Dental User Manual
Contents
1. F Claims inquiry Clan Sobenession Dental Claras Submission eslitulional FP Claims Submission Prolessional Revised on 10 08 2010 Page 17 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 3 Accessing KY Health Net 1 Onthe 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 15 January 2010 2 12 pm Sign Gut hp instit K YHealthnet Welcome to KyHealth Choices Applications Application Description Account Management Manages contact information password and authorizations for applications KY HealthMet Eligibility Verification Claims submission and inquiry Presumptive Eligibility RA Wlewer Date 10 23 09 During the Financial Cycle of Friday 10 16 2009 there were several claims that were nat processed 4s a result an additional Financial weekly cycle was processed last night 10 21 2009 This cycle includes ALL claims finalized since 101 2009 plus the claims that did not process an 10 16 2009 The impact to any provider with finalized claims is that you will possibly receive a payment for the 10 21 2009 cycle and an additional payment for a smaller amount of claims this will be only claims finalized on Thursday and Friday for the normal weekly cycle in the 10232009 Weekly cycle In addition any claim received and or processed after 10 77 2009 may not2. P erem ae p His day Perimetral y provides a cketks and bills pondra Switch Working Provider Included in the next pages is Member selections Card Issuance Revised on 10 08 2010 Page 19 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 1 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 Thursday 19 Movember 2009 08 05 am Member ID SOIN Last Updated 4 30 2008 Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2005 Commonwealth af Kentucky All rights re eserved The card issuances dates include begin and end dates along with issue type KENTUCKY CABINET FOR HEALTH ANO FAMILY DEAVICES Powder Home Member Chima PA Proska References RA Viewer Loge Card lasuance Wednesday 18 Augus 2010 3 15 pm Alombor ID sex Soarch laan Limiar Harte na Tras Is LLL ALL E ima Le FD TATA ar im ALL LLL 0731 5010 08013010 Cee be SEO KISS Yeu TEH 010 orerzoro onol KISS Yes A 1 999ize D Ves 04313010 _ corme E en 03332010 5501 2610 Yen CTE 3510 530132010 You
3. 13 Accident Date If anything other than none is selected from the Accident drop down menu enter the date of the accident If a date is entered indicating an accident the claim must be filed on paper rather than electronic 14 EPSDT If the service is the result of an EPSDT screening choose yes from the drop down menu If not leave the default selection no 15 Place of Service Select the appropriate Place of Service from the drop down menu 16 Rendering Provider Select the Kentucky Health Choices rendering NPI number and matching taxonomy that is in the drop down box The indicates that this is a mandatory field 17 Claim Charges Identifies the Claim Charges section of the Header screen 18 Total Charges This field will be auto populated after detail charges are entered in the detail screen 19 TPL Amount This field will be auto populated after detail TPL payments are entered in the detail screen 20 Total Amount Paid This field will be auto populated after all charges and payments are entered in the detail screen 21 Next Click the Next button to continue to the detail screen Revised on 10 08 2010 Page 40 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 5 1 3 Wednesday 25 November 20 Dental Claim Detail Screen Below are instructions for filling in the fields Detail Informaheon A tem C i Procedure e Quadrant O Prosthesis e M 09 11 58 am PR
4. button Kentucky Create New Account EyHe alth Choices You must agree to the terms below before creating an account Kentucky Medicaid Web UsER AGREEMENT or assistance email us al nis User Account Agreement hereinafter Agreement effective today is made by and KY EDI HalpDeskfohp com etween the Commonwealth of Kentucky Cabinet for Health and Family Seraces CHFS ir call OC 205 4596 during epartment of Medica Somces DMS and users who sign up for an account on this omal business hours 7 00 website hereinafter User the aforementioned being a licensed health care provider or an am 6 00 pm Monday ntity who acts on behalf of a licensed health care provider WHEREAS User renders certain professional health care senices Senices to members f employer groups and indiiduals and submits documentation of those Semces to DMS nd EREAS DMS in its implementation of the Medicaid program in Kentucky provides to salh care companies such as User a System of operational and informational support to spond to provider inquines lo exchange certain claims and balling information through lectronic communications and through the inteme hereinafter the System EHESS while periormang d seraces User may be qwen access to or may be exposed o certain confidential or Indeadually Identifiable Health Information or Protected Health nformation PHI as defined under the Health Insurance Portability and Accountability Act f 1995
5. entu RY UNBRIDLED SPIRIT ma Commonwealth of Kentucky KY Medicaid KyHealth Net Dental Companion Guide Version 6 2 Hevised October 8 2010 Revision History 1 0 12 27 2006 Patti George Created 2 0 12 27 2006 Ron Chandler Review and format 2 1 01 29 2007 Patti George Updates per DMS walkthrough 3 0 02 09 2007 Lize Deane Formatted according to KY standards 3 1 02 26 2007 Michelle Goins Updated with latest information 4 0 02 26 2007 Patti George Updates 5 0 03 06 2007 Ann Murray Updated according to comments 6 0 10 20 2008 Cathy Hill Updated screens and text as directed 6 0 3 12 2009 Cathy Hill Changed text references from KyHealth Choices to KY Medicaid 6 1 4 28 2010 EDI Revised per EDI 6 2 10 6 2010 Martha Senn Revised per EDI Marilyn Surratt Stayce Towles 6 2 10 8 2010 Martha Senn Remove PHI Format to DMS Marilyn Surratt standards Stayce Towles Ron Chandler Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Table of Contents 1 To Create a New Provider user account for KYHealthnet oooooocccccccoocccnncncnncccnnnos 1 UT HOW to recelve Voll PI AUDE s qo e is dede A luba co vu d d e we TUER Ee De ins 1 1 2 Cheating a New VACGOOLDPqm mv eoi cio 2 2 Sonne into Kye near E N ER 5 2 1 S00 MO Iyblealth CONOCE S una aa 5 2 2 ACCESSING User ADDIICALIONS et 6 2 2 1 How to Change the Password euis Dee
6. CE Mais R Uu ol 20 10 y Vea B osoo KR oroso Yas 02043010 LOL 3010 Yan GR313009 10012000 Yes FE 29 01 20608 Yen pisos cronos Ge E m 1 ororsooe 12008 pula E E 2008 12013008 200 Kenpec XI Na pone 11012008 2064 ef hi Ma 008 DOULE 1101 2063 a 2022008 UB 03i 2008 SUC Kenpa E E 2604 EA 1 Ati KEenpa js Ma 2008 07012008 oo 2008 Kenpac KISS Ma 2008 96012008 jo70i206P Kenpar KISS No ros 950 2008 o 0 2008 Kenpe Kiss i 3004 63013008 Ma 230 z b68 03012004 Mas 1322008 03 01 2008 20a ET 2008 Ro 01 012008 206 No sn prensas E 32 3007 500 Ma CEA r I ee B zi i 7 2b Me 6520300 zx Ma 0331204 HE Mea Revised on 10 08 2010 Page 20 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 5 Member Eligibility Verification KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES AY MEDICAS MARAGEMENI LFORMATIOM ATTE CYMMER Provider Home Member Claims PA Provider References RA Viewer Logout Member Eligibility Verification Provider Select Lookup Type Select Lasi Updated 4 30 2008 Copyright 2005 Coranomeeattn of Kentucky Privacy Di clanne Indeiduals with Disabilities All momig Sora 5 To Search Select Lookup Type KENTUCKY 1 LITE HARA GEM NT LARFORMA TLOR Tuc Provider Home Member Claims PA Provider References RA Viewer Liat Member Eligibility Verification
7. une 4 2010 ATTENTION ALL PROVIDERS On June 15 2010 The Centers for Medicare amp Medicaid Services CMS ill hast a national provider conference call on this important subject IKCD 10 Implementation in a 5010 Environment It is very important that all providers be informed on this subject You are strongly encouraged to access this link and learn how to register by June 14 to participate in this event Friday February 12 2070 Provider Representative Listing PDE hursday October 22 2009 Provider Representative Listing PDE vesday September 2 2008 Provider Representative Listing PDF uesday May 6 2006 FAQ regarding NPI Registration Friday April 25 2008 NPI Readiness Letter Tuesday April 15 2008 Provider Representative Listing PDF Tuesday April 1 2008 EOB Codes Listing PDF May 23 2007 Changes Encountered with New MAIS 05 23 2007 New CMS 1500 Claim Form for Atypical Providers 05 11 2007 NPI Contingency for CMS 1500 05 11 2007 NPI Contingency for UB 04 05 11 2007 NPI Contingency for ADA 05 11 2007 ATS Denied Claims August 11 2006 KyHealth Choices Prior Authorization Requirements A 70 doc 08 10 06 Frequently Asked Questions for the Prior Authorization Provider Letter Dated July 14 2006 07 31 06 To help expedite prior autharization requests see KyHealth Choices Prior Authorization Information 08 02 06 Includes KyHealth Choices Kentucky Medicaid P
8. HFAA 45 Code of Federal Regulations Parts 160 164 and applicable egulations that implement Title Y of the GrammeLeach Bliley Act 15 US C 56901 er seg he SLB Regulations VHEREAS User d smes to ule the System pronded by DMS and OMS desires to rovide the System and related serices and support to User as defined and according to Do you agree to the terms of service as stated above Yes lagree No I donot agree Revised on 10 08 2010 Page 2 Commonwealth of Kentucky MMIS 5 Enter the data On the Create New Account Form Kentucky Create New Account KyHealth Choices First Name Middle Name Last Name Kentucky Medicaid Web Site For assistance email us at KY EDI HelpDeski hp com r call 600 205 4696 during ormal business hours 7 00 am 6 00 pm Monday Address Line 1 Address Line 2 hp insti a A KYHealihret Lal 656 Chamberlin Ave edi KyHealth Net Dental Companion Guide riday EST City lirankfort State ky Zip Code 406071 Phone Humber eon 205 4636 E Mail Address e E Mail Address r verify Provider ID E Ud Provider NPI Provider OO Taxonomy ID Trading Partner TTT ID E Mail Address i E Mail Address wed r Provider 1D Ub Provider MPI Pieviiloi o Taxeneni IE Trading Paim AAA IE LUs dniame hpinas d Password HIITIIIII Ub ioe EEE Ty Select a security question from the list below and provide an answer that you will rememb
9. Required Age Restriction 0 909 Maximum Units 999 Gender Both Attachment is Mot Required CLLA is Mot Required Mot a Lifetime Procedure Mot Restricted to any Diagnosis Restricted to Type Specialitvs o 20 000 Revised on 10 08 2010 Page 30 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 8 2 TPL Carriers Enter a insurance company to find the mailing addresses Medicaid has 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 47 pm Business Name Last Updated 7 4 2010 Copyright 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities All rights reserved Enter the TPL Carrier select Search the response will return all carrier information on file KENTUCKY 3 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 FIRST HEALTH CARRIER FRANKFORT KY 40601 Code Business Name Telephone 777777 MEDICARE A FIRST HEALTH CARRIER 888888 MEDICARE B FRANKFORT KY 40601 ANYTOWN EY 90000 0090 Last Updated 7 1 2011 Contact Us Copyright amp 2005 Commonwealth of Kentu
10. Thursday 19 November 2009 08 06 am Las Updated 4 30 2001 Privacy Disclaimer individuals with Disabiliti s zagytight O 2005 Commonwealth of KenbacW All nor VET tera An example of member eligibility verification Revised on 10 08 2010 Page 21 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY BMEM CAL HAIFA Oe A LAP cee TII Te ETA Provider Home Henmber Cline FA Provider Relerence RA Virer Lograr Member Eligibility Verification Wednesday 18 August 2010 3 25 pm Provider Select Lookup Type Member ID Lookup v MemberID From Date of Service 88 2010 To Date of Service 5 15 2010 C7 Verification No 102300232L 8 18 2010 Status A Print ember Current ID First Name Date of Birth old ID Check Digit 3 Gender F Date of Death cier IDs Phone Number FSH County Code 076 County Name Address City ZipCode Hospice Election Date Medicare A Medicare B Case Number Case Name eno Plan Program Codi a A AN From Date e To Dato of Sree Hbl Chces Mand Pop NoCopay 08 18 2010 08 18 2010 Program Coca Program Status Copay indicator Powerty indicator I Prg mn amp inf anc 185 or chl 19 wine 200 P3 155 FPL WN Note PO IND An 259 in this field indicates that the member is at or below 100 of the federal poverty level If the indicator is N vou maw not refus
11. be paid due to the Cash Management Hold currently set at 12 days Last Updated 7 1 412009 Contact Lis Privacy Disclaimer Individuals with Disabilities Copyright 2007 Commonwealth af Kentucky 2 Verify Provider NPI Taxonomy in drop down box KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES mw ED CH kd ee Me Cape ECT eee 7 Ce be a ERE ER Proveler Home Beber Clan PA Proveer HRefernernies RA Veee Lope Provider Main Page Fnday 15 January 2010 213 pm Wiel ope fo Hes Kentucky Mex id et Ve Feri ky Depa pepi of Medic aie erri en vocum e petis Fk edad foe pu onse ccn Fo cured Dile ged s E B b Revised on 10 08 2010 Page 18 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 4 Functionality Roles are granted by the administrator if user agent account does not have access to one of the following tabs contact the administrator of the account Provider Home Displays all functionality user has access Member User has access to Card Issuance Eligibility Verification Pharmacy History Presumptive Eligibility Patient Liability and Spend down Claims Claim inquiry and Submit Dental claim PA PA Checklist Radiology Prior Auth Proc Code list PA letter and PA Inquiry Provider References Reference Search TPL Carrier and Documentation RA Viewer allows user to view 6 months of RA KENTUCKY FOR HEALTH AND FAMILY ER ee y Ward i dis
12. email notification from MEUPS prior to the expiration on the 20 day 8 Click on the Change Password button 9 Complete form 10 Click the Change Password button Kentucky KENTUCKY CABIMET FOR HEALTH AND FAMILY SERVICES Kou WINTHEUTITTHETITUBEETTTITENET Change Password KyHealth Choices Fill out the form below to change your password Your new password must Kentucky Hedicaid Web site d Have a length of at least 8 characters Contain at least one number Contain both lower and uppercase letters or aseisiance email us a KY ED4 HelpDesk hp com of call 800 206 4696 during normal business hours 7 00 Old Password r Hic Monday New Password Hew Password rarity Cancel Change Password j Conkact Up m Privacy Dirdeimer Individuals wth Dipsbiltiog Copyright 2007 Comrmoneaalth of Kanu AS right raterced 2 2 2 Emailexamples 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 HeloDesk hp com or call 800 205 4696 between 7 00 am
13. 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 Revised on 10 08 2010 Page 1 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 1 2 Creating a New Account 1 Enter the provider ID KY Medicaid provider id or Group id and 2 Enter the PIN number assigned KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KyHealth Choices Enter your Provider ID and temporary PIN provided to you in the letter Kentucky Medicaid Web Provider ID PO PIN or assistance email us al vin K _EDI_HalpDeekgphp com jr call 200 205 4696 during Kytlealth Choices ommal business hours 7 00 count Migration Privacy Disclaimer Individuals with Dirabilitiar All right rasarrad 3 User Agreement to Terms of Service window will display 4 Click the Yes agree or No do not agree
14. mfonmational support to espond to promder inquines to exchange certain claims and billing mformation through lecironic communications and through the Intemet hereinaBer the System EREAS while performing As sennces User may be green access to or may be exposed lo certain confidential or Indeadually Identifiable Health Information or Protected Health nformation CPA as defined under the Health Insurance Portabslity and Accountability Act f 1995 HIPAA 45 Code of Federal Regulations Parts 160 164 and applicable egulations that implement Title Y of the Gramm LeachBliley Act 15 U S C 5501 er seq he GLB Regulations EREAS User desires to ulilize the System pronded by OMS and OMS desires to rovide the System and related serices and support to User as defined and according to Do you aaree to the Terms of Service as stated above op AR Revised on 10 08 2010 Page 14 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 5 Manage Agent Roles 1 Allows user to add and or remove roles from the agent 2 Click on the KYHealthNet link KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Manage Agent Roles Ep AO This page allows you to add and remove roles from the agent Begin by selecting the system in which Kentucky Medicald Web you want to view or modify the Agent s access Site Agent Details de je et d Name edi test edi test Account Status Active orca G0 205 4696 dung al Addr
15. righis reserved Revised on 10 08 2010 Page 25 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 7 1 PALetter list Select the member letter under letter type KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization PA Letters Wednesday 18 August 2010 3 58 pm Search Criteria ide Letter Type PA Letters Letter Type Member ID Member Name Request Date Sent Date 01 25 2009 101 2007 Last Updated 7 1 201 Privacy Disclaimer Individuals with Disabilities Copyright amp 2005 Commonwealth of Kentuck Revised on 10 08 2010 Page 26 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 7 2 PA Inquiry KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES LEY MEDICAL MANAGEMENT INFORMATION SYSTEM TANIA Provider Home Member Claims PA Provider References RA Viewer Logout TER Prior Authorization Inquiry Wednesday 18 August 2010 4 03 pm Provider v Transaction EE Member na PA ID ID Category s suf ae First Name Start Date ae Type Submitted B Last Updaled 71 2010 1 au H A Privacy Disclaimer Individuals with Disabilities Copyright 2005 Cisl To PU Br ok A PA search is completed by entering Transaction ID is the PA number or Member ID or SSN or Name of member or Start date is required with all search criteri
16. 0 OT OZ ZOl1O0 RA Payee Ix 7 6 2010 0623 2010 RA Payee ID O 6 26 2010 DO6 15 2010 FLA Payee ID 6 12 2010 06 16 2010 RA Payee ID 6 16 2010 Revised on 10 08 2010 Page 34 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 1 Claims KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYHMIS Provider Home Member TB PA Provider References RA Viewer Logout Claims Inquiry Friday 13 November 2009 Claims Submission Dental Claims Submission Professional Claims Submission Institutional LTE Router Submit al ORG Letter apartment of Medicaid Services secure website is intended for Land billing agents Welcome to the Kentuck switch Working Provider You currently receive paper and electronic RA in an effort to go green would you like to discontinue Paper RA Yes s Submit Institutional Claim e Elgbility Venhcahon Revised on 10 08 2010 Page 35 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 2 Claim Inquiry KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY HEDICAL MARA GIUM NT LAPONA TION STEM PRES Provider Home Member Claims PA Provider References RA Viewer Logout Claim Inquiry Friday 20 August 2010 1 24 pm Refresh Unfinished Claims Search Member ID Claim Status Any Status Pati
17. 009 04 30 2009 396 52 2396 22 05 01 2009 07 31 2009 3 915 00 50 00 08 01 2009 10 31 2009 3 915 00 T zL Ld Erntvacr Disclaimer mdra duas with Disabilibos Copyright 2005 Commons malih of Kentucky Aj nghis Mesnard Revised on 10 08 2010 Page 24 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 7 PA Prior Authorization KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES EEE M O UM BUY MDL CAL MAJHA GME IMF DAMA TOON S9S TEM ar oie oop Provider Home Member Claims A Provider References RA Viewer Logout Prior Aulberisation Cha kl xs Radiology Prier Amh Pror Coda List Friday 13 November 2009 12 04 prj gt eeey wer ero Prise Authorization Leli EF Swatch Working Freder You currently receive paper and electronic RA in an effort to go green would you like to discontinue Paper RA Yes Subrut Dental Clam cubanit Professional Clas Submut Institutional Clam Ehmbity Venbcabon PA Letters Search by provider only or by a specific member KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES EY MEDICAL MARAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Clims PA Provider References RA Viewer Logout Prior Authorization PA Letters Wednesday 18 August 2010 3 55 pm Search Criteria Search PA Letters Last Updated 7 1 2010 Copyrigni amp 2005 Commonwealth of Kentucky Privacy Disclaimer Indn duals wah Disabilities All
18. 30 days UIT BNET DIMBE ID ELIEBI BET er E All rights reserved click on the My Information button the following screen displays ocroll to the Security Question amp Answer section Select the security question Enter the answer oe UE xev e Click on Save Revised on 10 08 2010 Page 7 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide For astislance email us M KY EDI HalpDaskfhp com or call B00 205 4656 during normal business hour 7 00 am 6 00 pm Monday Friday EST Contact Us Revised on 10 08 2010 METE First Mamo Ihn inslit Middle Name Last Mame EYHe thre Contact Address Lite 1 FSS Chambertin Ae Address Line eh City frankot Siate NW 3 ZipCode O Phone Humber 00205 4696 E Mail Address secunty Question amp Answer Select a security question from the list below and provide an answer that you will remember This question wil help the Help Desk venfy your identity f you need assistance Question In what city were you bom Enter full name of city only Answet frankfort ae gm raum Cancel Page 8 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 2 1 How to Change the Password The account password expires every 30 days A pink banner will display on the Home page with a countdown of days prior to password expiration beginning with 10 The user will receive an
19. 6 00 pm Monday Friday EST should you have questions regarding this notification Medicaid Enterprise Users Provisioning System MO Revised on 10 08 2010 Page 9 Commonwealth of Kentucky MMIS KyHealth Net Dental 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 HeloDesk 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 Revised on 10 08 2010 Page 10 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 3 Viewing Agent Roles View Agent Roles button user may see the No agents found screen as shown below when no agents have been added to the provider account Shown for provider admin and billing agent user accounts KENTUCKY View Agent Roles KyHealth Choices Lise this screen to manage the roles for your agents Kentucky Medicaid Web Site To edit the user s permis
20. ATION SYSTEM YH MD y Prowider Home Member Claims PA Provider References RA Viewer Logout E RA Viewer Friday 20 August 2010 1 08 pm Provider ww Click the Search button below to find RA reports associated with your provider number When the RA listing displays click the Run Date link beside a specific RA to view or download RA report details Hon activity for 40 minutes or longer will result in a time out for this system You will be required to log back in Last Updated 7 1 2010 Copyright 2005 Commonwealth of Kentucky All rights rese d Privacy Disciaimer Indetdualz with Disabilities Revised on 10 08 2010 Page 33 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Select the applicable Run Date Proview Pinar Maeda e Pe Peover helo Ba Viewer Er ETE RA Viewer Friday 20 August 2010 1 11 Provider Click the Search button below to find RA reports associated with your provider number Vihen the RA listing displays click the Run Date hink beside a specific RA bo view of download RA report details Prosvmlor I Ron Date Losd Dato REIIIIL agent PS ane 08 13 2010 RA Payee 1D 5 13 2010 8 14 2010 08 06 2010 RA Payee ID E 6 2010 6 9 2010 07 30 2010 RA Payee ID 7 31 2010 07 23 2010 RA Payee ID 7 26 2010 OT Te 2010 RA Payec LD 7 19 3010 07 09 2010 RA Payee IL T7T 12 201
21. Confidential Message Inquiry e KenPAC Referral Confidential Message Submit x KenPAC Referral Inquiry LU KenPAC Referral Submit LUI Iv Eligibility Verification O LTC Claims O Iv PA Inquiry PA Submission 9 Pharmacy History 9 l Presumptive Eligibility T Pricing Iv Ra Viewer Iv TPL Carrier 9 Save Changes Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2007 Commonwealth of Kentucky All rights reserved 5 Click the Save Changes button to save modifications 6 The screen returns Successful Revised on 10 08 2010 Page 16 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide CKY CABINET FOR HEALTH AND FAMILY SERVICES a Manage Agent Roles TIE This page allows you to add and remove roles from the agent Begin by selecting the system in which TL youwantto view or modify the Agent s access ELE or assistance omen ys al 4f Successful adding role of Eligibility Venfication tor system K rHeakhiNal KY EDI BeipDeckfenn cam R Agent Details mul basinci hours 7 00 Ham adi basi edi jagi Aceeum 5 ratus Arts E00 pm Monday Email Address nday EST Address Telephone B00 205 455 Ficcomnt Chumer hp inetd EY Heahrert hiisi El selectthe system to modify access EJ Modify the permissions for KyHealthhet System r Roles Select Acccunt Management T Card teeuance T F E 2 zl hl se i
22. EOS e cach peel eee d M E E 46 9 5 3 zillisiedlaciidseo cR ET 46 Revised on 10 08 2010 Pagei Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 1 To Create a New Provider user account for KYHealthnet The user creating the KY Healthnet account should be the office manager or someone deem responsible for accessing provider information A pin number is required to create a user account The EDI Helpdesk will assign a pin number to each KY Medicaid provider id 1 1 How to receive your Pin number Go to KY Medicaid Website www kymmis com Click on Electronic Claims Click on Frequently Asked Questions gt Tm Click on the hyperlink at the bottom of page last paragraph first sentence for pin release form user instructions included 5 Complete the attached PIN Release form and return to EDI Helpdesk along with a copy of a valid driver s license via e mail or fax Include your phone and e mail address and someone will contact you with your PIN and website information 6 Fax your PIN Release form to 502 209 3242 or 502 209 3200 7 E mail your form to ky edi helpdesk hp com 8 The HP EDI department will respond within 2 business days via email 9 The Pin release email example is below From Jane doe hp com Sent Monday August 9 2010 10 30 AM To Daisy Duck Manywhere com Subject KY Medicaid pin release request To create a KY Health Net account user the following information Provider
23. Indicator Revised on 10 08 2010 Page 28 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Provider References KENTUCKY CABINET FOR HEALTH FAMILY SERVICES MY CAL RAMA GEM ENT FNFORMATION SYSTEM EVA Provider Home Member Chrimea PA Provider References FA Viewer Logout Matar Geach jain Page Wednesday 18 August 2010 4 24 pm pusiste Welcome bo the d amp entucky Medicaid Website The Kentucky Department of Medicaid Serac s secure website is intended for providers clerks and billing agents Switch Working Prowder Clas Inquiry e Subari al Ciim Subs Tut Profcssiorad Class Last Updated 7 1 2010 8 1 Reference Search KENTUCKY b CABINET FOR HEALTH AND FAMILY SERVICES Provider Home Member Claims PA Provider References RA Viewer Logout Reference Search Eligibility listed does not guarantee payment of a claim Wednesday 18 August 2010 4 25 pm Choose Search Type Procedure Code v Procedure Code Benefit Flan OCEDA Compr Chces Exp Pop Bas AA 8 Date Of Service Te Last Updated 71 2010 Revised on 10 08 2010 Page 29 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Enter the procedure code and date of service select the Benefit Plan click Search The response will return the Limitation for the date of service KENTUCKY CABINET POA HRALTH AND PARMILY SEAVICES EY Bag GCA MA HA DHAN A LPP pii A TEA a eee Provo Hi
24. N SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logout Pharmacy Claims History Thursday 2 September 2010 2 39 pm Note Pharmacy information is updated every two weeks Disclaimer Claims shown are paid claims only Denied suspended or waiting to be paid claims will not be listed Member ID Last Updated 7 1 2010 Contact Us Copyright amp 2005 Commonwealth of Kentucky Privacy Disclaimer Individuals with Disabilities AII rights reserved Revised on 10 08 2010 Page 23 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 6 Spend down 1 Enter the Member ID or SSN and click the Search button to find the spend down data KENTUCKY 1 CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM K YMMIS 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 All rights reserved KENTUCKY Provwicker Home Member Climo PA Prowler Reforences RA Ves Logout x Spend Down Friday 20 August 2010 12 21 pm Member ID SSN Search Alember ID Mame Spend Down_ Begin Date m FEE El reas 03 10 2
25. OVE ROTererCes Dental Claim Header Drinit i a a Place of posQr c0 T Mr ro Surfaces EN E 1 1 1 1 Units Qo 1 0 Status Q 7 0 Contact Lis Charges lo OO o Allowed anon Warrant Amount Amount Last Updated 11 24 2009 Detail Information cription 1 Identifies this as the Detail Information section of the Details screen 2 Item Line number of the detail This field is auto populated 3 DOS Enter the date the service was provided The indicates that this field is required 4 Place of Service oelect the appropriate place of service from the drop down menu 5 Procedure Enter the ADA procedure code that identifies the service provided The indicates that this field is required 6 Tooth Number Enter the tooth number on which the procedure was performed if applicable 7 Surfaces Enter the tooth surface on which the procedure was performed if applicable 8 Quadrant Use the drop down menu to select the quadrant if applicable 9 Prosthesis Use the drop down menu to select the prosthesis if applicable 10 Cavity Codes Enter Arch code 11 Units Enter the number of units 1 is the default value The indicates that this field is required Revised on 10 08 2010 Page 41 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Field Field Descriptio
26. Summary Screen 5 Details Identifies this section as the Details section of the Summary screen Click on the Detail number to return to that detail Revised on 10 08 2010 Page 43 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 5 1 5 Adjust or Void Claim Screen To adjust or void a paid claim select Claims Inquiry enter member information and dates of service or enter the ICN of the claim Click on the Next button to advance correct the information Save the updated information then click on the Adjust button To Void a claim follow the same process to find the claim then select the Void button If the claim does not show a Adjust or Void Claim button the claim was previously adjusted or void KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES Er HA OCA HA A Sea PAP T OA Te fe Ree Provider Home Member Claims PA Provider References RA Viewer Logout Dental Clair Thursday 7 October 2010 12 58 pm Header gt Details gt Summary Claim Status Paid Claim ICN Pasd Date 20100827 Allowed Amount 63 10 Spenddown Amount EOB Description 9918 PRICING ADIUSTMENT MAX FEE PRICING APPLIED EOB Deserphon 9918 PRICING ADJUSTMIENT MAX FEE PRICING APPLIED Billmg Information Provider Number Member ID HS Last Name LL mum First Name NEN EN Date of Birth 09 25 2003 Gender Ir Patent Acct O Insurance Den
27. a KE NTUCKY CABINET FOR HEALTH AND FAMILY SERVICES EF SER EAL MA PA AE T A A VE ER E TEC NEN a YH ES J Provider Home Member Claims PA Provider References RA Viewer Logout Prior Authorization Inquiry Friday 20 August 2010 12 27 pm Provider s Transaction i 3 Member m PA ID ID Category SSN Last Mame First Mame Start Date 07 07 2008 ru Type Submitted Search Dec tere ID Marrmter MM M Lans Marne Peral Hara PA tCotegory Inpatient Hospital Last Updated 7 1 2010 Pipar Luschsiemer Indhessouagls wim Disabili e dug O 2005 Commeoanweaiin of Kenriucky All nights resend Revised on 10 08 2010 Page 27 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Selecting Search returns the Transaction ID click to open the PA Click on the next button to view the Summary page KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MA AME MT DROS TEA ATOM fa ey Provider Home Hember Claims PA Provider References RA Viewer Logout PA Summary Friday 20 August 2010 12 29 pm Header gt Diagnosis gt Details gt Summary Header Requesting Provider Number PA Category Inpatient Hospital Servicing Provider Number Nursing Facibty Type Member ID Diagnosis Code 1490 First Name Admission Date 07 07 2009 Last Mame Emergency N Accident N Discharge Date Special Consideration M Case Management Disease Management
28. alized on Thursday and Friday for the normal weekly cycle in the 10 25 2009 Weekly cycle In addition any claim received and or processed after 10 17 2009 may not be paid due to the Cash Management Hold currently set at 12 days Last Updated 74 4 2008 Page 6 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 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 Change Password allows user to change the current password Admin and Agent View Agent Roles allows the provider administrator to view the roles granted to an agent Add Agent allows the provider administrator to add agents Kemao KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES eeu ntu rus My Information Change Password View Agent Roles Add Agent Account Home KyHealth Choices Good a emoon hp instit KrHealthnet Kentucky Medicaid Web Site Please select a button above to view or edit your account or assistance email us a ho instit K YHealthnet IKY EDI HelpDeskGhp com 656 Chamberlin Ave or call 800 205 4596 during adi normal business hours 7 00 fam 6 00 pm Monday frankfort KY 40601 Friday EST 200 205 4696 LastAccessed 1 15 2010 1 45 21 PM Last Password Change 1 15 2010 1 45 71 PM Your password wall expire in
29. cky All rights reserved Privacy Disclaimer Individuals with Disabilities Revised on 10 08 2010 Page 31 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 8 3 Provider References Documentation Select Documentation for additional provider resources available at www kymmis com Kentucky gov KENTUCKY kentucky Contact Information F A Q Prowider Letters Prowider Workshop HIPAA Status Forms Prowider Billing Instructions DDE User Manuals Department for Medicaid Services Electronic Claims HIPAA Companion Guides Medicaid Preferred Drug List Contact Information If you need assistance contact us by sending an e mail to the following address KY EDI HelpDesk ContactUs Site Map Privacy Disclaimer Individuals with Disabilities Revised on 10 08 2010 CABINET FOR HEALTH AND FAMILY SERVICES KYW MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Search Advanced Search k yimmis Provider Relations Index Provider Resources Provider Relations is the first line contact for medical provider s questions The area consists of trained skilled staff who respond to both written and telephonic inquiries Please refer to the DMS Provider Enrollment website for specific forms and documentation required for enrollment The Provider Relations area is available for service 8 00 a m until 6 00 p m ET Monday through Friday Page Updates
30. e 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 pass if this is the current business practice for all patients Please note that the Medicare Savings benefit package which includes CQ MIB program code Zy SLAIB program code ZL and O11 Program code ZJ is not full Medicaid coverage This benefit package is for members who have Medicare and KY NMedicaid paws their Medicare premiums Of this group those with Program Code A or OME are also eligible for co pays and deductibles E Service Limitation Ho current coverage for date of service entered Copay Coinsurance Cost Share T ee El Va z Note Cost Share Mei An indicator of YX in this field indicates that the member has met the cost sharing limit for the quarter and is no longer subject to co pawments for the remainder of the quarter Ma current coverage for date of service entered TPL Year History Mo current coverage for date of service entered Partnership Passport E E a le po LEES Sid LINES TET EIETS Shs aor LE N Pree Da A Soe Dace LA a Se ub 08 18 2010 08182010 Lockin Lock Year History No current coverage for date of service entered Revised on 10 08 2010 Page 22 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 5 2 View Pharmacy Claim History KENTUCKY b CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATIO
31. en 7 DEO am 6 00 pen Monday Friday EST whould you hie questions ragandeg this notibcalion Medicaid Erierpmee Users Promsiorang System 5 When user clicks the link in the email example above the Terms of Service User Agreement window appears as shown below Revised on 10 08 2010 Page 13 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 6 User must click agree in order to proceed Kentucky Terms of Service KyHealth Choices You must agree to the terms below before delegating permissions Kentucky Medicaid Web Site UsER AGREEMENT or assistance email us al KY_EDl_HalpDsakf2 hp com is User Account Agreement hereinafter Agreement effective today is made by and of call 200 205 4636 duning between the Commonwealth of Kentucky Cabinet for Health and Family Senices CHFS vonmal business hours 7 00 epartment of Medicaid Serices OMS and users who sign up for an account on this am 5 00 pm Monday rebsite hereinafter User the aforementioned being a bcensed health care provider or an nday EST ritity who acts on behalf of a licensed health care provider EREAS User renders certain professional health care senices Senices ta members f employer groups and indriduals and submits documentation of those Senaces to DMS nd WHEREAS DMS in its implementation of the Medicaid program in Kentucky provides to aahh care companies such as Weer a System of operational and
32. ent Acer Date Type Date OF Service O Warrant Date ICN or TON From Date mej Search From E To Ec RETI ETO fa rat Tera Claim Status Member ID i Last Updated 7 1 2010 nun m rights nos served Select the applicable NPI and Taxonomy if using an agent or billing agent account Enter Member ID and From Date Thru Date or Patient Acct ICN Enter ICN and remove From Date Thru Date Claim Status Any Status Paid Denied and Suspended Date of Service is a search for claim using the dates of service entered or Warrant Date Warrant Date should read as RA date Unfinished claims is a claim not completed but save for future submission Revised on 10 08 2010 Page 36 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 3 Submitting Dental Claim KENTUCKY E CABINET FOR HEALTH AND FAMILY SERVICES Provider Home Member Claims PA Provider References RA Viewer Logout _ Provider Main Page Friday 15 January 2010 2 15 pm e Clam Inqury Subset Dental Clary a cubmrgt Prefeznonal Clam TTT Ru Revised on 10 08 2010 Page 37 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 4 Verify Provider Box Verify the correct NPI and taxonomy display click on next CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORMATION SYSTEM KYMMIS Provider Home Member Claims PA Provider References RA Viewer Logo
33. er This question wall help the Help Desk verify your identity if you need assistance Question In what city were you bon Enter full name of city only Answer kanifol in icabes required fid Mieri Contact Ls Revised on 10 08 2010 Page 3 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 6 The Your account was successfully created window will display You can now log into KyHealth Choices using your new usemame and password you just created by clicking on the Sign In button below or assrtance emi us al Sign In KY EDi HeipDeskfhpcom Privacy Ditdaimar ladividuah B LETT T topynght amp 2006 Commonwealth of Kentucky All rights rerarvad Revised on 10 08 2010 Page 4 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 Signing into KyHealth Choices 2 Sign into KyHealth Choices 7 Access https home kymmis com 8 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 Change your password e Providers Manage your agents access Password Username For assistance email us at KY EDI HelpDesk hp com or call 800 205 4696 during ES ness hours rng you are a biling agent or YOU wish to complete a provider application vou may register here KyHealth Choices Reset your passw
34. ess ormal business hours 7 00 Address im 600 pm Monday Telephone BOC 205 4656 Friday EST Account Owner hp instit KY Healthnet hpinet Remove All Roles el Select the system to modify access O Modify the permissions for selected system System r Roles Select Account Management 7 Seleri KYHealthiet ya Contact Us Revised on 10 08 2010 Page 15 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 3 Notice the 2 Modify the permissions for KYHealthNet section opens 4 Roles are granted or removed in this section Kentucky Account Home My Information Change Password View Agent Roles Add Agent B m Manage Agent Roles KyHealth Choices This page allows you to add and remove roles from the agent Begin by selecting the system in which aay Medicaid Web you want to view or modify the Agent s access Agent Details db Tom nt m Hame edi test edi test Account Status Active or call G00 205 4696 during Email Address ormal business hours 7 00 Address am 6 00 pm Monday Telephone 500 205 46355 riday EST Account Owner hp instit KY Healthnet hpinst Remove All Roles 1 Select the system to modify access E Modify the permissions for KYHealthMNet System Roles Select Account Man agement 7 Card Issuance Select Y HealthMet al Claims Inquiry e Claims Submission Dental La Claims Submission Institutional LU Claims Submission Professional Ed KenPAC Referral
35. he email address of the agent you are adding access to your application and click search 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 Emal Address Email Zuldress viri Firat Naina aet Harms Wamama hptestt ul Eco 0 465 a Phone Ing A TN I 2 Click Add amp Manage Agent buiton Revised on 10 08 2010 Page 12 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 3 The Agent Account Created window appears and You have successfully created a new agent account Your agent wil recae instractions va emad on how to set their password 4 User will receive an email as shown below Automated MEUPS email Example E PASSWORD SETUP Message HTML aep aimed d h Y B 3X ev a ud Ele dt yew eri Format Took Actors Hap G Snagit ES Window 7 deni FRliINOOU 11 55 AM Kentucky user hptestt You have been sent thes massage becausa you have had a new Modicaod enterprise user account created on your bohak Your new account username is hptesri To establish yout password please visit the following URL and follow the on screen instructions https public kymmis comfwink Tlekid 1308711 0785 4 acD 300 1 395c1 013633 Please contact the EDS helpdesk al KY EDI HeipDerkfhnn eom ar call 500 205 4596 betwe
36. ied Authorization Accident Date Place of Service Rendering HBEm Provider lau Charges Total Charges as 00 TPL Amount O 00 Total Amount Paid 63 10 O o Adjust Void Claim Print O Last Updated 8 15 2010 Contact Ls Revised on 10 08 2010 Page 44 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 1 Next Will navigate the user through the claim 2 Adjust To adjust a paid claim make the correction and click save when a save button is available 3 Void Claim To reverse a paid claim click on Void 4 Print Allows user to print this screen Revised on 10 08 2010 Page 45 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Appendix A 9 5 2 Forms Web site link for blank PIN Release form www kymmis com Click on electronic claims Click on frequently asked questions Head What is KYHealthnet Click on link for PIN Release Form 9 5 3 Billing Instructions www kymmis com Click on Provider Relations Click on Billing Instructions Click on Dental Revised on 10 08 2010 Page 46
37. n Definition of Field Description 12 Charges Enter the usual and customary charge for the procedure The indicates that this field is required 13 otatus otatus of the claim if you are accessing a previously submitted claim 14 Allowed Amount The amount allowed by Kentucky Health Choices paid claims only 15 Warrant Amount Total amount of the check 16 Save Saves the detail line on the claim 17 Add Allows user to add an additional detail line 18 Delete Allows user to remove the detail line previously entered 19 Next Click on next to continue to the detail screen 20 Print Allows user to print this screen 9 5 1 4 Dental Summary Screen Below are instructions for filling in the fields Verify the Summary and Click on Submit Claim Options are at the bottom of each claim to void claim adjust claim and submit claim and print claim Revised on 10 08 2010 Page 42 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Prowder Number Member ID Last Name Fen Name Date of Bath Patient Acct i 1 Summary Identifies this as the Summary screen 2 Billing Information Identifies this section as the Billing Information section of the Summary screen 3 Service Identifies this section as the Service Information section of the Information Summary screen 4 Claim Charges Identifies this section as the Claim Charges section of the
38. nes ML EE PA Provider cL cL Ux s MEME 7 Reference Search Eligibility listed does not guarantee payment of a claim Friday 20 August 2010 12 39 pm Provider Choose Search Type Procedure Code Procedure Code 99213 Benefit Plan CCEBW Compe Chost Exp Pop Exp Bas with copay Date Of Service 0001 2010 T l Search Procedure 99213 Compr Chces Exp Pop Exp Bas with copay Limitations for date of service 08 01 2010 Ae PA Requmed Age Restriction O0 999 Maximan Units ooo Gender Borh JActachmentis Do Required CLLA is Not Required Mot a Lifetime Procedure Not Restricted to any Dingnosis jew Resiicted te any ype Specialty Ll LI m Procedure 99213 Compr Chces Exp Pop Exp Bas with copay Linton fer dae of amp erxace 000120010 Ho PA Required Age Restrichon 0 999 Mazemon Lite 5d CLLA is Not Required Mot a Lifetime Procedure Mot Restricted to any Diagnosis Restricted to Tvpe Speciality s o 85 000 Procedure 99213 Compr Chces Exp Pop Exp Bas with copay Limitations for date of service 08 01 2010 Mo PA Required Age Restriction O 999 Maximum Units 999 Gender Both Attachment is Mot Required CLLA is Mot Required Mot a Lifetime Procedure Mot Restricted to any Diagnosis Restricted to TIvpe Speciality s o 80 000 Procedure 99213 Compr Chces Exp Pop Exp Bas with copay Limitations for date of service 08 01 2010 Wo PA
39. ord Contact Us Privacy Disclaimer Individuals with Disabilities Copyright 2006 Commonwealth of Kentucky All rights reserved Revised on 10 08 2010 Page 5 Commonwealth of Kentucky MMIS KyHealth Net Dental 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 MEDICAID SERVICES Friday 15 January 2010 1 45 pm KyHealth Choices Home Sign Out hp instit KYHealthnet Welcome to KyHealth Choices Applications ccount Management WT HealthNet Description Manages contact information password and authorizations for applications Eligibility Verification Claims submission and inquiry Presumptive Eligibility RA Viewer Messages Revised on 10 08 2010 During the Financial Cycle of Friday 10 16 2005 there were several claims that were not processed As a result an additional Financial weekly cycle was processed last night 10 21 2009 This cycle includes ALL claims finalized since 0472009 plus the claims that did not process on 10 16 2008 The impact to any provider with finalized claims is that you will possibly receive a payment for the 0 21 2009 cycle and an additional payment for a smaller amount of claims this will be only claims fin
40. p oi 9 2 2 2 Email examples of password reminder and account change notification 9 2 3 VIEWING Agen HO lGS a cvcstuiqresc uH iPod vv bred pev E abrVpPNDVENN uU PR DP D aud N 11 24 Add an AgentorNew Employee aaa 11 2 4 1 No Email Address Found Create USErname cccccccsssseeeeeceeeseeeeeeeeeeseeeeseaeeeeeeseaas 12 2 5 Manage Agen ROES desean vec ved dev CN id 15 3 ACCESS INS KY Hoani Nel AAA Mr 18 Ass d renonce tU e mmm 19 5 Member ER Vera ii tia 21 5 1 To Search Select Lookup Type coooocccncccconcconcccnonncnncnononcnnnnnononcnnnnnnnnncnnnnnnnnnrnnnnnnnnnrnnnnrnnnnennnnnnnns 21 5 2 View Pharmacy Glaim IISIOLY nenita ia iii 23 6 ODER WT acti ss Motus aces co date totu M catene seta cc ipit EU M peel ioa ta o d aae Seo M ated cotes At at EM oes 24 7 PACPIOLOAUtBOEIZAt OT cas one mi ote deo esc obe uio idend ole LR Rudd ter o mM 25 EN PALETE er mM 26 Te PAMOQUI eR 27 8 Provider Rotten id bi 29 A ie Rm 29 e TIPE GANNON S tess ates aie ahah a a 31 8 3 Provider References DocuMentati0ON cccoonccncccncnnccconcnnoconnnnnononnncononcnnnnnnnnncnnannnnononnnnnnnannncenanens 32 9 A ote A T E ht tre Mnkaden tected E tea Mei sania Getnea matin wemeeate 33 Jek TEMERE E E R 35 SE 36 9 Suba Dental Ol 37 94A Vamy Provider BOCs tud odi nima c Dein eR ee oe a C me Dao Dea 38 SENA gh GF eee O 39 APENAS RUE 46 9 5 2
41. pulated based on the previous screen selection 2 Member ID Enter the Member s Kentucky Health Choices ID number The indicates that this is a mandatory field 3 Last Name The member s Last name This field is auto populated after the member number is entered 4 First Name The member s First name This field is auto populated after the member number is entered Revised on 10 08 2010 Page 39 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide Field Field Description Definition of Field Description 5 Date of Birth The member s date of birth This field is auto populated after the member number is entered 6 Gender The member s Gender This field is auto populated after the member number is entered 7 Patient Account Enter the provider assigned patient account number This field is optional 8 Insurance Denied Paper bill with attachment 9 Prior Authorization If the service requires Prior Authorization enter the 10 digit PA number here 10 Service Information Identifies the Service Information section of the Header screen 11 Emergency If the service is the result of an emergency choose yes from the drop down menu If not leave the default selection no 12 Accident If the service is the result of an accident choose the type of accident from the drop down menu If not leave the default selection none
42. rogram Update 07 14 06 Information on new prior authorization requirements and the DMS Communication Resource Guide KyHealth Choices Prior Authorization Call Checklist 08 02 06 Instructions and interactive response prompts about your prior authorization requests and Radiology Services that Require Prior Authorization 08 01 06 Thank you for your attention to this announcement Last Updated 8 8 2005 Copyright 2005 Commonwealth of Kentucky All rights reserved Page 32 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide O RA Viewer KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES BT BES CAL PLACER SEAT Le NCA Sse CEVAPMERE Provicier Hom ELIT Claims PA Provider 5 1515 2 TST Ea ell Provider Main Page Friday 20 August 2010 1 03 pm Welcome to ihe Kentucky Maicald Vibe The Kentucky Department of Fecdecaid Services secure website is infonaed for providers clerks and balling agents Switch Working Prowder Last LpdMed 71112010 Click RA Viewer to review the remittance advice RA Viewer holds 6 months of RA displaying the most current at the top of the screen Each RA can be downloaded to the desktop or saved to a folder Verify the provider NPI and Taxonomy if using an agent or billing agent account A drop down box is available for these accounts Select the applicable provider to view KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES KY MEDICAL MANAGEMENT INFORM
43. sions selectthe user by browsing below or assistance email us a KY EDI HalpDeskfehp com Pa fn sr call B 206 4686 during aan found Mc You are not sharing permissions to any agents To begin the process of giving access to your agents click on the cara p ral Add Agent button above me Cisdairier Individual wah Gigebibtias Copyright 4 23007 Caommonreath ef Rantuchy 2 4 Add an Agent or New Employee For provider admin and billing agent user accounts Enter email address of agent to search or create an account Kentuck qa KENTUCKY CABINET FOR HEALTH AMD FAMILY SERVICES Add Agent KyHealth Choices Lise this screen to add access to an agent for your application Kentucks Hedicald Web Site Enter the email address of the agent you are adding access to your application and click search or asersiance email us d CC VTL KY EDI HelpDeskfthp com Seach of call 800 206 4696 during ommal business hours 7 00 am 6 00 pm Monday riday EST Contact Us Privacy Disdalmer Individuals Ah Cig ebhiltieg Copyright 23007 Comrmonveaith rp a right ra perred Revised on 10 08 2010 Page 11 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 2 4 1 No Email Address Found Create Username 1 Complete the fields boxed in red below Ketuk Add Agent Use Ms scneen lo add access lo an agent For your appar ahon EvHealih Ehaiens Ernturcky Hedicald weh Enter t
44. ut Dental Claim ef Eligibility Verification Pharmacy History Presumptive Eligibility l y Medicaid If not please take a moment and contact First Health Services to register your NPI at 800 639 5195 As of May 23 2008 KY Medicaid will deny all claims submitted with a legacy provider id m Last Updated 8 15 2010 Revised on 10 08 2010 Page 38 Commonwealth of Kentucky MMIS KyHealth Net Dental Companion Guide 9 5 Dental Claim 9 5 1 1 Dental Claim Header First Column Billing Information oecond Column Service Information Please follow Billing Instructions for Claim type when completing fields Appendix B Web site link for All Medicaid Billing Instructions Below are instructions for completing the fields 9 5 1 2 Below this screen are instructions for filling in the blocks KENTUCKY CABINET FOR HEALTH AND FAMILY SERVICES u Roi RCM Aon RE Red AA Provider Home Member Claims PA Provider References RA Viewer Logout Dental Claim Thursday 19 November 2009 02 15 am Mfeader Bilkng Information rSerace Information Provider Number 2 None j Accident Dac QSOS Mlember ID O Last Name pot la Place of Service B Rendering qur Provider Q First Name Date of Parth Gender Patent Acct Insurance No Demed Q No en o Authonzaton 1 Provider Number Enter the Kentucky Health Choices NPI number This field is auto po
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