2 Payor Code 8 Payor Code 8 Agreements should be between the LHD and a public or private entity. Payor Code 8 Agreements should never be with an individual, unless they are the public or private entity.

3 Payor Code 8 Through Payor Code 8 Agreements, LHDs have the ability to negotiate, with public or private entities, higher rates for services, than rates that are listed on the 501 Service File (exceptions: KDPH/KDCBS Hep B agreement, KY Fire Commission, and Jail contracts involving incarcerated individuals) Negotiated rates should not be less than the DPH rate listed on the 501 Service File in the “Other” field. Rates should cover the direct and indirect cost of the service.

4 Payor Code 8 A HIPAA Business Associate Agreement (BAA) shall accompany the initial Payor Code 8 Agreement or an agreement initiated by a First Party. Payor Code 8 Agreements shall be completed on a fiscal year basis; after the initial BAA, another would not need to be completed unless there are significant material changes.

5 HIPAA Changes from the 2013 HIPAA OMNIBUS Final Rule required language changes to Business Associate Agreements. What does that mean? ALL BAAs, whether previously existing or new, have to contain the new language. The compliance date was 9/23/13. More information and examples of Business Associates can be found at: redentities/businessassociates.html

6 Payor Code 8 A Payor Code 8 Agreement or other agreement shall be completed prior to providing services. LHDs should assign and set-up a Contract Code for each entity with whom they have a Payor Code 8 Agreement. This would include other agreement formats initiated by a First Party. Contract codes have to be setup in Bridge and Portal.

7 Payor Code 8 Contract Codes # should be entered into the “CnctC” field on PEF entry and “P8” should be entered in the “over-ride” field for each CPT code.

8 Payor Code 8 Rates negotiated by the LHDs that are “higher” than the system assigned rates may be over-ridden without submitting a request to AFM for approval. A rate is required for services rendered and an appropriate audit trail should be documented. Invoices shall not be setup as “0”. Nor should LHDs use nominal fee rates.

9 Payor Code 8 P8 Contractors should be treated as third party payers and the expectation would be they are charged at 100% of the cost (direct and indirect) of the service.

10 Payor Code 8 First Aid Safety Team“FAST” CHFS and DPH have agreed to the provision and payment of DCBS field staff for Hepatitis B and Flu vaccinations for designated First Aid Safety Team – “FAST” employees. “FAST” ONLY those DCBS employees designated as “FAST” employees will be paid.

11 Payor Code 8 Vaccine administration $22.00 Vaccine administration will be $22.00; however, the actual VACCINE should be charged at the cost the LHD purchased the vaccine. Over-rides for making changes to the LHD cost of the Hep B or Flu vaccine for this project is approved.

12 Payor Code 8 DPH will provide quarterly payments to LHDs after validating services reported; DPH will bill CHFS/DCBS annually. LHDs will use Payor Code 8, Contract Code 701, for reporting these services; if not reported correctly LHDs may not receive timely payment for services provided.

13 Payor Code 8 LHDs may contract with Jails through P8 contracts to provide services to incarcerated individuals. KRS 441 provides information regarding the responsibility of jails to provide access to and payment for “necessary care” for prisoners. KY Medicaid Physician’s Fee Schedule rates should be used.

14 Payor Code 8 Contracts for services provided to Jail employees should be treated the same as contracts with other public or private entities. A sample CH-52 Jail contract (with language for services provided to incarcerated individuals) is available.

15 Payor Code 8 DPH encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. LHDs are to use the CH-52 Fire Commission contracts when contracting to provide Hepatitis B vaccinations to those firefighters approved for the service. DPH encourages ALL LHDs to contract with the Fire Commission for these Hepatitis B services. Health Departments are the ONLY entity that the Fire Commission will reimburse for these services. Health Departments are the ONLY entity that the Fire Commission will reimburse for these services. Language in the contract should not be changed. LHDs need to fill in their name & address and have LHD & Fire Commission authorized signatures.

16 Payor Code 8 completed prior Contracts should be completed prior to providing the Hepatitis B vaccination services. and LHDs will setup their own P8 contract code number. This needs to be done in CMS Portal and in Bridge.

17 Payor Code 8 LHDs should submit the Fire Commission Hepatitis B Voucher along with their billing document to the Fire Commission. However, the LHD will not receive payment from the Fire Commission unless a valid Contract is on file. on_Programs/Hepatitis_B_Vaccinations.aspx on_Programs/Hepatitis_B_Vaccinations.aspx

18 Payor Code 8 Vaccine administration Vaccine administration rate is determined by the LHO Branch using the AMA Code Manager software. The current rate is $23.00 (already set in the 501 Service File and updated annually); however, the actual Vaccine should be charged at the cost the LHD purchased the vaccine. Over-rides for making changes to the LHD cost of the Hep B vaccine for this project is approved.

19 Payor Code 8 Payor Code 8 Contracts folder L-Drive Payor Code 8 contracts will not be reviewed by DPH, but we would like for LHDs to save these contracts to the Payor Code 8 Contracts folder on the L-Drive for referencing (if applicable).

20 Payor Code 8 For questions concerning Payor Code 8 contracts, hepatitis b or flu CHFS contracted services, contact (502) , ext. 4120

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