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Cash Refund Hints<br />
The Cash Refund Documentation Form is used when refunding<br />
money to KY <strong>Medicaid</strong>.<br />
Please keep the following points in mind when refunding:<br />
• Attach to the Cash Refund Documentation Form a check for<br />
the refund amount made payable to the KY State Treasurer.<br />
• Attach applicable documentation, such as a copy of the<br />
remittance advice showing the claim for which a refund is<br />
being issued.<br />
• Do not send a refund and an adjustment/void on the same<br />
claim.<br />
Cabinet for Health and Family Services<br />
21
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