS Approved 10 6 2015 Page 12 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 agent 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 4 Manage Agent button Cisse Apphegton AAA A A Add Agent KyHealth Choices Use this screen to add access to an agent for your appication Kentucky Medicaid Web site Enter the email address of the agent you are adding access to your application and click search Of asentarse emad ys a Y_EDLHelpDesk hp com _Search or call G00 206 4696 ding peral business teers 700 An agent with the email address you specified was not found in the system Please verify that the address is correct Fill out the fields below with the agent s information to create a new agent account in the system Email Address fhprest v 10 205 453 u Ad amp Manage Agent DMS Approved 10 6 2015 Page 13 Commonwealth of Kentucky MMIS KyHealth Net Professiona
34. N MUMD OMe i e a a a a 2 1 5 2 Using the PIN to Create a New Account occcccoocccncccccnccnnccccnoncnnncnnnancnnnonnnnncnnnnonanncnnnnnnnas 3 SIGNING into KyHealth CHOICES srie dida ica 6 21 SIMMO KyHe alt GNOICES nica ii 6 2 2 ACCESSING USEF APPIICAUONS nnen A AN e EA bi 7 2 2 1 HOWTO Change tne Password iinan NS 10 2 2 2 Email examples of password reminder and account change notification 10 20 VIEWINO Agent ROOS aia di a AA 12 24 Add anAdent or NeW Employees ui ence wile aa eee 12 2 4 1 No Email Address Found Create USErname cccccsseeccceecseeeceeecaeeeeeeeseaeeeeeeesaaees 13 20 Manage Agen ROES a a o LD NU 16 ACCESSING KY Health NOU uosicontia ion o ocacion alciios cid 19 FUNCUON AM aaa aid 21 Memberinto Mal ciar aR 22 5 1 Member Card ISSUANCE idad 22 5 2 Member BHigibDINY Veriticatlom ii 25 5 2 1 Searching for a Member ooocccccoocccncoccnoccnnccononncnnnnononnnnnonnnnncnnnnonnnnrnnnnnnnnnrnnnnonannrnnnnnnnaness 26 5 2 2 Member Eligibility Suspension DisenrollMent oocccccccccncnnncccconnnnncnnnancnnnonnnancnnononons 36 5 3 View Pharmacy Claim History oocccccconnnnccnoncnccnnncnnnnnnnononnonnnnnnncnnonnnnnnnnnrnnnnnnnrnnnnnnrnnnnnarnnnnnanennss 38 A A A E 40 PENA DOWN iaa 42 PA Prior AUTNOFIZATIO N iii AA A A A A AA AAA ad 44 Gal PROF AUMorizali n necia da iS 44 8 2 Radiology Prior Authorization Procedure Code LiSt oocccoonnnccccccnoncconcconnnccnncnonanccnncnonanccnnnn
35. Page Frid y 17 December 2010 Claims Submission Dental Claims Submission Professional Claims Submission Institutional LTC Roster Submittal Welcome to the Kentucky ans a ross 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 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 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 70 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYHMIS Provider Home Member Claims PA Provider References RA Viewer Logout Claim Inquiry Friday 17 December 2010 2 25 pm Provider Refresh Unfinished Claims search Criteria Member ID Claim Status Patient Acct Date Type Date PE O Warrant Date ICN or TCN From Date 12 10 2010 Thru Date 12 17 2010 3 Select the applicable NPI and Taxonomy if using an agent or billing agent account ICN Enter ICN and remove From Date Thru Date Date of Service A search for claim using the dates of service entered
36. S Approved 10 6 2015 Page 17 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The screen returns Successful adding role of Manage Agent Roles This page allows you to add and remove roles from the agent Begin by selecting the system in which you want to view or modify the Agent s access y Successful adding Card Issuance role for system KYHealthNet Successful adding Claims Inquiry role for system KYHealthNet Successful adding Claims Submission Institutional role for system KYHealthNet Successful adding Eligibility Verification role for system KYHealthNet Successful adding Ra Viewer role for system KYHealthNet Agent Details Name Jane Doe Account Status Active Email Address janedoe yahoo com Address Telephone Account Owner select the system to modify access Modify the permissions for KYHealthNet System Roles Select Account Management Card Issuance Select Electronic Prior Authorization E Select KYHealthNet y Claims Inquiry Magellan Web Portal Claims Submission Dental Select Magellan Web Portal resource partner URI Claims Submission Institutional Claims Submission Professional KenPAC Referral Confidential Message Inquiry KenPAC Referral Confidential Message Submit KenPAC Referral Inquiry KenPAC Referral Submit W Eligibility Verification Electronic ADO Electronic EFT
37. S Approved 10 6 2015 Page 63 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The following screen will appear KENTUCKY t 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 rivacy 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 FRANKFORT KY 40601 FIRST HEALTH CARRIER FRANKFORT KY 40601 FRANKFORT KY 40601 Last Updated 7 1 2011 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 64 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 9 3 Provider References Documentation 1 Select Provider References from the Menu 2 Choose Documentation from the drop down KENTUCKY J
38. aim inquiry for Primary Care and Rural Health Providers 2 fA 5 2013 Maagen INW eligibility screens with ACA changes a Para O for PE and Eligibility Group pe pe a Screen Shots for Eligibility Group oe pare Redmon RI Attestation Form per CO 19856 lt lt ae 4 Martha Senn ee ee O l to screen shots a 4 Martha eo Updates to PA screen shots and name billing codes fee 4 Martha A oe DMS ae S 3 i 4 Martha tation sm 22265 and 22673 Provider Status Information screen shots ae 4 Martha Senn DMS approval 12 16 2014 Martha Senn CO 23838 removal of Attestation screenshots DMS approved 12 19 2014 2 11 2015 Martha Senn Updates to screen shots removal of ADO and EFT DMS approved 3 31 2015 Pw 5 Martha Senn Removal of PE screen shots _ oo 5 Martha Senn Removal of BCCTP screen shots 3 8 8 28 2015 Martha Senn Update screen shots for Suspension Disenrollment status pages 36 and 37 3 9 9 24 2015 Martha Senn Updated eligibility verification screenshots for CO 25433 DMS approved 10 6 2015 10 11 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Table of Contents ss A vhaancavobunteaadeussPaibinsacsacbaaniuvedsnoexaveanetertiaadavauiuantaieduncesatierstaweinacn 1 Wl O O E AA 1 12 HOW CO MUSE MISS SOMA vi elena II O IES 1 13 Waris a Provider Admi IO us ie O A Wien 1 144 VV Flat Sel BIMI AGEM A s a a a a a C eE 1 To Whatisa PIN UMD rta a a a e e Qoddomechatcbeds 2 1 5 1 HOwtooDtain a RI
39. aimer Individuals with Disabilities ages All rights reserved The new Supplemental Claims panel will allow the provider to click on each encounter ICN and it will pull up the matching encounter in KYHealth Net so that they can see additional data from the encounter Please note these are the standard KYHealth Net claims panels and nothing has been changed added to these panels KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout a Professional Claim Monday 1 July 2013 1 35 pm Header gt Billing Codes gt Detail gt Summary Clam Status Paid Clam ICN Paid Date 20130402 Allowed Amount 0 00 Spenddown Amount Header EOB Description 4420 MEMBER MANAGED CARE REGION CODE MISSING EOB Description CUTEACK DUE TO HMO PAYMENT 16 PRICING ADJUSTMENT PROVIDER SPECIFIC PER DIEM RATES APPLIED Description CLAIM DENIED PROCEDURE NDC CODE INVALID FOR DATES OF SERVICE PRICING ADJUSTMENT ZERO PAID PRICING APPLIED PRICING ADJUSTMENT BUNDLED RATE PRICING APPLIED Click here for EOB Code listing DMS Approved 10 6 2015 Page 96 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Service Information Claim Type Medical From Date 12 11 2011 To Date 12 11 2011 Last Updated 6 21 201 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Comm
40. al provider is part of the Group Provider Practice a link is available in the Identification section allowing the user to view active providers KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Provider Status Information Friday 15 August 2014 10 48 am Identification Name Provider Number ID Type National Provider ID Effective Date 02 01 1978 End Date 12 31 2299 Providers that participate in Group Practice The user will click on the link allowing access to the Group Practice KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Providers That Participate in Group Practice Friday 15 August 2014 1 34 pm Group Practice CENTRAL KY MEDICAL GROUP PSC Provider Name Effective Date End Date 12 10 1996 05 01 1994 09 01 2001 05 01 1994 05 01 1994 05 01 1994 12 31 2299 12 31 2299 12 31 2299 12 31 2299 12 31 2299 12 3 1 2299 Last Updated 8 1 1 2014 Copyright 2005 Commonwealth of Kentucky All rights reserved Privacy Disclaimer Individuals with Disabilities DMS Approved 10 6 2015 Page 101 Commonwealth of Kentucky MMIS Appendix A 13 2 1 Forms Website link for blank PIN Release form www kymmis com 1 Click on Electronic
41. ance Provider Main Page Monday 13 Dece Eligibility Verification Patient Liability site The Kentucky Department of Medicaid Services secure website is intended for Spend Down providers clerks and billing agents Provider e Clam Inquiry e Eligibility Verification Last Updated 9 15 2010 DMS Approved 10 6 2015 Page 38 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 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 Last Updated 9 1 5 2070 Copyright amp 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities dela All rights reserved 3 Enter the Member s ID and click Search The Pharmacy Claims History screen will appear 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
42. ankfort KY 40601 nday EST 800 205 4696 LastAccessed 1115 2010 1 45 21 PM Last Password Change 1115 2010 1 4521 PM Your password will expire in 30 Gays Copiright 2007 Commonwealth 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 Pa RF VN Click on Save DMS Approved 10 6 2015 Page 8 Commonwealth of Kentucky MMIS For assistance email us at KY_EDI_HelpDeskibhp com or call 800 205 4696 during normal business hours 7 00 am 6 00 pm Monday Friday EST Contact Us errs First Name hip irrgtit Middlo Hamo Last Hame KYHeathnet r Contact Address Line 1 655 Chamberin Ave Address Line 2 jedi City franktont State hoy Zip Code 40601 Phone Number 800 205 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 wall help the Help Desk venfy your identity f you need assistance Question in what city were you bom Enter full name of cay only Answer tankfor Cancel Swe DMS Approved 10 6 2015 KyHealth Net Professional Companion Guide Page 9 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 2 2 1 How to Change the Password The account password expires every 30 days
43. ble Service Type pa ate verage _ e jE ee e p Effective Ll E e e Pay Insurance Deductible Remaining 1 Medical Care onos2oi4 jovos2o Y o o o E a T Y o 0 7 35 Dental Care Otos 2014 jovos2o Y o o oo a proso r o pp o o KCE e Y 0 oo pee i AG A Kamm aam paa e e o A a a r oe HOT EC CI EA ES UC Urgent Care Otwo8 2014 fowosnoa Y o o o o ___ Accurate information regarding KY Medicaid member copay coinsurance for MCO plans should be obtained directly from the appropriate MCO For 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 12 14 2013 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright e 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 29 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide If the member eligibility has end dated the following message will display 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 Monday 21 September 2015 4 05 pm Provider x Select Lookup Type _ Service Type Emerge Member ID Lookup Famil 7 Member ID From Date
44. cable eguiations that implement Title Y of the GramrmmLeachBliley Act 15 USC 66801 et seg he GLB Regulations EREAS User d sires to uthze the System pronded by OMS and OMS desires to rovide the System and related sernces and support to User as defined and according to Do you aaree to the Terms of Service as stated above KyHealth Net Professional Companion Guide r oO Oe re DMS Approved 10 6 2015 Page 15 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 2 5 Manage Agent Roles After an Agent is associated with a Provider account permissions or roles must be granted in order for that Agent to act on the Provider s behalf To add roles for KY Health Net claims eligibility etc follow the instructions below 1 Click on the KY Health Net link KENTUCKY HEALTH AND FAMILY SERVICES CABINET Kone EERE der E Manage Agent Roles KyHealth Choices This page allows you to add and remove roles from the agent Begin by selecting the system in which TST Terk ae you want to view or modify the Agent s access 51 r gent Detads Or aseisiance email ws af Harn edi teat edi best Account Status Email Address Address Telephone 600 205 4655 Account Owes hep ine tit KY Healthnet hpirvs4 Remove Al Roles Select the system to modify access EJ Modify the permissions for selected system Select Account Managemen el Select KYHealihhe ed 2 Notice secti
45. ccount If no Agents have been added No Agents Found will appear KENTUCKY CABINET FOR HEALTH ANO FAMILY SERVICES Knudi rot ricos creta igor it z Emmer 3 View Agent Roles kyHealth Choices Lise his screen to manage the roles for your agents Kentucky Medicaid Web ie Gite To edit the user s permissions select the user by browsing below oraraiciance mail ws 34 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 Sl Gisdaivesr individuals Ah Gisebiltieg Ceapwight 3007 Cormrronraalth 24 Rantucky ad rige ra rerced 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 Kentucky KENTUCKY CABINET FOR HEALTH ANO FAMILY SERVICES Add Agent A ME r 5 Add Agent KyHealth Choices Lise this screen to add access to an agent for your application kentucks Hiedicald Web DP a f Site Enter the email address of the agent you are adding access to your application and click search orascistance email us af KY_ED HelpDeakgphp com or call 800 2056 4636 during normal business hows 7 00 am 6 00 pm
46. der References RA Viewer Logout Member Eligibility Verification Monday 15 July 2013 1 42 pm Provider Select Lookup i Ambulatory Service Center Facility Search Type Select i Anesthesia E Cardiac Rehabilitation SSN Lookup Last Updated 411 201 Case Number Lookup Fri Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky y d cy a 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 Professional Companion Guide The Member Eligibility Verification page will appear This screen will display the most current eligibility information available KENTUCKY q CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Member Eligibility Verification Wednesday 23 September 2015 10 22 am Logout From Date of Service 09 23 2015 To Date of Service 09 23 2015 CF Ver
47. des Chnical Cntena Procedure Codes DMS Approved 10 6 2015 Page 46 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 KYHMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Checklist FEEFFE 124112 Radiology Prior Auth Proc Code List Friday 16 January 2015 11 25 am eee eee ee CareWise Prior Authorization Letter PA Inquiry Welcome to the Kentucky Medica A eee oe Y Services secure website is intended for Provider 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 Submit Dental Claim Submit Professional Claim Submit Institutional Claim Fli it ili Verica Provider Status Ah i A PDF version of the Radiology Prior Authorization Procedure Code List will appear DMS Approved 10 6 2015 Page 47 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Revised KyHealth Choices Radiology Codes Requiring Prior Authorizatio
48. e 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 KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer RA Viewer Wednesday 4 February 2015 2 20 pm Provider 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 print or save 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 8 28 2014 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonweaith of Kentucky All rights 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 68 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 4 Select the applicable Run Date KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMA TLON SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout RA Viewer Wednesday 4 February 2015 2 20 pm Provider o Click the
49. en tees DO Total Charges 000 QO Referring TO TPL Amount oo Q Physician Total Amount Paid O polo eee O Carrier Denied no 10 Co Pay Amount Last Updated 11 412011 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved Description Provider Number A Number of billing provider auto populated DMS Approved 10 6 2015 Page 74 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Member ID Enter 10 digit Member s KY MEDICAID ID number Last Name Member s last name auto populated Member s first name auto populated Date of Birth Member s date of birth auto populated Member s gender auto populated Patient Account Number Patient s account number optional Referring Physician Enter Referring physician NPI number This is the KenPac provider otherwise leave blank Prior Authorization Enter Prior Authorization number or Treatment Authorization Number if applicable Claim Type Select the appropriate claim type in drop down box From Date Enter the first date of service Thru Date Enter the through date of service Indicate whether accident related Yes or No Accident Date Date of accident EPSDT Indicates an EPSDT related service if applicable DMS Approved 10 6 2015 Page 75
50. er gt Diagnosis gt Details gt Summary Header Requesting Provider Number PA Category Inpatient Hospital Servicma Provider Number Member ID Last Name Nursing Facility Type agnosis Code 1490 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 56 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 8 6 DME PA Smart Sheets 1 Select PA from the Menu 2 Choose DME PA Smart Sheets 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 Radiology Prior Auth Proc Code List Monday 13 December 2010 11 27 JT oe Prior Authorization Letter PA Inquiry DME PA Smart Sheets Welcome to the Kentucky Medicai f Medicaid Services secure website is intended for providers clerks and billing agents Provider e Claim In iry 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 57 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The following screen will appear KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES
51. er Field Descriptions A aim Type Claim Type tte Crossover from the drop down box when Medicare is primary 20 Paidbate Date Sn the Medicare paid date from the Medicare A DMS Approved 10 6 2015 Page 89 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide lt lt Professional Claim Friday 9 December 2011 08 46 am Detail Information Item f aa El E To DOS E POS KA School 1D Number Procedure Modifiers of Children Diag Cross C II I I Units 0 00 Ch ooo Ref nits harges 0 O Pregnancy O Emergency a an DEE p EPSDT 1D Rendering Physician cane E Allowed bo Co Pay loo ee Amount ial Amount ial Patient Responsibility 0 00 Medicare Paid Amount 000 Medicare Deductible 0 00 6 Medicare Coinsurance 0 00 Add NDC Add Delete Last Updated 11 4 2011 Contact Us 11 2 8 2 Medicare Crossover Detail Field Descriptions Patient Responsibility Enter the Patient Responsibility amount from the Medicare EOMB Medicare Deductible Medicare Paid Amount Enter the Paid Amount from the Medicare EOMB Enter the Medicare Coinsurance from Medicare EOMB if applicable PE ter the Deductible from the Medicare EOMB if applicable DMS Approved 10 6 2015 Page 90 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 9 Summary Screens The summary screen allows the user to verity the data entered KENTUCKY
52. ervice entered Managed Care Managed Care 5 Year History From Date of To Date of MCO Mame PMP ID Region Date Added Service Service o6 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 if member is enrolled in Managed Care please refer to MCO Member Information panel Waiver 5 Year History No current coverage for date of service entered Last Updaated 8 20 20 1 Contact Us Privacy Disclaimer individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 36 Commonwealth of Kentucky MMIS KyHealth Net Professional 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
53. ese 91 113 AGIUSt OF V OIG CaN SN tico adas 93 113 1 lt AdjUst Void Field Descriptions asii diari 94 12 Supplemental Clais iaa succeumerectede 95 12 1 The Supplemental Claims display of encounter data cocccccccccconoconcnncccnnnnnonannnnonononnnnoncnnnnnns 95 13 Provider Tall a a Ea 98 ta The Provide Status IMIOFMAON senas a aa a a aa 98 13 2 Provider Group Practice MY De Cura o 101 ADDENADCA Negi a A A A E 102 Mee RONS acca kaha hl se lt st ace ch hs eth te a a Maint Aaa ae ha te nol chil 102 1922 NBIC WAS MUCHOS siete tied li aan tala 102 DMS Approved 10 6 2015 Page ii Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 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 account 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 Functions for All Users Functions for Provider Func
54. f Kentucky All rights reserved 11 2 4 1 Professional Claim Anesthesia Screen Field Descriptions Sequence Number The sequence number of the anesthesia This field is auto populated Anesthesia Code Enter the appropriate code Saves the diagnosis information on the claim Must save to continue Add Code Allows the user to add an additional diagnosis code to the claim Save code after each additional code added a e SSCS DMS Approved 10 6 2015 Page 79 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Delete Code Allows the user to remove a diagnosis code previously entered on the Advance to the next screen Allows user to print this screen DMS Approved 10 6 2015 Page 80 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 5 Billing Code Screens Condition Code KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 9 December 2011 09 08 am Header gt Billing Codes gt Detail gt Summary Condition Codes Diagnosis Anesthesia Condition Sequence Number O Last Updated 11 4 2011 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright amp 2005 Commonwealth of kentucky All rights reserved 11 2 5 1 Professional Claim Condition Code Screen Field Descriptio
55. h Information or Protected Health nformation PHI as defined under the Health Insurance Portability and Accountability Act f 1996 HIPAA 45 Code of Federal Regulations Parts 160 164 and applicable gulations that implement Title V of the Grammm Leach Bliley Act 15 U S C 55501 ef seg the GLB Regulations EREAS User desires to utilize the System promded by DMS and OMS desires to roide the System and related seraces and support to User as defined and according to j Do you agree to the terms of service as stated above Yes lagree No do not agree op i mre IOS Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 4 Enter the data On the Create New Account Form Kentucky gt Create New Account AA tdt a KyHealth Choices Kentucky Medicaid Web First Name hp insti Middle Name no For assistance email us at Last Hame KYHealthret KY_EDI HelpDesk hp com r call 600 205 4696 during omal business hours 7 00 Address Line 1 656 Chamberlin Awe eae Menta Address Line 2 edi City Frankfort State ky Zip Code 10601 Phone Number 600 205 4696 E Mail Address e E Mail Address verity Provider ID e Provider NPI Provider Taxonomy ID Trading Partner ID i E Mail Address i E Mail Address y ett Provides 1D ii Provide NPL 0 Prados nP 4 Taxonomy I Trading Panna p Ith Uaanmanii hpinas tk Password SAA Eb slo P
56. ider References RA Viewer Logout Managed Care 5 Year History Tuesday 29 January 2013 5 53 pm L D Last Name First Name Date of Birth SSN County Code 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 Last Updated 1 29 2013 Copyright 2005 Commonwealth of Kentucky A Privacy Disclaimer Individuals with Disabilities OO ene All rights reserved DMS Approved 10 6 2015 Page 33 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY BINET FOR HEALTH AND FAMILY SERVICES DICAL ma MT INFORMA TIO TEA IA Provider Home Member Chims PA Provider References RA Viewer Logout KenPAC 5 Year Histo Monday 4 February 2013 10 20 am LO Last Name First Name SSN County Code Case Number 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 Privacy Disctaimer individuals with Disabilities Copyright 2005 Commonwealth of Kentuck Ali rights reserved LT TE eee EA Lockin 5 Year History No current coverage for date of service entered lf member is enrolled in Managed Care please refer to MCO Member Information panel KENTUCKY i CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS
57. ification No 3ecb599 2f 9 23 2015 Status Active hh i eee Le Current ID Last Name First Name Date of Birth Old ID Check Digit Date of Death Other IDs Phone Number SSN County Code County Name Physical Address Member s Mailing Address city State KY Hospice Election Date Medicare A Medicare B Case Number Eligibility Eheibility 5 Year History Eligibility Group et Program Status ee bed re of panty y KY Managed Care XC P1 Child at least 6 and under a Pa Organization without Co Pay Child 19 Attending School if 18 si NENANA eee e Link onthe hyper link to view member mailing address DMS Approved 10 6 2015 Page 27 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Logout Member Mail Address Wednesday 23 September 2015 10 24 am 1 D Last Name First Name Address1 Address2 Address3 city State ZipCode Displayed Member Geographic Information is Members Current Information Last Updated 8120 201 Copyright amp 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities All rights reserved e Ifthe member is not eligible an error code is returned KENTUCKY CABINET FOR HEALTH AND
58. ity IO wO 0 Detal Navigation Detail Number 32 Search Details Count 2 O Next Pu Last Updated 9 24 2008 11 2 6 1 Professional Claim Detail Screen Field Descriptions DMS Approved 10 6 2015 Page 83 O O 3 3 O 5 D v Q A D Cc O 2 lt lt ep KyHealth Net Professional Companion Guide Enter the first date the services were provided The indicates that this field is required To DOS Enter the last date the services were provided The indicates that this field is required Select the appropriate place of service from the drop down box Enter the Employee ID number only if you are a School based or Community Mental Health Provider Enter the code which represents the service provided Enter the appropriate two digit modifier s which further describes the service performed Number of Children Enter the number of students when billing for a group service School based only Diagnosis Cross Reference Enter the one byte digit which refers to the diagnosis code line item which is primary to the procedure This field must be entered or the claim will deny Enter the number of units 1 is default Amount charged by the provider Check the box if service is related to pregnancy Check if service was an emergency DMS Approved 10 6 2015 Page 84 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide EPSDT Cho
59. l Companion Guide 3 The Agent Account Created window appears Agent Account Created You have successfully created a new agent account Your agent wall recene instrections va ead on how lo sel their password 4 User will receive an email as shown below Automated MEUPS email Example E PASSWORD SETUP Message HTML 15 x eepy Gy Foverd 4 D al 1 3 e 4 5 a8 Bile Edit View Insert Format Took Actions Heb From MEUPS Automabed Mader MEUPS_DoholReplyibemad kym oa Seek Pri 112008 11 55 AM Keniucky user piest You hava boon sent ihes message because you have had now Medicaid emterpriso user account created on your behall Your mw accour username is hptestt To establish your pastercrd please weil 1h following URL and follow the on tctr en mabig hitps public kymmis convivdink Mhinkid 43807 1 9785 4ac5 al0 135c1 clea Please contact the EDS helpdesk al RY_EDI_HelpDeckghpeom or call 600 206 4696 between 7 00 am 6 00 prii Monday Friday EST should you have questions regarding this notibcalion Medicaid Erterpnte Users Promsiorang System p 5 When user clicks the link in the email example above the Terms of Service User Agreement window appears as shown on the next page DMS Approved 10 6 2015 Page 14 Commonwealth of Kentucky MMIS 6 User must click l agree in order to proceed KyHMealth Choices Kentucky Medicaid Web Site or assistance email us at KY_
60. l 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 CABINET FOR HEALTH AND FAMILY SERVICES _ A A A __ _ _ IMO KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References Trade Files RA Viewer Logout Member Eligibility Verification Thursday 27 August 2015 11 28 am Select Lookup Type Service Type Member ID Lookup w From Date of Service 06 01 2015 a To Date of Service 08 31 2015 ej Verification No 3ecb59972f 9 23 2015 Status Active Member Current ID Last Name First Name Date of Birth Old ID Check Digit Gender M Date of Death Other IDs Phone Number SSN County Code County Name Address City 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 Comsurance Cost Share 5 Year History No current coverage for date of service entered FEE A IS A TPL S Year History No current coverage for date of s
61. lchairs Senior Megative Pressure Wound Therapy NWPT Pump General Nesate Pressure Wound Therapy NWPT Pump Senior Nonnvasive Atrwavy Assist Devices General Noninvasive Amway Assist Devices Senior The DME Smart Sheets allows the user to view the InterQual criteria before requesting a PA DMS Approved 10 6 2015 Page 58 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 s 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 10t or 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 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 15 2010 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 59 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The following screen will appear KENTUCKY
62. lth Net Professional Companion Guide e Annual Disclosure ADO panel displays the last ADO received by Provider Enrollment 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 Recevet 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 51 2299 01 01 1978 12 51 2299 Licenses License Number State Issued Effective Date End Date 01 01 1978 12 31 2299 Revalidation 60 Day Letter Date 30 Day Letter Date Note fno 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 99 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide e Location Address panel displays the provider physical pay to and correspondence addresses Location Address Address 1 Address 1 Last Updated 8 20 2014 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright amp 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 100 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 13 2 Provider Group Practice Hyperlink If an individu
63. n Effective September 15 2006 contrast material s Magnetic resonance eg proton imaging orbit face and neck with contrast material s Magnetic resonance eg proton imaging orbit face and neck without contrast material s followed by contrast material s and further sequences Magnetic resonance angiography head without contrast materials Effective 03 01 2007 Magnetic resonance angiography head with contrast materials Effective 03 01 2007 Magnetic resonance angiography head without contrast materials followed by contrast materials and further sequences Effective 03 01 2007 Magnetic resonance angio 1 neck without contract material Magnetic reso neck with contrast material s 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 70540 Magnetic resonance eg proton imaging orbit face and neck without contrast material Magnetic resonance eq Proton imaging brain including brain stem with contrast material Magnetic resonance eg Proton imaging brain including brain stem without contrast material followed by contrast material and further sec 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 malformatio
64. n without contrast material 70558 Magnetic resonance eg Proton imaging brain including brain stem and skull alll 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 48 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 8 3 MMIS PA Letters 1 Select PA from the Menu 2 Choose MMIS Prior Authorization Letter from the drop down KENTUCKY q CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization PA Letters Friday 16 January 2015 12 59 pm Search Criteria Provider Member TD Letter Type E DateSet E Last Updated 8 11 2014 Privacy Disclaimer Individuals with Disabilities Sin ah SE ET d EE All rights reserved 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 Professional Companion Guide 8 4 CareWise PA Letters 1 Select PA from the Menu 2 Choose CareWise Prior Auth
65. ng materials can be found at http Awww_kymmis com kymmis Provider s 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 5 8 2009 Privacy Disclaimer Individuals with Disabilities Copyright amp 2007 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 7 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 CABINET FOR HEALTH AND FAMILY SERVICES Clese Apphbeabca AA AAA Account Home KyHealth Choices Good afternoon hp instit K YHealthnet Kentucky Medicaid Web aj Y_EDI_HelpDeskOhp com Please select a button above to view or edit your account or assistance email us at ho instit K YHealthinet lt Y_EDI_HelipDesiieds com or call 600 205 4596 during ES ae ormal business hours 7 00 6 00 pm Monday fr
66. nnnns 47 6 0 MMIS PASOS 300 est cies A E A E E ee ES ee 49 OA Care WiSe PA GTS A A A A AS 50 8 4 1 PAL Ste WEIS teehee A O E ee OE AE 52 Bre PAM o de 53 6 6 DME PA SMS y ee ee acest eae ocr de eae eee ect 57 Provider Referenc eS iaa 59 S L Provider FElEre MGS Sede aeee na o da eds 59 92 TRE CAMS lt a a eee eee 63 9 3 Provider References DocuMentatiON cococcccccnnccccnncoccnncconnnononnnononnnnnnnnnnnnnnonnnnonnnnnnnnnnonencnnnnnos 65 RA VIEW AAA AA AS A 67 ClalMS tii iia ico 70 A ctarattuee tennadeucaeclscaundua rene dgutgeammaisadiuausnsniaroomtuebmcwmiucemanencuiin asennad oats 70 11 2 Submitting Protessiona ls ancla feeutcestastoradetesaateeccenn totes 72 EZT Veni Provider BOX maana odio cda 73 Mia ce POTESSIONA Glam CAG o idas da dos 74 11 23 Billing Code Screens Diagnosis cccccccconcnncccnnnncnnncnnnnnnonnnonnnnnnnnnononnnnnononanrnnnnnnnanennnoss 77 11 2 4 Billing Code Screens ANesthesia ccoooonccnccccconccnnccononcnnncononncnnonononnnnnnnonannnnnonnnanennnnos 79 11 2 5 Billing Code Screens Condition Code ccccoccccccnoncccccncccnnnnnoncccnnncconnnnnnncnnnnnnnonnnannncnnns 81 DMS Approved 10 6 2015 Page Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide A SA A A A A ted teas aaa toe 83 11 2 7 Detail Screen Ambulante sia diodo 87 11 2 8 Special Instructions for Submitting a Medicare Primary Claim ccccccoocccnncnconnnnnn 89 Ar EE o O E e E ea a nae i
67. ns Sequence Number The sequence number of the condition This field is auto populated Condition Code ss appropriate condition code D e Saves the diagnosis information on the claim Must save to continue 4 Add Code Allows the user to add an additional diagnosis code to the claim Save code after each additional code added DMS Approved 10 6 2015 Page 81 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Delete Code Allows the user to remove a diagnosis code previously entered on the Advance to the next screen Allows user to print this screen DMS Approved 10 6 2015 Page 82 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 6 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 a Professional Claim Friday 9 December 2011 3 43 pm Header gt Billing Codes gt Detail gt Summary Detail Information From m OS Item FO E hora To DOS 10 11 2017 POS Ome Fe School 1D EY Number Procedure ERE e Modifiers 9 TI _ lof Children re OT TT Us O Charges po Y d Pregnancy BD d Emergency BH Employee ay est 0 vE Rendering FO Allowed Co Pay SHS Amount ae Amount al Hide Noc J Count RX Number Prescription Unit of Measure Quant
68. o PA Required Age Restrictiom 0 999 Maximum Units 999 Gender Both Attachment is Not Required CLIA is Not Required Nota 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 Nota Lifetime Procedure Not Restricted to any Diagnosis Restricted to Type Speciality s o 80 000 DMS Approved 10 6 2015 Page 61 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Procedure 99213 Compr Chces Exp Pop Bas ABI Limitations for date of service 08 01 2010 No PA Required e Age Restriction 0 999 e Maximum Units 999 Gender Both Attachment is Not Required e 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 2010 No PA Required Age Restriction 0 999 e Maximum Units 999 Gender Both Attachment is Not Required e CLIA is Not Required Nota 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
69. of Service 09 21 2015 Fa To Date of Service 09 21 2015 Verification No cc940dfa06 9 21 2015 Status Non Active Print Error code 78 Subscriber Insured Not in Group Plan Identitied DMS Approved 10 6 2015 Page 30 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide KENTUCKY _ i CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM EYHMES Provider Home Member Claims PA Provider References RA Viewer Logout Eligibility 5 Year History Monday 4 February 2013 10 16 am Member 1 D Last Name First Name Date of Birth SSN County Code Case Number Case Name Displayed Member Geographic Information is Members Current Information Eligibility History Program Begin End Date Status Date Program Program Code EY Managed Care Orgarazation 1 Pre wmn e mf wine lt 185 of chil lt 19 without Co Pay wine lt 20 I Pre wmn amp inf wine lt 185 of chi lt 19 Pi 100 FPL 110102011 12312209 Fam Che Man Pop Med Kids Pi 100 FPL 07 01 2006 1031 2011 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 vou may refuse to provide services for non payment of co pays if this is the current Cost Sharing aa Chia Fla Medical CoPay Pha
70. ompanion 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 Logout Prior Authorization Checklist 4 E 424112 Radiology Prior Auth Proc Code List Friday 16 January 2015 11 25 am E a A CareWise Prior Authorization Letter PA Inquiry Welcome to the Kentucky Medicaid o eo Services secure website is intended for 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 e Clam Inquiry Submit Dental Clam Submit Professional Claim Submit Institutional Clam A TEF e T PEA Provider Status DMS Approved 10 6 2015 Page 44 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The following dialogue box will appear File Download x Do you want to open or save this file Mame KYHCPACal Checklist doc Type Microsoft Word Document 32 5 KB From ns serimis com sem sow mos Y Always ask before opening this type of file WW hile files from the Internet can be useful some
71. on 9 Modify the permissions for KYHealthNet section opens 3 Roles are granted or removed in this section DMS Approved 10 6 2015 Page 16 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide My Information Change Password View Agent Roles Add Agent Manage Agent Roles This page allows you to add and remove roles from the agent Begin by selecting the system in which you want to view or modify tr Agent s access Agent Details Name Jane Doe Account Status Active Email Address janedoe yahoo com Address Telephone Account Owner O Select the system to modify access O Modify the permissions for KYHealthNet System Roles Select Account Management Card Issuance Select Electronic Prior Authorization Claims Inquiry Select Magellan Web Portal Select Magellan Web Portal resource partner URI Claims Submission Dental cece O0 O0 O O O0 O0 0 0O 0O 0 0 0 0 0O 0O 0 0 0 0 0 Claims Submission Institutional Claims Submission Professional KenPAC Referral Confidential Message Inquiry KenPAC Referral Confidential Message Submit KenPAC Referral Inquiry KenPAC Referral Submit Eligibility Verification Electronic ADO Electronic EFT Provider Status LTC Claims PA Inquiry PA Submission Pharmacy History Presumptive Eligibility Pricing Ra Viewer TPL Carrier 4 Check the roles you wish to grant agent 5 Click the Save Changes button to save modifications DM
72. onic PA Letters in an effort to go green would you like to discontinue Paper PA Letters Claim Inquiry Submit Professional Claim Supplemental Claims 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 6 21 201 tact Us Copyright 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities All rights reserved KENTUCKY b CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout supplemental Claim Information Monday 1 July 2013 1 30 pm Provider Claim ICH Last Updated 6 21 20412 y Contact Us Privacy Disclaimer Individuals with Disabilities Copyright e 2005 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 95 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 A supplemental Claim Information Monday 1 July 2013 1 32 pm Linked ICH MCO Paid Amount Encounter Medicaid Allowed Amount Encounter TPL Amount AA 59 95 S21048 80 00 Y 359 95 210 48 80 00 Copyright amp 2005 Commonwealth of Kentucky Privacy Discl
73. onwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 97 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 13 Provider Status 13 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 Logout Provider Status Information Wednesday 27 August 2014 08 09 am Provider Name Identification Provider Number Effective Date End Date 01 01 1978 12 31 2299 01 01 1978 12 31 2299 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 3 1 2299 03 01 2013 12 51 2299 DMS Approved 10 6 2015 Page 98 Commonwealth of Kentucky MMIS KyHea
74. orization Letter from the drop down KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Checklist y pn MMIS Prior Authorization Letter CareWise Prior Authorization Letter PA Inquiry elcome to the Kentucky Medicaid DME PA Smart Sheet edicaid Services secure website is intended for providers z ents 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 Br eiaa 7 To ee DMS Approved 10 6 2015 Page 50 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Member Last Name Pal To Date a 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 de
75. ose the appropriate selection from the drop down if it is applicable to the procedure Employee ID Enter the Employee ID number only if you are a School based or Community Mental Health provider Rendering Physician Enter the NPI of the rendering physician 7 Status of the claim Allowed Amount The amount allowed by Kentucky Medicaid paid claims only Co pay The co payment deducted from reimbursement No information should be entered into this field Add NDC Enter the 11 digit NDC code This is currently only used by hospitals for outpatient services Drop down box to choose RX Prescription Enter prescription number NDC Enter the 11 digit NDC no dashes Unit of Measure Drop down box to choose unit of measure Quantity The quantity of the NDC Count This field is auto populated count of the NDC lines 7 Save NDC Click to save the NDC DMS Approved 10 6 2015 Page 85 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Saves the detail line on the claim Add Detail Allows user to add an additional detail line Delete Detail Allows user to remove the detail line previously entered Detail Navigation Use to move to other detail lines Detail Number Shows what detail page you are on Details Count Shows number of details Advance to the next screen Allows user to print this screen DMS Approved 10 6 2015 Page 86 Commonwealth of Kentucky
76. pm Monday Friday EST should you have questions regarding this notification Medicaid Enterprise Users Provisioning System MO DMS Approved 10 6 2015 Page 10 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 1 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 Professional 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 a
77. r Administrator grants access DMS Approved 10 6 2015 Page 1 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 Goto the KY Medicaid Website www kymmis com 2 Click on Electronic Claims 3 Click on Frequently Asked Questions 4 Click on the hyperlink at the bottom of the page last paragraph first sentence for PIN release form user instructions included 5 Complete the attached PIN Release form and return to the EDI Helpdesk along with 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 Whp com The HP EDI department will respond
78. rks 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 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 droit 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 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 2015 Page 21 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 5 Member Information 5 1 Member Card Issuance 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 Provider Main Page Eligibility Verification MCO Member Information Pharmacy History Thursday 29 Jan Welcome to t gt The Kentucky Department of Medicaid
79. rmacy CoPar Coat Share Mot Rael wv a e How ke Ho he Hol oh AENA Rae Ba a Ba EAS ES E Z 1 22 Z ZSZB2ZBBEAZBAZE SZ ee ee ee ee ee ee oe Note Cost Share Met An indicator of Y in this field indicates that the member has met the cost sharing limit for the quarter and is no longer subject to co payments for the remainder of the quarter Last Updated 1122 2017 Privacy Disclaimer ndtrduals with Disabilities Copright 2 2005 Commonwealth of Kantucky al mig hts 103000 DMS Approved 10 6 2015 Page 31 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide C T FOR HEALTH AND FAMILY SERVICES EF MEDCAL MA MAGLIA EAT 1 HFEA TETE ETETEA E YIA EN j Prowider Home Member Claims PA Provider Reference RA Viewer Logout Service Limitations 5 Year History Monday 4 February 2013 10 17 am Member Last Name County Code Note The following shows the history of PAID claims only no pending claims are shown below This screen does NOT guarantee payment Claims are paid as they are received at Medicaid Dental Procedure Coda Description Dato of Service DENTAL PROPHYLAXIS CHILD 1110712011 DENTAL PROPHYLAXIS CHILD 11 06 2012 INTRACRAL PERIAPICAL FIRST 10222009 DENTAL PROPHYLAXIS CHILD 10 07 2010 INTRAORAL PERIAPICAL FIRST 0922 2009 AMALGAM TWO SURFACES PERMANE 08 25 2008 DENTAL PROPHYLAXIS CHILD 07 30 2009 DENTAL PROPHYLAXIS CHILD 07 10 2008 DENTAL PROPHYLAXIS CHILD 034292010 INTRAORAL
80. stance email us at KY EDL HelpDeski hp com or call 800 205 4696 during AA E sine hours a f Well are a biling agent or YOU wish to complete a am 6 00 pm Monday provider application you may register here KyHealth Choices Friday EST Reset your password Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2006 Commonwealth of Kentucky All rights reserved DMS Approved 10 6 2015 Page 6 Commonwealth of Kentucky MMIS KyHealth Net Professional 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 MEDICA SERVICES KyHealth Choices Home Thursday 16 December 2010 1 55 pm Jane Doe Welcome to KyHealth Choices Applications Application Description Account Managemen Modify your account information Providers can also use this application to give application permissions to their agents a t KyHealth Choices This is the KyHealth Choices portal application KY HealthNet Model Office KYHealthHet For Eligibility Claims PA PE Transactions to the Model office environment Message 12 01 10 Reminder Electronic Prior Authorization is available for use by all providers today excluding orthodontics and school based providers Traini
81. tails 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 O 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 51 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 8 4 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 Provider Search Criteria Member ID Case Number Member First Name Member Last Name From Date To Date 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 Search Letter 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 52 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 8 9 PA Inquiry 1 Select PA from the Menu 2 Choose PA Inquiry from the drop down
82. tes can potentially harm your computer IF you do not trust the source do not open or save this file What s the rsk 3 Select Open or Save DMS Approved 10 6 2015 Page 45 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide An example of the checklist follows Health Choices 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 vour request more quickly We thank vou for vour 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 A ID Number Member Address Zip Code Responsible Party for Member Under Age of 18 Ordermg Provider Name Ordermg Provider s Medicaid Number non Medicaid providers should enter license number and state Ordermg Provider Contact Person Name Ordenng Provider Contact Person Phone Facility Name Facility s Medicaid Number Facility Contact Person Name Facility Contact Person Phone Date s of Service Diagnosis Co
83. th Choices ormal business hours 7 00 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 or assistance email us at KY_EDI_HalpDeekibhp com call G00 205 4696 duning rmal business hours 7 00 DMS Approved 10 6 2015 is User Account Agreement hereinafter Agreement effects today is made by and etween the Commonwealth of Kentucky Cabinet for Health and Family Seraces CHFS epartment of Medicaid Seneces OMS and users who sign up for an account on this bs e hereinafter User the aforementioned being a bcensed health care provider or an ntay who acts on behalf of a licensed health care pronder EREAS User renders certain professional health care sernces Serices to members f employer groups and mdmduals and submits documentation of those Semces to OMS nd REAS DMS in its implementation of the Medicaid program in Kentucky prondes to salih care companies such as User a System of operational and informational support to spond to promder inquines to exchange certain clams and bling information through fectronec Communications and through the intemet hereinafter the System REAS while performeng as semces User may be gwan access to or may be exposed o Certain Confidential or Indmdually Identifiable Healt
84. tion as the Details section of the Summary screen Click on the Detail number to return to that detail Medicare Details Identifies these sections as the Medicare Details section of the Summary screen Click on the Detail number to return to that detail DMS Approved 10 6 2015 Page 92 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 3 Adjust or Void Claim Screen To ADJUST a paid claim 1 2 3 4 5 6 Select Claim Inquiry Enter Member information and dates of service or enter the claim Internal Control Number Click the Next button to advance Correct the information on the claim Save the updated information Click the Adjust button To VOID a paid 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 lf the claim does not show an Adjust or Void Claim button the claim was previously adjusted or voided DMS Approved 10 6 2015 Page 93 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide Provider Number Member ID Last Name First Name Date of Bath Clam Charges Total Charges 80 00 TPL Amount 10 00 Total Amount Paid 123 52 Carrier Denied No v Co Pay Amount lo 00 2 O Adjust Void Claim Print 0 Last Updated 11 24 2004 Coprmian
85. tions for Billing Admin Only Agents Only Account Allows you to manage Allows you to view Management your personal agents with access to information change your your account and add security question answer an agent to your and reset your account password KyHealth Net Allows user to submit Functions are limited to Functions are limited claims PA requests those that are applicable to those authorized by check eligibility etc to the Provider type the Provider Administrators Functions are limited to Functions are limited those that are applicable to those authorized by to the Provider type 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 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 Provide
86. 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 ICN NITROFURANTOIN 11 06 2014 NABUMETONE 11 06 2014 6O psis321007901 NITROFURANTOIN 11 062014 fo rsis32wmo6s SC NABUMETONE 11 06 2014 fC eC 7814321011967 Last Updated 8 28 2014 Copyright O 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities SAIZ All rights reserved DMS Approved 10 6 2015 Page 39 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 6 Patient Liability 1 Select Member from the Menu 2 Choose Patient Liability 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 Card Issuance Member Links _____ Eligibility Verification MCO Member Informatio Pharmacy History MCO Member Je end Down Patient Liabilt Pharmacy Histo Spend Down Last Updated 6 1 1 2014 Contact Us Copyright amp 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities peis All rights reserved DMS Approved 10 6 2015 Page 40 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide The following screen will appear KENTUCKY t CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANA
87. ut Card Issuance Friday 30 January 2015 11 50 am MemberID SSN Search Issue Date Retroactive Beginning Date End Date Type Source Currently Billable 01212015 0201 2015 03 01 2015 Regular KMIDC Yes 12180014 0101 2015 02 01 2015 RegularKMIDC Yes o ee 10222014 11012014 1201 2014 RegulariKMIDC Yes isa 10012014 11 01 2014fRegular KMIDC Yes 08202014 09012014 to 01 2014 RegulariKMIDC Yes waa osorno PO 2014fRegurevaDC Yes 06 19 2014 E E E 05202014 06012014 07 01 2014 RegulariKMIDC Yes 04212014 05 01 2014 06 01 2014 RegularIKMIDC Yes 03 20 2014 rra ortega KDE Yas 0219 2014 031012014 04 01 2014Regula KMIDC Yes 012204 ozo12014 03 01 2014 RegularKMIDC No 1172013 01012014 02 01 2014 Regular KISS No 11 18 201 a A A T 1022 2013 1001 2013 12 01 2013 Regular KISS No 09 192013 10012013 11 01 2013 Regular KISS No 08 21 2013 09012013 10012013 Regular KISS No 07 22 2013 sra fooor2013fteqiad_xass Ne 06 19 2013 07012013 08 01 2013 Regula KISS No 05 21 2013 06 01 2013 07 01 2013 Regular KISS No 04192013 05 01 2013 06 01 2013 Regular KISS No 03202013 04012013 o5 01 2013 Regular KISS No 02102013 AAA 01 31 2013 02012013 03 01 2013 Regular KISS No 12 17 2012 owo12013 02 01 2013 Regular KISS No 11 19 2
88. was dropped off Enter the state where the member was dropped off Zip Code Enter the zip code where the member was dropped off Advance to the next screen Allows user to print this screen DMS Approved 10 6 2015 Page 88 Commonwealth of Kentucky MMIS KyHealth Net Professional Companion Guide 11 2 8 Special Instructions for Submitting a Medicare Primary Claim KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES qER_EO_AAA u A A Ia A A O a re A KA KY MEOTCAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Professional Claim Friday 9 December 2011 08 45 am Header Billing Information Service Information Provider 9999999099 Claim CrossOver ne 99 IV SON VSS eee Number eee Lda rom Member ID 0000000000 Date ov0v2011 cay ToDate 7012011 C3 y Accident Date Es Last Name DOE Accident None FirstName MARY LE Date of Birth 02 11 2000 Gender fF Patient Acct Referring AAA Physician Prior Authorization EPSDT No Claim Charges Total oo Charges whe 0 00 No x Medicare Medicare Paid Date is required when claimis a crossover r Last Updated 11 4 2011 Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth of Kentucky AAA IA All rights reserved 11 2 8 1 Medicare Crossover Head

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