Providers Must Comply with Medicaid Requirement by July 1
Tuesday, June 13, 2017 7:58 AM
With the implementation of the Affordable Care
Act (ACA), the Centers for Medicare and Medicaid Services (CMS) requires all
ordering, referring and prescribing providers to be enrolled in the state
Medicaid program. Further, all Attending Providers must also be enrolled in
Kentucky Medicaid and be eligible on the claim's date of service.
The Department for Medicaid Services implemented new claim editing to
monitor this requirement on April 1, 2017. As such, this requirement
is applicable to all claims with dates of service beginning on that
date and going forward. In order to allow providers time to comply with
this requirement, claims with dates of service between April 1. 2017, and
July 1, 2017, that do not meet this requirement will continue to be paid
and providers will receive an "informational" EOB indicating that incorrect Attending Provider
data has been submitted.
dates of service beginning
on and after
2017, that do
comply with this requirement will be denied.
Please verify the Attending Providers you are using to submit
your claims are enrolled in Kentucky Medicaid and are currently eligible. Further, please verify that you are submitting the correct NPI for
these providers. If you are submitting an Attending Provider taxonomy
along with the NPI, please verify that you are submitting the Attending
Provider's correct taxonomy.