Kentucky Medicaid Managed Care Commercial claim process for codes not covered outside of Medicaid

The Kentucky Department of Medicaid Services (DMS) and Kentucky Medicaid Managed Care Organizations (MCOs) collaborated to develop a process for Anthem Blue Cross and Blue Shield Medicaid to pay claims for specific procedure codes and modifiers typically deemed as not covered outside of Anthem Blue Cross and
Blue Shield Medicaid.

This process is effective for dates of service on or after May 1, 2023.

For detailed information about the process provided by DMS, read their notice to providers. 

We have posted the documents associated with this process on our website:

• Kentucky Medicaid Managed Care Commercial Attestation Form
• Kentucky Medicaid Managed Care Commercial Code List

If you have questions about this communication, please contact your Provider Relations Management representative or the Provider Services department at 855-661-2028.