Insurance Updates
Anthem
Anthem Medicaid contract expiring after December 31, 2024
Effective January 1, 2025, Anthem will no longer participate in Kentucky’s Medicaid Managed Care Program. Anthem will continue to be responsible for proper and timely adjudication of all claims for services rendered to its enrollees until 11:59 p.m. on December 31,...
Important reminder: The correct original claim number must be included if submitting a corrected claim
Anthem March 12, 2024 - Anthem Provider Communications When we receive a corrected claim and it doesn’t have the original claim number, or the original claim number is not correctly entered, we are not able to process it because we’re not able to connect it to the...
Humana
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...
96/97 Modifier
The KAC is working on issues providers are having with Humana Commercial plans. One area we have had consistent complaints with is the 96/97 modifiers. Humana has informed us that these modifiers are only necessary when it is...
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
2025 Medicare Fee Schedule for Chiropractors
The fee schedule below is current as of 11/27/2024. Please note, facility fees are listed on the top row. Most chiropractors are NOT in a facility so please make sure you're looking at the correct line. The 2025 Medicare deductible is $257, an increase in $17 from...
Humana Medicare Advantage notice to patients
Some KAC members have contacted us about a Humana Medicare Advantage notice their patients received regarding 2025 coverage changes. The notice, part of the Annual Notice of Changes, highlights updates to the plan but doesn’t reflect full coverage details. It states...
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...