At WellCare of Kentucky, we value everything you do to deliver quality care to our members – your patients – and to ensure they have a positive healthcare experience. As a valued partner in providing quality behavioral healthcare to our Medicaid members, we want to inform you of an important change that will affect your WellCare patients.
Due to changes in regulation, all managed care organizations are implementing co-pays for Kentucky behavioral health Medicaid claims as of Jan. 1, 2019. The Department for Medicaid Services (DMS) has created a new policy update that provides a summary of the copays that will become effective, as well as answers to some frequently asked questions. In addition to the policy update, DMS has created a quick reference guide that provides examples that will assist providers in viewing and interpreting copay information in Kentucky HealthNet. Both of these documents are available on the DMS website.
In addition to the codes listed below, we encourage you to review the policy update from DMS for important information regarding exempt member populations, multiple services provided on the same day, refusal of services, and other key topics.
- The following procedure codes will be assessed a $3 copay on behavioral health claims. Please note that if more than one code is billed on the same date of service the copay is charged only one time.
90785, 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90845, 90846, 90847, 90853, 90863, 90865, 90870, 90875, 90876, 90887, 90889, 90899, 96101, 96102, 96103, 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96125, 96150, 96151, 96152, 96153, 99201, 99213, 99214, 99215, 99354, 99355, 99408, 99409, H0001, H0002, H0006, H0012, H0015, H0018, H0019, H0020, H0024, H0025, H0031, H0032, H0036, H0038, H0040, H0046, H0047, H0049, H0050, H2010, H2012, H2014, H2015, H2019, H2021, H0027, S9480, S9484, T1007 - Case Management (T2023) and Crisis Services (H2011,S9485) are excluded from copay collection;
- Partial hospitalization (H0035) and all outpatient hospital claims will be assessed a $4 copay per day; and,
- Inpatient hospital claims will be assessed a $50 copay per admission. Inpatient rules are applicable to acute care hospitals, psychiatric hospitals, and psychiatric Distinct Part Unit
If you have questions and/or need additional information, please contact your Provider Relations Representative or your Quality Practice Advisor.
Again, we truly value this partnership, and continue to support our provider partners with quality incentive programs, quicker claims payments and dedicated local market support. Please register for access to the secured provider area of our Website at www.wellcare.com, and get instant access to eligibility information, claims and authorization status information and much more.
Quality care is a team effort. Thank you for being a starring player!
