Payer List

Please follow the Enrollment Instructions below to become an electronic submitter for Kentucky Medciad.

Required Documents for those applying for new EDI Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the KY Medicaid office prior to initiation of electronic claims submission or inquiry.

If you are a Provider

1. EDI Application (to be completed first)

2. Electronic Media Addendum (MAP 380) (only submit after receipt of submitter ID)

3. 835 Request Form

If you are a billing agency,

• Ensure you have completed an Electronic Agreement (form MAP-246) for an existing approved Medicaid provider,
• Electronic Agreement(form MAP-246)
  • Ensure that the Medicaid provider for which the Electronic Agreement was filed is accompanied by an approved Electronic Agreement (form MAP-380) from the provider.
  • Electronic Agreement (form MAP-380)

If you experience problems with the links provided above, you may go to this link to access the forms:
http://kymmis.com/kymmis/Electronic%20Claims/5010provoutreach.aspx

If you have any questions regarding any of the documentation required, please contact the EDI Support Help Desk anytime Monday through Friday, 7:30 a.m. to 6:00 p.m. EST at 1800-205-4696

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Our Vendor Information

BBS EDI Application

- Enter your Company name

- Select “Provider” or if you’re a Billing Service select “Billing Agent”

- Enter your demographic information

- Enter the contact information for the main contact person in your office

- Electronic Agreements on File with the Commonwealth of KY

- Map 380 – No (since you are a new applicant and will be barely submitting a 380 form)

- Map 246 - No

- EDIFECS Certificate - No

- Select ALL Applicable transaction types:

- 837 Professional

- 837 Institutional

- 835 Remittance/277 Pended Claims

- Signature information

***Please submit this form first. You will be given your submitter ID, and then you may fill out the additional forms listed below***

Electronic Agreement (form MAP-380)

Page 1

• Enter the Day, Month, and Year
• Enter the Providers Name and Demographic information
• Write the Type of Provider, the Provider Number, and NPI

Page 2

• Enter the Providers Name
• Have the Provider Sign the application
• Enter the name and title of the main contact person in your office
• Enter the Date and your phone number
• For Software Vendor enter AXIOM Systems, Inc. Formerly Ivertex
  • Media enter SolAce-EMC

5010 Contact Information

• Enter the Trading Partner ID you received after sending in the first form
• Enter AXIOM Systems Inc. Formerly Ivertex
• Insert your mailing address, email address, and phone number
• Putting your information in this section ensures you will be contacted, not SolAce

835 Request Form

• Enter the Trading Partner ID you were assigned
• Enter your Company’s Name, Demographic and Contact information
• Enter the NPI’s, Taxonomy’s, and KY Medicaid ID numbers that will appear on your electronic Remittance Advices

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Submit all forms
Except the Agreement (MAP 380)

By FAX TO:

502-209-3242

Mail the Original MAP 380 Form here:

Electronic Claims Submission
P.O. Box 2016
Frankfort, KY 40602-2016

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If you don’t receive a confirmation after two weeks, contact the Technology Support Center toll-free at 805-205-4696

Testing

Once you have received your Submitter ID and Password from KY Medicaid, please call the SolAce Support Team and set an appointment for a Mailbox setup and Test Transmission to Medicaid.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.