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Kentucky Medicaid Managed Care Organizations Changes

Pursuant to KRS 205.640 and managed care contracts, Kentucky Medicaid Managed Care Organizations (MCOs) are required to provide a Paid Claims Listings (PCLs) to all in-state hospitals.

The department and each Medicaid Managed Care Organization shall supply a Paid Claims Listing (PCL) to each hospital within ninety (90) days of the last day of the hospital’s fiscal year end date and a second set of data twelve (12) months after the hospital’s fiscal year end date.

The PCL shall include all claims with discharge/service dates within the hospital’s fiscal year that are paid from the first day of the hospital’s fiscal year to ninety (90) days or twelve (12) months, respectively, after the end of the hospital’s fiscal year. They should provide separate reports for adjudicated claims associated with both inpatient services and outpatient services provided to eligible members.

Kentucky Medicaid Managed Care Organizations Changes

As of September 30, 2021:

  • If your facility has a FYE of 6/30/2021, you should have received the 90 day PCLs from each of the MCO plans.
  • If your facility has a FYE of 8/30/2020, your facility should receive 12 month PCLs from each of the MCO Plans.

Be sure you have identified the main MCO contact within your facility. They are the ones who will be receiving the PCL files via secure email or secure payer portal.

You should receive a file from each of the Kentucky Kentucky Medicaid Managed Care Organizations:

  • Aetna
  • Anthem
  • Humana
  • Passport- Molina- portal
  • UHC
  • Wellcare

If your facility is not located in Kentucky, the Paid Claims Listings from MCO’s may not be required by law at this time.

Contact Us

If you are unsure, please reach out to your trusted Blue & Co. Advisor. Since many of these MCO payers are located across the country, you may be able to request a PCL. If you need assistance tracking down your Paid Claims Listings from the MCO’s, reach out to a member of the Medicare Bad Debt team.

Dan Rice, Director

Michelle Trowell, Director

Stephanie Bernhardt, Manager

Rebecca Meredith, Manager

Shawn Wise, Manager

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