Kentucky Medicaid - Kymmis.com

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Required Information FIELD NUMBER NAME AND DESCRIPTION 33 Physician/ Supplier’s Billing Name, Address, Zip Code and Phone Number Enter the provider’s name, address, zip code and phone number (including area code). 33A EXCEPTION: 33A NPI Enter the appropriate Pay to NPI Number. Provider types ONLY: Hands, Commission for Handicapped Children, Title V, First Steps, Impact Plus and Non Emergency Transportation, LEAVE BLANK 33B EXCEPTION: 33B (Shaded Area) Enter ZZ and the Pay to Taxonomy Number. Enter 1D and the Pay to Provider Number. (Provider types ONLY: Hands, Commission for Handicapped Children, Title V, First Steps, Impact Plus and Non Emergency Transportation) Cabinet for Health and Family Services 14
Forms • Third Party Liability • Adjustment and Claim Credit • Cash Refund Cabinet for Health and Family Services 15
Page 1 and 2: Kentucky Medicaid Spring 2009 Billi
Page 3 and 4: Representative List Cabinet for Hea
Page 5 and 6: Reference List Helpful Phone Number
Page 7 and 8: Required Information FIELD NUMBER N
Page 9 and 10: Bottom Half of CMS Claim Form Cabin
Page 11 and 12: Required Information FIELD NUMBER N
Page 13: Required Information FIELD NUMBER N
Page 17 and 18: TPL Helpful Hints • When to use t
Page 19 and 20: Adjustment, Claim Credit/Void Hints
Page 21 and 22: Cash Refund Hints The Cash Refund D
Page 23 and 24: Timely Filing Examples 1 Year From
Page 25 and 26: Timely Filing Examples KyHealth Net
Page 27 and 28: FAQ’s If you bill Medicare and d
Page 29 and 30: FAQ’S Cont. Internal Control Num
Page 31 and 32: Did You Know * Coming Soon--Paper
Page 33: KY MMIS Project Provider Evaluation

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