State · KY
Medical billing services in Kentucky
Short answer
Medical billing services in Kentucky are managed care billing with one state rulebook: six MCOs cover every county, CMS counted 90 percent of Kentucky Medicaid enrollees in them in 2024, and each plan carries the state's 12-month filing limit from the date of service.
Commercial claims fall under the prompt-pay law in KRS 304.17A-700 to 304.17A-730, which adds interest at 12, 18 and 21 percent a year as a clean claim ages past its due date. Medicaid rides are booked 72 hours ahead through the Transportation Cabinet's regional brokers, not the health plan, and personal care visits run through EVV. A Remitwright dedicated biller works those rules per payer, serving Kentucky practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Kentucky: what's different
The rules below change how a claim is filed and paid in Kentucky. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Kentucky | Source |
|---|---|---|
| Medicaid program | Kentucky MedicaidDepartment for Medicaid Services (DMS), Cabinet for Health and Family Services | 1 |
| Fee-for-service portal | KYMMIS (Kentucky Medicaid Management Information System) | 1 |
| How Medicaid is delivered | Almost all managed care | 3 |
| Managed care plans | 6 plansAetna, Anthem, Humana, Molina, UnitedHealthcare Community Plan of Kentucky, WellCare of Kentucky | 4 |
| Medicaid timely filing (stated in the MCO manuals) | 12 months from the date of service | 2 |
| Prompt-pay law | KRS 304.17A-700 to 304.17A-730, Kentucky's prompt-pay law | 9 |
| NEMT | Human Service Transportation Delivery | 7 |
Kentucky Medicaid
Kentucky Medicaid is run by the Department for Medicaid Services (DMS), Cabinet for Health and Family Services. Fee-for-service claims and provider enrollment go through KYMMIS (Kentucky Medicaid Management Information System)1, at www.kymmis.com. Almost all managed care: CMS counted 1,303,955 of Kentucky's 1,449,651 Medicaid enrollees, 90.0 percent, in full-benefit managed care organizations as of July 1, 20243. The six MCOs each cover the whole state, so the member's plan comes from the eligibility response rather than the county. Every enrollee is also counted in the Transportation Cabinet's non-emergency medical transportation program.
Medicaid timely filing (stated in the MCO manuals): 12 months from the date of service for outpatient and professional claims, or from the date of discharge for an inpatient stay, the Kentucky Medicaid limit that the MCO provider manuals carry2. WellCare of Kentucky accepts initial, corrected and voided claims up to 12 months from the date of service or six months from the Medicaid or primary insurance payment date, whichever is later, and points to the DMS website for the state rule. UnitedHealthcare Community Plan of Kentucky states the same 12-month rule, treats a rejected claim that is not corrected within 90 days as late billed, and accepts an EDI submission report as proof of timely filing only when the acceptance report comes with it.
Managed care plans4
- AetnaStatewide Kentucky Medicaid MCO, 222,208 members in CMS's 2024 count
- AnthemStatewide, 157,364 members in 2024
- HumanaStatewide, 142,985 members in 2024
- MolinaStatewide, 280,749 members in 2024
- UnitedHealthcare Community Plan of KentuckyStatewide, 81,613 members in 2024
- WellCare of KentuckyStatewide, 419,036 members in 2024, the largest plan
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Kentucky Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Kentucky11: Anthem Health Plans of Kentucky, Molina Healthcare of Kentucky, WellCare Health Plans of Kentucky, UnitedHealthcare Insurance Company, UnitedHealthcare of Kentucky, Ltd. A Kentucky practice works to a separate provider manual for each, with its own filing window, corrected-claim process and appeal levels. Verified payer deadlines, each with its source, are in the timely filing limits table.
Prompt pay in Kentucky is governed by KRS 304.17A-700 to 304.17A-730, Kentucky's prompt-pay law9. The law requires an insurer to adjudicate a clean claim within the claims payment time frame set in KRS 304.17A-702. Under KRS 304.17A-730, as the Department of Insurance's reporting instructions restate it, a clean claim paid 1 to 30 days after its due date carries interest at 12 percent a year, 31 to 60 days late at 18 percent, and more than 60 days late at 21 percent, all running from the date payment was due. Insurers and the Medicaid MCOs file quarterly prompt payment reports with the department. In A/R follow-up, a clean claim that sits unpaid is escalated with the statute cited.
NEMT and home care in Kentucky
Non-emergency medical transportation. Human Service Transportation Delivery: the Kentucky Transportation Cabinet's Office of Transportation Delivery arranges Medicaid non-emergency medical transportation through regional transportation brokers, and the member calls the broker at least 72 hours before the appointment, counting weekends and holidays7. A trip qualifies when the member is going to or from a covered, medically necessary service and no free transportation or appropriate operational vehicle is available. The cabinet took over transportation for the Department for Medicaid Services, the Department for the Blind and the Department of Vocational Rehabilitation. The NEMT billing in Kentucky page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Required for Medicaid personal care services under the state plan personal care benefit and the 1915(c) home and community based services waivers; CMS accepted the Department for Medicaid Services' EVV compliance attestation on January 19, 2021, so federal matching reductions do not apply to those services12. CMS reserved the right to apply the reductions if the system does not match the attestation and requires an updated survey if Kentucky adds a personal care authority. The letter covers personal care services only and does not address home health care services. See home care billing in Kentucky for waiver programs, EVV exceptions and authorizations.
Rules that change how Kentucky claims are billed
Six statewide MCOs since 2011, with a 90-day window to change plans5
CMS's 2024 state tables describe the Kentucky Managed Care Organization Program as a statewide program of full-benefit MCOs under 1915(b) authority, running since November 1, 2011 with its waiver approved through December 31, 2025. Enrollment is mandatory for low-income adults, aged, blind or disabled members, non-disabled children, full dual eligibles, Native American members and children in foster care or adoption assistance, and the enrollment choice period is 90 days. The companion plan file counts six plans for 2024, from WellCare's 419,036 members to UnitedHealthcare's 81,613, each operating in every county.
A retroactive MCO change reopens the filing window2
WellCare of Kentucky's manual defines retroactive Medicaid coverage as up to three months before the application month and covers medically necessary services in that period without prior authorization. When a provider learns of a retroactive change in MCO only through a recoupment letter after the filing period has closed, the plan must accept the claim and may not deny it for timely filing. The manual also lets a hospital rebill an inpatient stay as outpatient within 365 days of the end of the service month when the outpatient setting would have met the member's needs.
Provider disputes can end in a DMS administrative hearing1
UnitedHealthcare Community Plan of Kentucky's 2026 manual says that under 907 KAR 1:671 providers have the right to an administrative hearing beyond the plan's own dispute process, requested in writing within 30 days of the plan's internal appeal determination to the Office of the Commissioner, Department for Medicaid Services, Cabinet for Health and Family Services in Frankfort. The same manual asks providers to verify eligibility before every service through the plan portal, Provider Services or the Kentucky Medicaid Management Information System, KYMMIS, and lists a timely filing denial among the top reasons claims come back.
The prompt-pay law protects contracted providers only8
In Advisory Opinion 2004-01 the Office of Insurance narrowed its reading of KRS 304.17A-700 to 304.17A-730: it enforces the Prompt-Pay Law against an insurer only when the insurer has a contractual obligation to pay the provider, a clean claim can be made only by a provider with the contractual right to submit it, and only providers who have directly or indirectly contracted with the insurer can submit the properly completed billing instrument a clean claim requires. Non-participating providers and covered persons fall back on KRS 304.12-235 and 806 KAR 12:092 instead.
Insurers report clean-claim timing to the Department of Insurance every quarter10
Under KRS 304.17A-722 every insurer offering a health benefit plan files a quarterly prompt payment report with the Department of Insurance, and dental-only limited health service benefit plans file annually. The report counts clean claims received and the percentages adjudicated within the claims payment time frame, 1 to 30, 31 to 60 and 61 to 90 days after it, more than 90 days after it, and not yet adjudicated, plus the interest paid and the share of clean claim dollars paid on time, split by hospital, physician and all other providers. A biller aging a Kentucky commercial claim is measuring the same intervals the regulator reads.
Rides are brokered by the Transportation Cabinet, not the health plan6
Kentucky consolidated transportation for the Department for Medicaid Services, the Department for the Blind and the Department of Vocational Rehabilitation under the Transportation Cabinet's Office of Transportation Delivery, whose Human Service Transportation Delivery branch runs the regional brokers. CMS lists the non-emergency medical transportation program as statewide under 1915(b) and 1902(a)(70) authority since October 21, 2010, and counts all 1,449,651 Kentucky Medicaid enrollees in it. A transportation provider bills against the broker's authorization, and the MCO is not part of the trip.
Services for Kentucky practices
Remitwright serves Kentucky practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Kentucky practices
What is the Kentucky Medicaid timely filing limit?
Which Medicaid MCOs do we contract with in Kentucky?
How quickly must insurers in Kentucky pay a clean claim?
Does Kentucky require EVV for home care visits?
Who arranges NEMT rides for our Kentucky Medicaid patients?
Where do Kentucky Medicaid fee-for-service claims go?
Which commercial payers did you list for Kentucky, and why those?
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