Item | Last Modified |
---|---|
Universal Claim Forms (UCF) | external link |
Title | Last Modified |
---|---|
Universal PA Request Form – All Others | 10/07/2021 |
For telephonic prior authorization requests or inquiries regarding a prior authorization please call (800) 477-3071.
Please fax prior authorization requests to one of the following numbers —
Regular Fax Line:
800-365-8835
Urgent Requests:
800-421-9064
Nursing Facility:
800-453-2273
Mental Health Drugs:
800-453-2273
Denials and Appeals
- Only a patient or family member can appeal a prior authorization denial
- The member has 30 days from receipt of the denial letter to submit a written appeal to the address below:
- Kentucky Department for Medicaid Services
Division of Administration and Financial Management
Administrative Services Branch, 6W-C
275 East Main Street
Frankfort, KY 40621-0001
- Kentucky Department for Medicaid Services
- The prescribing physician can attend the appeal hearing and testify on the patient’s behalf
Item | Last Modified |
---|---|
340B Non-participation Notice Form | 02/23/2022 |
340B Participation Notice Form | 02/23/2022 |