At WellCare of Kentucky, we value everything you do to deliver quality care to our members – your patients – to ensure they have a positive health care experience. That’s why in response to several questions and/or payment issues about medical supplies and DME items that we’ve recently received, we have put together an FAQ to help you.
WellCare of Kentucky wants to accurately reimburse our home health providers according to the specific terms of your contract. WellCare of Kentucky is aligning our payment system more closely with the Department of Medicaid Services (DMS). Our goal is a more transparent payment methodology.
Below are the FAQs and references detailing these points.
Q1: Can a home health agency provide supplies to a WellCare of Kentucky member if the items are under $250 without an authorization?
A: No. All services provided in a home setting (POS 12) require an authorization. If a provider has a current authorization for skilled nursing services such as wound care (or other services requiring supplies), the supplies needed for the authorization period only will be covered under the same authorization.
Q2: Can I bill for all supplies under one authorization up front?
A: Supplies should be billed for the applicable date of service upon disbursement. Supplies should not be distributed in bulk to the member.
Q3: If the supplies are part of the service, how do I bill for them?
A: Home health schedule of supplies as defined by DMS can be billed using revenue code 270 and associated HCPCS codes.
Q4: Can a home health agency obtain an authorization to provide supplies for a member who is not currently their patient?
A: No. Any supplies outside of an authorized home health service should be provided by a certified DME supplier contracted with WellCare of Kentucky.
Q5: Can a home health agency provide durable medical equipment to a WellCare of Kentucky member?
A: No. Durable medical equipment must be provided through a certified DME provider contracted with WellCare of Kentucky.
Q6: Does WellCare of Kentucky policy align with KY DMS in reference to incontinence supplies limits?
A: Yes. T4521 through T4534 limits include any combination of these codes to a maximum of 192 per month, as listed on Home Health Schedule of Supplies. DMS fee-for-service (FFS) allows incontinence supplies to be provided by the Home Health agency through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) FFS for members 21 and under.
To download the Medicaid DME Fee Schedule, please visit Medicaid DME Fee Rates. For the Home Health Schedule of Supplies, visit Home Health Schedule of Supplies (PDF).
We’re here to help, and we continue to support our provider partners with quicker claims payments and dedicated local market support. Please feel free to contact your provider representative if you have questions or need assistance.
Quality care is a team effort. Thank you for playing a starring role!
