Medical Billing Services in Kentucky
Billing, coding, credentialing and denial management for Kentucky practices, with Medicare claims through CGS Administrators (Jurisdiction J15) and Kentucky Medicaid handled by people who know the rules.
Medical billing for Kentucky practices
Kentucky has one of the highest Medicaid enrollment rates in the country, and most members are in managed care. Practices in Louisville and Lexington bill a mix of Anthem, Humana and Medicare Advantage, while Eastern Kentucky and Appalachian clinics depend heavily on Medicaid and Medicare. Five MCOs serve Kentucky Medicaid, and Anthem left the Medicaid program on January 1, 2025, so many patients changed plans.
SFA Solutions works with Kentucky practices remotely. We bill Medicare Part B through CGS, keep your KY MPPA enrollment and MCO participation current, and work denials across Aetna, Humana, Passport, UnitedHealthcare and WellCare. Most clean claims are submitted within 24 hours, and claims are reviewed against applicable payer rules before submission to help catch preventable errors.
Kentucky at a glance
| Medicare contractor | CGS Administrators, Jurisdiction J15 |
|---|---|
| Medicaid timely filing | 12 months from the date of service (907 KAR 1:673) |
| NP practice authority | Reduced |
| Cities we serve | Louisville, Lexington, Bowling Green, Owensboro, Covington, Richmond, Georgetown, Florence, Elizabethtown, Hopkinsville |
What Kentucky billing involves
These are the programs and rules our team works with for Kentucky claims.
Medicare
CGS Administrators · J15Kentucky Part B claims are processed by CGS Administrators in Jurisdiction J15. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Kentucky Medicaid
Kentucky Medicaid, administered by the Cabinet for Health and Family Services Department for Medicaid Services (DMS); KCHIP for children; Kentucky SKY for children in foster care
Portal: Kentucky Medicaid Partner Portal Application (KY MPPA) for enrollment and revalidation; fee-for-service claims through KYHealth-Net, with Gainwell Technologies as fiscal agent
Medicaid managed care
Kentucky Medicaid MCOs are Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport Health Plan by Molina Healthcare, UnitedHealthcare Community Plan and WellCare of Kentucky. Anthem is no longer a Medicaid MCO as of January 1, 2025, and Aetna administers Kentucky SKY.
Timely filing
12 months from the date of service (907 KAR 1:673).
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield is the largest commercial carrier, with Humana (headquartered in Louisville), UnitedHealthcare, Aetna and CareSource also active. Humana and UnitedHealthcare lead Medicare Advantage enrollment.
Prompt pay law
KRS 304.17A-702 requires insurers to pay, deny or contest clean claims within 30 calendar days of receipt. Under KRS 304.17A-730, late payments carry interest of 12% to 21% a year depending on how late the payment is.
Nurse practitioners
Reduced practiceKentucky NPs need a collaborative agreement with a physician to prescribe controlled substances (CAPA-CS) unless the Board of Nursing grants an exemption, and a separate agreement for non-scheduled drugs (CAPA-NS) during their first four years of prescribing. NPs can still enroll under their own NPI, but payers may ask for these agreements during credentialing.
Credentialing
Kentucky Medicaid enrollment and revalidation are done only online through KY MPPA, and enrollment can take 60 days or longer if documents are missing. After DMS approval, each MCO credentials you separately. Anthem, Humana and most commercial carriers use CAQH ProView, so keep that profile attested every 120 days.
Billing challenges Kentucky practices face
Five MCOs and recent plan changes
Anthem's exit from Medicaid in 2025 moved many members to other plans, and patients can still present old cards. Each of the five MCOs has its own prior authorization lists and claim edits. We verify the current plan before each visit.
KY MPPA record accuracy
MCOs match claims to your Medicaid enrollment, including group linking, taxonomy and service address. A missing group link or outdated location in KY MPPA causes denials even when your MCO contract is active. We audit and maintain these records.
Northern Kentucky and cross border patients
Practices near Cincinnati, Evansville and Huntington see patients with Ohio, Indiana and West Virginia coverage. Out of state Medicaid plans require their own enrollment before they pay. We check coverage and enrollment before the visit.
Our services in Kentucky
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Kentucky
Kentucky medical billing questions
What is the timely filing limit for Kentucky Medicaid?
Under 907 KAR 1:673, Kentucky Medicaid claims must be submitted within 12 months of the date of service. MCOs set their own limits in provider contracts, so confirm each plan's deadline in its provider manual.
Who is the Medicare contractor for Kentucky?
CGS Administrators is the Jurisdiction 15 (J15) A/B MAC for Kentucky and Ohio. Enrollment changes go through PECOS, and the CGS myCGS portal handles eligibility and claim status.
Which Medicaid MCOs operate in Kentucky?
Aetna Better Health of Kentucky, Humana Healthy Horizons in Kentucky, Passport Health Plan by Molina Healthcare, UnitedHealthcare Community Plan and WellCare of Kentucky. Anthem stopped serving Kentucky Medicaid on January 1, 2025.
How fast must Kentucky insurers pay clean claims?
KRS 304.17A-702 requires insurers to pay, deny or contest clean claims within 30 calendar days of receipt. KRS 304.17A-730 adds interest on late payments. Self-funded employer plans follow federal rules instead.
Get a free billing audit for your Kentucky practice
We will review your recent claims and denials against Kentucky payer rules and show you what can be recovered.
Nearby states
Primary sources
- Kentucky DMS: Managed Care Organizations
- Kentucky DMS: New Enrollment, Revalidation or Maintenance
- 907 KAR 1:673 Claims processing (Kentucky Legislature)
- KRS 304.17A-702 Claims payment time frames
- Kentucky Board of Nursing: APRN Prescriptive Authority
- CMS: Medicare A/B MAC Jurisdiction 15 (CGS Administrators)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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