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Anthem Kentucky Managed Care Plan, Inc.’s Termination 

Anthem will no longer be a Kentucky Medicaid Managed Care Organization starting January 1, 2025. Anthem will continue to process claims up to 365 days post termination. Anthem will also complete all appeals and grievances for claims with dates of service through December 31, 2024. For questions on claims or services rendered prior to January 1, 2025 you may contact Anthem Provider Services at 855-661-2028. If you have any issues or questions, you may contact Humana Provider Services at 800-444-9137. You may also take steps outlined in the How to Reach Us section in this Kentucky Medicaid flyer .

From time to time, Humana Healthy Horizons® in Kentucky send our provider partners information via network notice. These notices cover information from us as well as from the Kentucky Department for Medicaid Services (Kentucky DMS). You’ll find below network notices we’ve issued since 2020. We list these network notices in the order we issued them. Please note: The date we reference is the date of issuance and not necessarily the effective date.

Visit our prior authorization webpage for prior authorization guidance. We strongly urge our providers to review this guidance, as it outlines changes to existing procedures and provides information on when the changes go into effect.

Electronic visit verification for home health care services

Electronic Visit Verification (EVV) for home health care services (HHCS) is scheduled to begin Dec. 28, 2023. HHCS providers should use EVV to document service visits as soon as possible and no later than Jan. 1, 2024. DMS expects providers to follow the adoption schedule below for EVV. As stated in the DMS Electronic Visit Verification Compliance notice , effective Jan. 1, 2025, any HHCS claim without a corresponding visit documented using EVV will be denied.

  • Jan. 2024: Providers must use EVV to capture data for at least 50% of service visits.
  • Feb. 2024: Providers must use EVV to capture data for at least 75% of service visits.
  • March 2024: Providers must use EVV to capture data for 100% of service visits.

Therap Services® partnered with the Cabinet for Health and Family Services (CHFS) in the commonwealth of Kentucky to bring its EVV system to providers of home health and personal care services across the state. Providers with questions about EVV for HHCS adoption rates should call Kentucky DMS at 844-784-5614 or email Kentucky DMS at 1915cWaiverHelpDesk@ky.gov . Providers with questions about the Therap system should visit the Therap Kentucky EVV website or email Therap at KYSUPPORT@therapservices.net .

Contact Information

Providers with questions can also reach out to DMS and Therap directly.

To contact DMS, call (844) 784-5614 or email  1915cWaiverHelpDesk@ky.gov .

To contact Therap, email KYSUPPORT@therapservices.net .

Medicaid public health emergency (PHE) unwinding information

Consumer alert: What to know if someone calls a Medicaid recipient about short-term health insurance products

The Public Health Emergency (PHE) ended on May 11, 2023. Kentucky began annual renewals in April 2023 and will continue renewals over 12 months.

Learn more about the PHE unwinding from the Cabinet for Health and Family Services

Learn more about the Medicaid revalidation process

Network notices

2025

Behavioral Health Authorization Resumption Frequently Asked Questions

Psychoeducation, Peer Support, and Out of Network Policies

Humana Learning Center on Availity Essentials

Corrected claims reminder

Applied Behavior Analysis Reminder

Humana Healthy Horizons in Kentucky Provider Manual Update

Invoices for high-cost prescription drugs

Behavioral health authorization reinstatement

Webinar training for behavioral health authorization reinstatements - update

American Society for Addiction Medicine (ASAM) Fourth Edition

Prior Authorization for Behavioral Health Services – Rescission of the March 14, 2025 and Partial Rescission of the November 9, 2024 Letters

Kentucky Department for Medicaid Services: Resumption of Prior Authorization (PA) for Certain Behavioral Health Services

Humana Coverage Policy Updates - effective April 25, 2025

Humana Healthy Horizons in Kentucky’s partnership with ProgenyHealth®

Humana Coverage policy updates – effective March 26, 2025

Provider inquiry, grievance, contracted rate dispute, appeal and external independent review

Humana Coverage policy updates – effective February 10, 2025

Behavioral Health Policy Updates for Psychoeducation (H2027) and Peer Support Services (H0038)

2024

Kentucky Department for Medicaid Services - Vaccines for Children (VFC) billing modification

Oral Surgeon Billing Change

New Avēsis Portal Access

Medicaid Provider External Independent Review (EIR) Intake Form Network Notice

Humana Healthy Horizons in Kentucky Humana Coverage Policies Updates November 4, 2024

Expanded Retrospective Review Policy

Humana Healthy Horizons in Kentucky Humana Coverage Policy Updates - effective August 2, 2024

Claim Coverage Policies Network Notice

Contracted Rate Dispute Form and Process Network Notice

KY MCD Provider Modifier 52 and 53 Network Notification

KY MCD Provider Modifier 78 Network Notification

KY PROV NN ASC Bundled Svcs Network Notice

KY PROV NN DME Capped at Rental Network Notice

KY PROV NN Venipuncture EM Network Notice

Humana Healthy Horizons in Kentucky Humana Coverage Policy Updates - effective May 6, 2024

Urine drug testing policy

Humana Healthy Horizons in Kentucky Humana Coverage Policy Updates - effective February 12, 2024

Medicaid Physicians Certification Statement (PCS) Form for Non-Emergent Ground Transportation

2023

Partial Hospitalization Place of Service after Public Health Emergency

Rural Health Clinic (RHC) amended regulation provider letter updated October 12, 2023

Durable Medical Equipment Provider (PT 90 / PL #A-42) updated October 20, 2023

Humana Healthy Horizons in Kentucky Humana Coverage Policy Updates- effective November 15, 2023

Public Health Emergency Prior Authorization Guidance – updated December 6, 2023

NEMT services for methadone treatment

Humana Healthy Horizons in Kentucky Humana Coverage Policy Updates- effective August 18, 2023

Emergency department E/M claim reimbursement policy update

Fee schedule – 90-day notice – effective Aug. 14, 2023

Substance use disorder (SUD) inpatient and residential services prior authorization (PA) reinstatement – effective Mar. 31, 2023

Humana Healthy Horizons in Kentucky coverage policy updates – effective Mar. 27, 2023

Annual sports physical exam

Annual MCG clinical guideline update

Neonatal Intensive Care Unit (NICU) DRG claims payment policy – effective July 1, 2023

Clinical trial attestation form requirement – effective May 10, 2023

Out-of-network claims payment policy update – effective March 3, 2023

Humana Healthy Horizons in Kentucky coverage policy updates – effective Feb. 20, 2023

Provider relations on-site visits with primary care physicians – effective Jan 1., 2023

2022

Adult benefit expansion for Kentucky Medicaid fee-for-service and Managed Care Organization (MCO) enrollees – Dec. 1, 2022

Enrollee eligibility redetermination and Compass enhancements - Nov. 14, 2022

Emergency department E/M reimbursement – Oct. 3, 2022

Colorectal cancer screening awareness - Sept. 23, 2022

PT/OT/ST Preauthorization notice – Sept. 1, 2022

Provider guidance for anesthesia modifier billing from Kentucky DMS – Aug. 2, 2022

Grievance and appeal time frame change – July 26, 2022

Billing requirements according to the SUD 1115 Waiver – July 25, 2022

Substance use disorder (SUD) inpatient and residential services prior authorization (PA) reinstatement – June 7, 2022

Neonatal Intensive Care Unit (NICU) claims payment policy – May 2, 2022

Required documentation: Notice, completion, retention and claim submission – Jan. 1, 2022

2021

PCP-enrollee relationships: Proactive status monitoring and involuntary dismissals – Dec. 14. 2021

Provider annual compliance training deadline notice – Oct. 8, 2021

Provider requirement to report incarceration guidance from Kentucky DMS – Sept. 2, 2021

Provider appeal time frame for medical necessity determination – Jan. 1, 2020 (posted August 31, 2021)

Interim billing requirements for enrollee disenrollment after inpatient admission – July 1, 2021

MedImpact single pharmacy benefit manager notice – July 1, 2021

Kentucky Revised Statute: 205.6312 – June 29, 2021

Durable Medical Equipment (DME) Claims Payment Policy update – June 21, 2021

No-show or cancellation fees for Medicaid members guidance from KDMS – May 21, 2021

State-supplied vaccines policy – May 1, 2021

Updated Retrospective Review Policy – March 1, 2021

Required forms: Notice, completion, retention and claim submission – Feb. 11, 2021

Reminder of department IMD requirements and Humana reimbursement policy – Feb. 1, 2021

Kentucky Medicaid Regulation: 902 KAR 2:020 Reportable Disease Surveillance – Jan. 1, 2021

Out-of-Network Claims Payment Policy update – Jan. 1, 2021

2020

Acupuncture value-added service notification – Dec. 1, 2020

Doula value-added service notification – Dec. 1, 2020

Reminder: Claim submission requirements update – Dec. 1, 2020

Claim dispute process network notification – Nov. 1, 2020

Incontinent supply reimbursement – Oct. 1, 2020

Introducing Humana Healthy Horizons® in Kentucky – Sept. 1, 2020

Updated Retrospective Review Policy – Aug. 7, 2020

Out-of-network Claims Payment Policy update – Aug. 1, 2020

Medicaid and CHIP Provider Relief Fund application deadline extended to Aug. 3, 2020 – July 31, 2020

Provider Relief Fund for Medicaid and CHIP distribution webinar – July 8, 2020

Timely filing change – July 1, 2020

Humana Urine Drug Testing (UDT) Policy – July 1, 2020

Urine Drug Testing Policy from KDMS – July 1, 2020

Kentucky New Horizon provider newsletter

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Kentucky Medicaid

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