Kentucky Medicaid - Kymmis.com

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Cash Refund Cabinet for Health and Family Services 20
Cash Refund Hints The Cash Refund Documentation Form is used when refunding money to KY <strong>Medicaid</strong>. Please keep the following points in mind when refunding: • Attach to the Cash Refund Documentation Form a check for the refund amount made payable to the KY State Treasurer. • Attach applicable documentation, such as a copy of the remittance advice showing the claim for which a refund is being issued. • Do not send a refund and an adjustment/void on the same claim. Cabinet for Health and Family Services 21
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 15 and 16: Forms • Third Party Liability •
Page 17 and 18: TPL Helpful Hints • When to use t
Page 19: Adjustment, Claim Credit/Void Hints
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

Kentucky Medicaid - Kymmis.com

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