Health care providers who deliver home infusion care to UnitedHealthcare Community Plan of Kentucky Medicaid members must register as both a pharmacy provider (PT 54) and a durable medical equipment (DME) provider (PT 90).
Specialty pharmacies that bill UnitedHealthcare Community Plan of Kentucky for nursing, administration or supplies must also register as a DME provider (PT 90) with Kentucky Medicaid.
Billing requirements
- The provider must bill drugs through the member’s pharmacy benefit using the provider’s pharmacy taxonomy by submitting a claim to the Pharmacy Benefit Manager (MedImpact) at point of service
- Bill nursing, administration and supplies directly to UnitedHealthcare Community Plan of Kentucky under the member’s medical benefit using the provider’s DME National Provider Identifier (NPI) number and DME provider taxonomy
- Claims should be billed using a CMS-1500 claim form
When we adjudicate these claims, the provider’s billing NPI and taxonomy will be compared to the Kentucky Medicaid provider enrollment file. The following will result in a claim denial:
- Claims received with a billing NPI or taxonomy that is not registered with Kentucky Medicaid as a DME Provider Type (PT 90)
- Nursing, administration or supply claims received using a provider’s pharmacy taxonomy
- Drugs billed to UnitedHealthcare Community Plan of Kentucky, instead of MedImpact
- If a CMS-1500 form is received using the pharmacy taxonomy
If nursing, administration or supplies claims are received with the appropriately registered DME taxonomy (PT 90) on the CMS-1500 form, the claim will be forwarded for further adjudication.
Resources
For additional information, please reference the Kentucky Injectable Drug List and the MedImpact prior authorization form.
To submit a prior authorization with UnitedHealthcare
- Sign in on the UnitedHealthcare Provider Portal Resources page
- Click on the Prior Authorization tool
- Select Create a new notification or prior authorization request
- Enter the required information on the submission site
Questions?
View the Kentucky Care Provider Manual for additional information or call Provider Services at 800-666-1353.
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