Billing Basics for Provider Services

Policy

Transformations agrees to reimburse providers for services that meet medical necessity and documentation guidelines that comply with Medicaid and the Correct Coding Initiative established by CMS and the Department for Medicaid Services, are approved by the third party payer and client, have a bill/and documentation of services accurately submitted to the agency through the Electronic Medical Records program or other agency designation and only after payment for services is made to the agency by the designated payer.

Procedures

Providers should familiarize themselves with policies and procedures for

• The Electronic Medical Records System and accompanying trainings on How to Enter a Client Session Bill
• CPT Codes
• Modifiers
• Location Codes
• Authorizations
• How to enter claims for secondary insurance plans

Resources and Links

KY Medicaid Provider Billing Instructions For Multi-Specialty Groups  State link is currently down.

National Correct Coding Initiative

Revised : 10-23-2018