2026
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Reimbursement Policy Statement - Medical Supplies, Equipment, and Appliance (MSEA) - Aetna 2526
Reimbursement Policy Statement - Intensive Outpatient Program (IOP) - Aetna 3351 (PDF)
MedImpact - Insulin degludec discontinuation (PDF)
Medicaid precertification updates for sensory integration 97533 - Aetna 2491 (PDF)
Medicaid precertification updates for DME - Aetna 2497 (PDF)
Kentucky Health Alliance credentialing form update (PDF)
Vaccines for Children (VFC) program guidance reminder - Aetna 2300 (PDF)
MedImpact - CGRP prior authorizations (PDF)
March 2026 training calendar (PDF)
MedImpact Entresto and sacubitrilvalsartan PDL status change (PDF)
New Medicaid benefits implementation RRSS and HRSN-RC - Aetna 2489 (PDF)
MedImpact Albuterol HFA and Ventolin HFA PDL status change (PDF)
MedImpact - hypertonic saline coverage updates (PDF)
MedImpact - Zegalogue discontinuation (PDF)
MedImpact - Pulmicort rebate status change (PDF)
Kentucky Medicaid policy updates coding and diagnosis requirements - Aetna 2471 (PDF)
Corrected claims submission - Aetna 2459 (PDF)
Enhancement to the EviCore Prior Authorization Process - Aetna 2437 (PDF)
2025
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TEAMKY 1115 Coverage of IMD stays update (PDF)
Best Practice for Provider Data Submission (PDF)
Resolved - enrollment file connection issue impacting member eligibility (PDF)
Enrollment file connection issue impacting member eligibility (PDF)
TRP – summary of provider education and reimbursement guidelines (PDF)
Time to Register! Aetna Better Health Webinar Understanding the CAHPS (PDF)
Psychological and neuropsychological testing (PDF)
Availity claim submission updates (PDF)
ASAM assessment requirements (PDF)
Targeted case management – TG modifier (PDF)
Xifaxan coverage update and patient assistance program (PDF)
Extension of Virtual Office Hours (VOH) for the remainder of 2025 (PDF)
Dental vendor transition to Skygen (PDF)
New policy updates - E&M service performed during a global surgery procedure (PDF)
New policy updates - multiple gestation and duplicate claim logic for drugs (PDF)
Evicore delegation removal for select codes (PDF)
Extension of Virtual Office Hours (VOH) through August (PDF)
DBHDID-TRIS Trainee Search & PSS, CSA, TCM prior authorization (PDF)
Reimbursement for emergency department services AMA rescinded (PDF)
Neonatal Intensive Care Unit (NICU) (PDF)
Authorization changes for DME providers (PDF)
Reimbursement for emergency department services - AMA (PDF)
Evicore delegation removal on select codes (PDF)
Tip Tuesday: Targeted case management (PDF)
Clarifying notice: Prior authorization requirement for TCM services (PDF)
Upcoming changes for behavioral health prior authorization (PDF)
Reimbursement Policy Statement - Definitive drug testing (PDF)
Reimbursement Policy Statement - Comprehensive community support services (PDF)
Reimbursement Policy Statement - Peer support (PDF)
Reimbursement Policy Statement - Psychoeducation (PDF)
Prior authorization resumes for select behavioral health services (PDF)
Clinical payment coding and policy changes - Infliximab (PDF)
Authorization Changes for DME providers - Brixadi (PDF)
Proprietary Evaluation and Management (E&M) program claim and code review (PDF)
Clinical policy updates: genetic testing (PDF)
Collateral Therapy (90887) education (PDF)
TRP and CCSS services billed on the same date of service (PDF)
ABHKY updated claim policy edits - audiology, vision and physician (PDF)
Missed appointment reporting in KYHealthNet (PDF)
Updated Claim Policy Edits - NCD labs and precertification optimization (PDF)
Senate Bill 111 – prior authorization guidance - stuttering (PDF)
2024
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Authorization changes for chiropractic providers (PDF)
Applied Behavior Analysis medical necessity criteria and claims edit (PDF)
Electronic Visit Verification (EVV) Program (PDF)
Edifecs Smart Trading platform implementation (PDF)
Contact us for providers (PDF)
Edifecs CRA program update (PDF)
Comprehensive community support services (PDF)
Tracking an appeal in Availity (PDF)
Evaluation and Management (E/M) Program - date correction (PDF)
Aetna and Quest Analytics Partnership (PDF)
Reminder: ERA/EFT vendor change to ECHO (PDF)
Home infusion billing guidelines (PDF)
Updated claim policy edits - genetic testing (PDF)
MedImpact continuous glucose monitors - prior authorization criteria changes (PDF)
Updated claim policy edits - vaccine, lab, DME and vision (PDF)
Updated claim policy edits - DME (PDF)
Updated claim policy edits - 98960-98962 and H0038 (PDF)
Material change clarification on Fee Schedule updates (PDF)
Diagnosis-related grouping review program (PDF)
Tip Tuesday: Grievance and appeal (PDF)
PHP coverage and staffing requirements (PDF)
Tip Tuesday: Access and availability (PDF)
INR monitor - new coverage update (PDF)
Q1 PUR clinical payment, coding and policy changes (PDF)
Payment policy: outpatient observation (PDF)
Recoupment time moving to 30 days (PDF)
New policy updates - venipuncture, NCCI, E&M, genetic testing (PDF)
Material contract change effective 8/1/2024 (PDF)
Transition to MCG - Milliman guidelines (PDF)
Authorization changes for therapy providers - reminder (PDF)
Change Healthcare update (PDF)
Tip Tuesday: Prior Authorization /ProPat - February 6, 2024 (PDF)
IOP covered services and requirements (PDF)
Reporting newborn birth weights (PDF)
DMS electronic visit verification (EW) for home health care services (PDF)
2023
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Authorization changes for therapy providers (PDF)
TRP and PSS services billed on the same date of service (PDF)
Authorization changes for cardiac codes (PDF)
Authorization changes for transportation (PDF)
Credentialing changes and updates (PDF)
Chest wall oscillation system (E0483) (PDF)
Tip Tuesday - November 13, 2023 (PDF)
Individual peer support limits (PDF)
Community support associate services (PDF)
New policy updates: modifier CS, ICD-10 for gestational diabetes (PDF)
New policy updates: anatomical modifiers (PDF)
Behavioral health assessments billing and frequency– 90791, 90792, H0031, H0001 (PDF)
Tip Tuesday - July 27, 2023 (PDF)
Update - Monthly billing for Targeted Case Management services (PDF)
Coverage of IOP/PSS/CCSS services by individual BH practitioners (PDF)
Prior Authorization Guidance (PDF)
Tip Tuesday - June 20, 2023 (PDF)
Incontinence supplies - coding update (PDF)
Targeted Case Management Care Plans - update (PDF)
Mandatory modifiers for therapy (PDF)
Therapeutic Rehabilitation Services Program (PDF)
New Aetna Better Health® of Kentucky Medicaid claims and encounters front end edits (PDF)
AvaiIabiIity Standards reminder (PDF)
Observation less than 8 hours (PDF)
CLIA (Clinical Laboratory Improvement Amendments) (PDF)
Targeted Case Management care plans (PDF)
Kentucky Medicaid Commercial Bypass List (PDF)
Change Healthcare EFT/ERA Registration Services (PDF)
Eviti Recommended Formulary Redirection (PDF)
Tip Tuesday: January 24, 2023 (PDF)
Introducing Dx Gap Advisor ™ (PDF)
New policy updates: clinical payment, coding and policy changes (PDF)
Billing expectations for Targeted Case Management Services (PDF)
2022
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Claims Received report summary moving to Availity (PDF)
Urgent admission notification – change in timeframe (PDF)
New Aetna Better Health® of Kentucky Medicaid claims and encounters front end edits (PDF)
Tip Tuesday: November 8, 2022 (PDF)
New policy to apply Medically Unlikely Edits (MUE) (PDF)
Medicaid Precertification Optimization - ABHKY Updated Claim Policy Edit (PDF)
Tip Tuesday: Department IMD requirements and Aetna Better Health of Kentucky payment policy (PDF)
Get Physical: Provider Education - Billing (PDF)
Neonatal Intensive Care Unit (NICU) (PDF)
Targeted case management - T2023 (PDF)
SUD residential billing requirement (PDF)
New policy updates - Clinical payment, coding and policy changes (PDF)
New policy updates – Drug and Biologicals and IUD (PDF)
Respiratory panel provider communication (PDF)
New policy updates – Drug and Biologicals and IUD (PDF)
Correspondence address update (PDF)
Claim edits platform enhancement (PDF)
Update – PA for inpatient and residential SUD services (PDF)
Update: Physician administered drug prior authorization criteria - Aduhelm (PDF)
Network Manager Staff Update (PDF)
April 18, 2022: Physician administered drug prior authorization criteria (PDF)
Tip Tuesday: April 12, 2022 (PDF)
Volunteer opportunity:Mayfield Remote Area Medical (RAM) clinic (PDF)
Tip Tuesday: March 29, 2022 (PDF)
Updated state guidance for Covid diagnosis (PDF)
New policy updates: spinal surgery PA requirement (PDF)
New update for feeding supply kits (PDF)
Prior authorization changes effective 4/18/22 (PDF)
Method of claims payment - virtual credit cards (PDF)
EviCore for OB Ultrasounds -Update (PDF)
Providers affected by the storms - Resuming PA (PDF)
Introducing a new Behavioral Health Prior Authorization form (PDF)
Tip Tuesday: January 28, 2022 (PDF)
Introducing a new Behavioral Health Prior Authorization form (PDF)
Change - claims processing for respiratory panels (PDF)
2021
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PA Removal -Storm Affected Counties (PDF)
New P.O. Box Address and Vendor for Paper Claim and Claim Correspondence (PDF)
Tip Tuesday: November 30, 2021 (PDF)
Encounter Updates - Holiday check run schedule (PDF)
Current Network Listing: November 19, 2021 (PDF)
Virtual Training Opportunities - November 16 & December2, 2021 (PDF)
New Policy Updates - Clinical payment, coding and policy changes MedImpact Universal PA Form (PDF)
Tip Tuesday: November 2, 2021 (PDF)
Trauma Informed Care Training (PDF)
New policy updates: clinical payment, coding and policy changes (PDF)
Tip Tuesday: October 19, 2021 (PDF)
Update to the communication platform (PDF)
Tip Tuesday: October 12, 2021 (PDF)
Changing Credentialing Verification Organization (CVO) (PDF)
Genetic testing policy update; MedImpact Grandfathering notice (PDF)
Provider survey (IPRO) starting soon (PDF)
Update to Prior Authorization Policy (PDF)
Claims payer ID number & MedImpact PA notice (PDF)
Retraction of credit balances/clinical payment updates (PDF)
Credit balances/clinical payment updates (PDF)
Tip Tuesday: July 7, 2021 (PDF)
Pending clinical claim edits -BH (PDF)
New pharmacy benefit manager FAQ (PDF)
No-show or cancellation fees for Medicaid members (PDF)
Availity and Care Web QI are sunsetting (PDF)
Summer webinar series - Availity (PDF)
Prior authorization resumes (PDF)
IPRO provider survey; multiplex nucleic acid amplified tests (PDF)
Health Runs DEEP sessions (PDF)
SKY Provider Information and Training (PDF)
Single preferred drug list formulary and Aetna supplemental formulary (PDF)
Tip Tuesday: February 23, 2021 (PDF)
Case management; high-risk pregnancies; reminder for SKY (PDF)
Better Health for high-risk pregnant moms (PDF)
Prior authorization guidelines (PDF)
2020
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Provider relief fund and prepayment review process (PDF)
Prior authorization (PA) reinstated and fax correction (PDF)
Kentucky Hospital Association and Center Care FAQ (PDF)
Negative balance network notice (PDF)
Vitamin D notice and sterilization update (PDF)
Tip Tuesday: April 28, 2020 (PDF)
Tip Tuesday: April 21, 2020 (PDF)
Clinical payment policy changes (PDF)
Tip Tuesday: April 7, 2020 (PDF)
Tip Tuesday: March 31, 2020 (PDF)
Tip Tuesday: February 25, 2020 (PDF)
Tip Tuesday: February 18, 2020 (PDF)
Fax provider IPRO survey notice (PDF)
Kentucky pharmacy medical duplicates provider notice (PDF)
Behavioral health code updates (PDF)
2019
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Tip Tuesday: December 10, 2019 open enrollment and pharmacy reminder (PDF)
Kentucky Hospital Association FAQ (PDF)
Tip Tuesday: November 19, 2019 (PDF)
Tip Tuesday: November 5, 2019 (PDF)
Tip Tuesday: October 29, 2019 (PDF)
Obstetric ultrasound PA policy change (PDF)
PA update for code S2900 and newborn notice requirement change (PDF)
Kentucky Health Information Exchange and network representative list (PDF)
Provider and hospital directories survey (PDF)
Countdown to Kentucky HEALTH release (PDF)
Prepayment high dollar claim and PA reminder (PDF)
PA changes effective March 10 (PDF)
New provider network relations team list (PDF)
Tip Tuesday: September 10, 2019 (PDF)
Tip Tuesday: September 3, 2019 (PDF)
Tip Tuesday: August 27, 2019 (PDF)
Tip Tuesday: August 20, 2019 (PDF)
Tip Tuesday: August 13, 2019 (PDF)
Tip Tuesday: August 6, 2019 (PDF)
Tip Tuesday: July 30, 2019 (PDF)
Tip Tuesday: July 23, 2019 (PDF)
Tip Tuesday: July 16, 2019 (PDF)
2018
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Kentucky provider manual letter (PDF)
Monthly collection letter to include supporting claims detail (PDF)
Centers for Disease Control and Prevention National Influenza Vaccination Week (PDF)
Year-end check run dates and new network relations consultant (PDF)
Approved policy edits for December 2 (PDF)
Discontinuing paper remits and refund or check address reminder (PDF)
PA changes effective November 15 and urine drug screen provider notice effective November 12 (PDF)
Editing changes and network relations listing (PDF)
Screening, Brief Intervention and Referral to Treatment (SBIRT) FAQ (PDF)
Policy edits for anesthesia effective September 25 (PDF)
Copay and network relations list (PDF)
Kentucky HEALTH updated webinars and network relations list (PDF)
Kentucky HEALTH webinars reminder (PDF)
Kentucky HEALTH webinars and network relations list update (PDF)
DMS survey for value-based payments for providers (PDF)
Kentucky HEALTH provider education webinars (PDF)
Hepatitis A vaccine and lock box address (PDF)
DMS provider forum notice (PDF)
ePA Kentucky provider notice (PDF)
Provider changes and improvements to provider processes (PDF)
Network relations representative list update (PDF)
2017
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Provider process change for PA requirements (PDF)
Hepatitis C policy updates and holiday check runs reminder (PDF)
Early elective delivery and Aetna Better Health of Kentucky provider forum reminder (PDF)
Change to check run date and updated Provider Relations representative listing (PDF)
Reminder unlisted and non-specific CPT and HCPCS codes (PDF)
Change unlisted and non-specific codes (PDF)
After-hours and weekend care codes and updated PR representative listing (PDF)
Correction to PR representative listing (PDF)
Updated PR representative listing (PDF)
After hours and weekend care codes and prenatal cytogenetic codes 99050-99051 (PDF)
Updated appeal PR listing ordering, referring and prescribing (ORP) reminder revision (PDF)
Behavioral health T2023 code (PDF)
Updated PR representative listing (PDF)
Updated clinical practice guidelines and ORP reminder (PDF)
Behavioral health applied behavioral analysis OTR form added to website (PDF)
Ordering referring prescribing behavioral health T2023 code 831 PR representative listing (PDF)
Claim reconsideration process discontinued reminder (PDF)
Claim reconsideration process discontinued (PDF)
Cross claim provider policy change PR representative listing (PDF)
Cotiviti PR representative listing (PDF)
Medical record claims review notice letter (PDF)
Medicare crossover claim edit (PDF)
Behavioral health CPT T2023 (PDF)
2016
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Duplicative coding check runs (PDF)
Check runs behavioral health telephone reminder (PDF)
Community Mental Health Centers update only (PDF)
Check runs and no policy change for in-person claims (PDF)
Bill 131, inpatient costs policy check runs map 811 flu shot (PDF)
Draft check run map 811 policy claims hepatitis C (PDF)
Policy changes observation stays open enrollment service in 2017 (PDF)
Open enrollment here to stay Coventry account do not bill map 811 forum flu (PDF)
Open enrollment here to stay Coventry account do not bill map 811 forum flu (PDF)
Open enrollment here to stay provider forums flu (PDF)
Provider forums eviCore update (PDF)
Provider forums eviCore update attending doctor to bill (PDF)
Provider forums eviCore attending doctor to bill (PDF)
eviCore update Provider Relations representative listing (PDF)
Pain cardiology portal updates provider newsletter (PDF)
Zika virus provider requirement flu prevention (PDF)
Void requests claims inquiries (PDF)
Behavioral health National Correct Coding Initiative claims edits (PDF)
Behavioral health contract Zika virus crib program (PDF)
Claims reconsideration reminder and provider reference guide update (PDF)
Clinic coding and policy communication under Affordable Care Act (PDF)
HCPCS/NDC code claim recon clearinghouse taxonomy (PDF)
eviCore MedSolutions portal hospital observation stays (PDF)
Formulary change portal enhancements prior authorization update (PDF)
Provider Relations updated list provider newsletter (PDF)
Location code 99 vaccines concurrent review fax inpatient ICD-10 code (PDF)
DMS updates concurrent review fax address form (PDF)
The Department of Community Based Services (DCBS) Benefind taxonomy NPI claims PR list (PDF)
iHealth edits claims denial review PR list (PDF)
High dollar claim check run primary care physician change WRAP payments pharmacy (PDF)
Lockbox PA ultrasound taxonomy member incentives (PDF)
eviCore member ID number (PDF)
Pharmacy PA update portal HEDIS (PDF)
Pharmacy requests ultrasound OB codes (PDF)
Portal claims tobacco cessation PR representative list (PDF)
Portal registration provider payment reminder (PDF)
Provider payment reminder PR representative list (PDF)