Insurance Updates

Anthem

Recoupment Request for No Prior Authorization

The KAC is aware that providers have been receiving recoupment requests for lack of prior authorization. In late 2019/early 2020, the KAC was successful in stopping Anthem from requiring prior authorization for chiropractors through AIM in Kentucky. Providers should...

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Humana

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 an ACA compliant plan. ...

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Prior Authorization

    Humana has reinstated the prior authorization requirement on the first date of service.  This went into effect starting October 1, 2019.  Please remember to obtain authorization at the start of care and not after the eighth...

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WellCare

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 obtain...

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Passport

Passport 10-7

We continue to work on denials from Passport when billing both a spinal adjustment and an extremity adjustment.  We have been told by Passport provider reps this edit has been identified and fixed.  However, providers are still seeing these denials. All affected...

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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...

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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...

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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...

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Medicare

2022 Medicare Fee Schedule for Chiropractors in Kentucky

The 2022 Medicare fee schedule has been released on the CGS website. For your convenience, the fee schedule is below. Should you wish to lookup the fee schedule on your own, please visit the CGS website here. 2022 Kentucky Part B Physician Fee Schedule Results...

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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...

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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...

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