Transformations will employ generally accepted accounting principles and practices that are in accordance with 907 KAR 15:010 and 907 KAR 1:604. Recipient cost-sharing.and the third party payer’s billing Instructions .
When the department for Medicaid services makes payment for a covered service and the individual behavioral health provider, behavioral health provider group, or behavioral health multi-specialty group accepts the payment:
- The payment shall be considered payment in full;
- A bill for the same service shall not be given to the recipient; and
- Payment from the recipient for the same service shall not be accepted by the individual behavioral health provider, behavioral health provider group, or behavioral health multi-specialty group.
- The agency agrees to accept payment from the third party payer for claims submitted as full and final payment for covered services rendered. The agency will not seek further payment from a recipient or the parent, guardian, or custodian of the recipient for a service beyond the reimbursed amount.
- The agency will receive approval for each employee intending to provide IMPACT Plus services on behalf of the Sub provider prior to the provision of the service by the individual.
- The agency will not provide IMPACT Plus service not authorized in xTransformations’ contract with the Department.
- Transformations’ agrees that the Department for Medicaid Services, the Medicaid Managed Care Organization Plans and private insurance plans shall not be liable for or exercise control over, the manner or method by which Transformations’ provides or arranges for services. Transformations’ understands that determinations, if any, to deny payments for services which any Managed Care Organization does not deem to constitute as medical necessary services or which were not provided in accordance with the requirements of Transformations’ contract with the Department may result in non-payment.
- Transformations’ understands that a denial of services does not absolve Transformations’ and its contracted providers of the responsibility to exercise independent judgment in treatment decisions.
- Transformations’ understands that the contract with the Department and applicable Medicaid Managed Care Organizations or commercial insurance plans or other third party payors does not intend to interfere with Transformations’ contractor’s provider-patient relationship with any individual.
- All billable documentation shall include the amount of units billed.
- A billable unit of service shall not include the rounding up of minutes or hours.
- Transformations agrees to follow and use all current billing instructions, and forms issued by the Department and any applicable Medicaid Managed Care Organization or commercial insurance plans or other third party payors for the routine administration of the program.
- The following costs shall not be billed: room and board, or educational, vocational, or transportation services unless otherwise contracted for services.
- Transformations’ agrees to the immediate recoupment of any and all payments made by the Department to Transformations and Transformations’ contractors for the delivery of Medicaid or Medicaid Managed Care Organizations or commercial insurance plans or third party payors covered services when a determination is made by the Department, the Department for Medicaid Services, or any applicable Managed Care Organization, that says Services were not delivered in accordance l.
Resources and Links
907 KAR 1:604. Recipient cost-sharinghttp://www.lrc.ky.gov/kar/907/001/604.pdf
Kentucky Medicaid Copay Policy 12/2018
Revised : 10-23-2018