Any services performed must fall within the scope of practice for any provider. Independent labs must meet the coverage provisions and requirements of 907 KAR 1:028 to provide covered services. Services are prescribed by a physician, physician assistant, podiatrist, dentist, oral surgeon, advanced registered nurse practitioner or optometrist. Headed by a laboratory director with education and experience based on CLIA level of certificationĪ laboratory provider may perform Medicaid laboratory services for the Medicaid beneficiary only to the extent authorized by the provider's CLIA certificate. Enrolled with Kentucky Medicaid, and if applicable, enrolled with the managed care organization (MCO) of any beneficiary for whom it provides services.Clinical Laboratory Improvement Amendments (CLIA) certificate certified by the Centers for Medicare and Medicaid Services.In Kentucky, independent lab service providers must contact the Office of Inspector General, Division of Health Care for a survey/license Licensed in the state in which it is located.To enroll or bill Kentucky Medicaid, independent laboratory providers must be: Kentucky Medicaid identifies independent lab services as Provider Type (37). Office of the Ombudsman and Administrative Review.Office of Application Technology Services.DPH Division of Maternal and Child Health.Office for Children with Special Health Care Needs.Division of Prevention and Quality Improvement.Division of Epidemiology and Health Planning. Division of Program Quality and Outcomes.Advisory Council for Medical Assistance.2022 Kentucky Fatherhood Virtual Summit.Division of Family Resource and Youth Services Centers.Department for Family Resource Centers and Volunteer Services.Division of Administration and Financial Management.Department for Community Based Services.Department for Behavioral Health, Developmental and Intellectual Disabilities.Department for Aging and Independent Living.In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The member's benefit plan determines coverage. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Members should discuss any matters related to their coverage or condition with their treating provider.Įach benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Treating providers are solely responsible for medical advice and treatment of members. The ABA Medical Necessity Guide does not constitute medical advice. The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions.
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