Effective Oct 1, 2013, the Center for Disease Control (CDC) changed the use of the Vaccine for Children (VFC) program for children in Kentucky's Medicaid and KCHIP program. As vaccines are to be given from designated Medicaid/KCHIP stock, providers/office staff must ensure that vaccines are used for the appropriate eligibility program.
WellCare Health Plans would like to remind providers that in order to comply with new the (CDC) guidelines, and per DMS guidelines, it is the provider's responsibility to not only confirm the MCO for the member, but to correctly identify the member's Medicaid/KCHIP eligibility through MMIS KY Health Net prior to providing services to the member.
To Verify Medicaid/KCHIP Eligibility:
Providers must access KY Health Net at home.kymmis.com. From the provider main page, please select Member/Eligibility Verification. On the Member Eligibility Verification page, the provider should enter the member's Medicaid ID or the SSN of the member and dates of service to proceed to the Eligibility page.
If the member has a status code of "P7" on the eligibility panel, the member is KCHIP and is given vaccines from KCHIP stock. If status code is not "P7", and the member is Medicaid eligible, the vaccine should be given from Medicaid stock. As DMS/KCHIP and the MCOs are partners in the VFC Program, DMS request that providers/front office staff be trained to correctly identify the members. If providers or office staff are having problems using the site or need training, please contact Medicaid's Physical Agent, HP EDI Helpdesk, at 1-800-205-4696 or through email.
DMS also encourages providers to enroll in the VFC Program to reduce barriers of vaccinations by giving vaccinations while in the office to maintain continuity of care and ensure that the child receives appropriate vaccines timely.
