Insurance Updates
Anthem
Humana and Anthem Chiropractic Issues Update
Humana Medicare Advantage We have begun to see Humana Medicare Advantage claims processing with payments issued toward the end of December. This is a positive development. We are continuing to actively monitor claims activity to ensure consistency and to identify any...
Claim filing update for contiguous county members
Starting December 18, 2025, claims that meet the criteria below must be submitted directly to Anthem. This update removes the need to verify the member’s home address, enhancing claims filing efficiency. If you do not have a contiguous contract, this change will not...
Humana
Humana Medicare Advantage: New Paper Claim Administrative Fee Effective July 1, 2026
Humana has announced that effective July 1, 2026, a $5.00 administrative fee will be assessed on each paper claim submitted on a CMS-1500 or UB-04 form for Medicare Advantage plans. This fee applies when the reimbursement amount for the claim is equal to or greater...
NOTICE: WholeHealth Living Authorization Submissions Moving to Availity on April 1
We want to make sure you are aware of an upcoming change from WholeHealth Living that takes effect on April 1, 2026, just around the corner. Beginning April 1, all authorization requests for WholeHealth Living must be submitted through the WholeHealth Living Payer...
WellCare
Ambetter Updates
Effective January 1, Ambetter has become an independent marketplace plan for Kentuckians. We have recently communicated with Ambetter regarding their chiropractic policies following the transition. It has come to our attention that the separation of their...
No Changes To PreAuthorization
WellCare sent out communication on 2/28/2019 stating there “would be an increase focus on ensuring that our providers follow our existing pre-service authorization and notification requirements.” This does not change what services you will need to...
Passport
January 25, 2022 – Insurance Update for Chiropractors
The KAC leadership continues to work hard on your behalf. Many of these updates were given in-person at our 2022 LB Payne Insurance Update. We wanted to send a follow up email reminding KAC members of these changes.Remember, if you are experiencing any issues, please...
Updates to Coordination of Benefits (COB) for all KY Medicaid Managed Care Members
The KAC received the following update from Passport: DATE: July 1, 2021 TO: KY Medicaid Managed Care Organizations FROM: MedImpact Healthcare Systems Updates to Coordination of Benefits (COB) for all KY Medicaid Managed Care Members On Thursday, July 1, 2021, a...
Humana Medicaid
GP Modifier
Providers have reached out to the KAC regarding denials for therapy codes (97XXX) when billing Humana Caresource. It appears they are now requesting these codes be billed with the GP modifier. You can rebill any denied claims as corrected and attach the GP modifier...
Aetna Better Health
Children Under 3
We continue working with Aetna on a variety of issues including Medicare crossover claims and denials for care given to children under three. We have sent requested information to Aetna on both these issues and will update members as soon as we have more...
Children Under 3
The Insurance Relations Committee recently met with ABH representatives regarding several issues our members have brought to the KAC. At this time, ABH continues to deny claims for children under three years of age. We discussed the...
Medicare
Updated Medicare Fee Schedule – 4/1/2026
2026 - Effective 04/01/2026 - Kentucky Part B Physician Fee Schedule NOTE: The 2026 Medicare Fee Schedule has been updated as of 4/1/2026. To see the previous fee schedule, click here. Results matching 98940: # – These amounts apply when service is performed in a...
Humana Medicare Advantage: New Paper Claim Administrative Fee Effective July 1, 2026
Humana has announced that effective July 1, 2026, a $5.00 administrative fee will be assessed on each paper claim submitted on a CMS-1500 or UB-04 form for Medicare Advantage plans. This fee applies when the reimbursement amount for the claim is equal to or greater...
Miscellaneous
New Medicaid MCO Contracts Awarded
On May 29th, Governor Beshear announced the new Medicaid MCO contracts that will take effect on January 1st, 2021. There will continue to be five MCO's with Aetna Better Health, Humana, and Wellcare having their contracts renewed. Molina Healthcare and...
Medicaid License Update
You will need to send your updated license to Medicaid prior to May 1, 2020. Medicaid now has a provider portal you will use to update your license. Some providers have reported this is not an easy process. The address for the Portal is located at the Partner...