Kentucky Medicaid — Kentucky Medicaid (Department for Medicaid Services)
| Program name | Kentucky Medicaid (Department for Medicaid Services) |
|---|---|
| Provider portal | https://chfs.ky.gov/agencies/dms |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Kentucky Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Kentucky
The Blue Cross Blue Shield Association licensee in Kentucky is Anthem Blue Cross and Blue Shield of Kentucky (Elevance Health). See the Anthem (Elevance Health) payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Kentucky
The dominant commercial insurers operating in Kentucky, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Kentucky
Kentucky Medicaid (Department for Medicaid Services) contracts with the following managed-care organizations to administer Medicaid benefits in Kentucky. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Kentucky
CGS Administrators, LLC is the Medicare A/B MAC for Kentucky: Part A and Part B fee-for-service claims from Kentucky go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to CGS Administrators, LLC as the DME MAC. Home health and hospice claims are processed by Palmetto GBA. In the current Medicare Coverage Database export, 215 active LCDs from these contractors apply to Kentucky claims.
- CGS Administrators, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- Palmetto GBA
Home health and hospice MAC
Selected active CGS Administrators, LLC policies for Kentucky
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L36690 Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities
- L40140 MolDX: Molecular Testing for Solid Organ Allograft Rejection
- L38111 MolDX: Pigmented Lesion Assay
- L38303 MolDX: Prostate Cancer Genomic Classifier Assay for Men with Localized Disease
- L38992 Electroretinography (ERG)
- L34064 Panretinal (Scatter) Laser Photocoagulation
- L34062 Dialysis Access Maintenance
- L40224 Automated Detection and Quantification of Brain MRIs
- L33944 Blepharoplasty
- L33946 Capsule Opacification Following Cataract Surgery: Discission and YAG Laser Capsulotomy
- L33950 Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
- L34008 Computerized Corneal Topography
Equipment, home health and hospice policies that apply in Kentucky
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L34544 Hospice - Liver Disease
- L34547 Hospice - Neurological Conditions
- L34548 Hospice Cardiopulmonary Conditions
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Kentucky billing
- KRS §304.17A-700 through §304.17A-730 (KY Out-of-Network Claim Dispute Resolution, 2017 / amended 2019)
- KRS §304.17A-708 (prompt pay — 30 days electronic clean claim)
- KRS §216B.019 (hospital financial assistance)
Provider licensing & enrollment in Kentucky
Providers enroll via Kentucky Medicaid Partner Portal Application (KYMMIS). MCOs credential through CAQH ProView.
Major health systems headquartered in Kentucky
| Health system | Headquarters |
|---|---|
| UK HealthCare (University of Kentucky) | Lexington, KY |
| Baptist Health (Kentucky) | Louisville, KY |
| Norton Healthcare | Louisville, KY |
| UofL Health | Louisville, KY |
| Appalachian Regional Healthcare (ARH) | Lexington, KY |
Frequently asked questions — Kentucky billing
What is the Kentucky Medicaid program called?
Kentucky's Medicaid program is known as Kentucky Medicaid (Department for Medicaid Services). Providers enroll and manage claims through the provider portal at https://chfs.ky.gov/agencies/dms.
What is the Kentucky Medicaid timely filing limit?
Kentucky Medicaid (Department for Medicaid Services) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Kentucky's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Kentucky Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Kentucky Medicaid (Department for Medicaid Services). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Kentucky?
The dominant commercial payers in Kentucky include Anthem (Elevance Health), Humana, UnitedHealthcare, Aetna, Cigna, along with the BCBS licensee Anthem Blue Cross and Blue Shield of Kentucky (Elevance Health). Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Kentucky?
Kentucky Medicaid (Department for Medicaid Services) contracts with 6 Medicaid MCOs tracked in the QuickIntell registry, including Anthem (Elevance Health), Aetna Better Health, Humana, UnitedHealthcare, Molina Healthcare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Kentucky?
Kentucky has 3 tracked state-level statutes that affect medical billing and RCM: KRS §304.17A-700 through §304.17A-730 (KY Out-of-Network Claim Dispute Resolution, 2017 / amended 2019); KRS §304.17A-708 (prompt pay — 30 days electronic clean claim); KRS §216B.019 (hospital financial assistance). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Kentucky with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Kentucky Medicaid (Department for Medicaid Services) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Kentucky Medicaid and the member ID card before submission.