Kentucky Medicaid: Home infusion claim requirements

Health care providers who deliver home infusion care to UnitedHealthcare Community Plan of Kentucky Medicaid members must register as both a pharmacy provider (PT 54) and a durable medical equipment (DME) provider (PT 90).

Specialty pharmacies that bill UnitedHealthcare Community Plan of Kentucky for nursing, administration or supplies must also register as a DME provider (PT 90) with Kentucky Medicaid.

Billing requirements

The provider must bill drugs through the member’s pharmacy benefit using the provider’s pharmacy taxonomy by submitting a claim to the Pharmacy Benefit Manager (MedImpact) at point of service
Bill nursing, administration and supplies directly to UnitedHealthcare Community Plan of Kentucky under the member’s medical benefit using the provider’s DME National Provider Identifier (NPI) number and DME provider taxonomy
- Claims should be billed using a CMS-1500 claim form

When we adjudicate these claims, the provider’s billing NPI and taxonomy will be compared to the Kentucky Medicaid provider enrollment file. The following will result in a claim denial:

Claims received with a billing NPI or taxonomy that is not registered with Kentucky Medicaid as a DME Provider Type (PT 90)
Nursing, administration or supply claims received using a provider’s pharmacy taxonomy
Drugs billed to UnitedHealthcare Community Plan of Kentucky, instead of MedImpact
If a CMS-1500 form is received using the pharmacy taxonomy

If nursing, administration or supplies claims are received with the appropriately registered DME taxonomy (PT 90) on the CMS-1500 form, the claim will be forwarded for further adjudication.