Shoreline Healthcare Technologies is a proud Maine-based  company that offers end to end revenue cycle management services to physicians and Medical billing companies in Kentucky. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your Kentucky-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

Shoreline Healthcare Technologies in Kentucky exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

Kentucky Billing Challenges we solve

Fixing the MCO Corrected Claim & Appeal Chaos

Every MCO in Kentucky handles corrected claims differently like whether resubmission requires a claim number, medical records must be attached or whether the appeal deadlines follow calendar days or business days. And providers lose time and money on these improper submissions. We at Shoreline Healthcare Technologies takes charge by tracking each MCO’s corrected claim workflow like format, data, attachments, deadlines, submit corrected claims with the exact resubmission codes that are required, document everything for appeals, including EOB trails and manage appeals end-to-end when MCOs deny unjustly.

Managing the CHFS Program Layering

Kentucky Medicaid is overseen by CHFS, and the program structure is unusually layered. Providers often face confusion when a patient is technically eligible under CHFS but not yet assigned to any managed care plan. CHFS switches someone from Medicaid to a waiver, or from a waiver into an MCO, mid-month. Coverage does not update in the portal immediately, but claims need to follow whichever program was active on the exact date of service. This results in claims getting denied for wrong payer sequence. Shoreline runs a multi-layer eligibility check before every claim (state + MCO + waiver verification) and tracks mid-month eligibility changes so claims are billed to the right entity the first time. We use the eligibility timestamp logs to prove eligibility when the state system shows gaps. This results in fewer wrong-payer denials with stronger proof for appeals and faster payments without back-and-forth.

Managing Six Different MCO Rulebooks Without Confusion

The state of Kentucky have multiple contracted MCOs with each one having their own PA list, provider portal quirks, claim editing logic and different interpretations of the same CPT code rules. Providers constantly struggle with the same service approved by one MCO but denied by another. At Shoreline we maintain a separate Kentucky MCO rule library with constant updates, flagging claims that need specific modifier logic and route prior auth to the correct plan by attaching the right supporting documents for each one. We use plan-specific scrubbers, so the claim meets the exact edits that MCO uses. This dramatically reduces the coding or modifier denials improving the rate of clean claims by 95% and speeding up the payment cycles.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of Kentucky providers. Our team of experts understands the intricacies of the Kentucky billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for Kentucky

Specialized Services tailored to meet Kentucky Medicaid rules and regulations

🩺 Services	📍Kentucky Specialization	📈 Typical Improvement	⏱️ Turnaround Time
End-to-End Medical Billing	Tailored to meet the needs of Kentucky Medicaid and all major MCOs and FFS Medicaid Programs	20–35% reduction in denials, faster payment cycles across multiple plans.	Claim submission within 24–48 hours
Eligibility & Coverage Verification	Multi-layer checks for CHFS, MCOs, and waivers programs detects mid-month eligibility flips unique to KY.	15–30% drop in eligibility-based denials.	Same-day verification
Prior Authorization Management	Plan specific PA handling and routing	40–60% reduction in PA denials	3–5 business days for standard PAs
Denial Management	AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.	Reduce rate of denial by 75% and with quicker appeals.	7–14 days for backlog cleanup; ongoing daily follow-up
Telehealth Billing	Applies telehealth geography rules, specific codes, modifiers, and POS	25–40% fewer telehealth denials	Same-day telehealth claim processing.
Patient Statements & Follow-Up	Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options.	Reduces overdue balances and better collection rates.	1-2 weeks
Audit & Compliance Support	Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation.	Minimizes risk of penalties and supports successful audits.	Ongoing, depending on audit schedule

Medical Billing Resources for Kentucky

Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Managed Care Organizations Billing rules and guidelines

Specialized billing guidelines and documentation procedures for MCOs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in Kentucky

Kentucky’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across Kentucky

From Adair to Woodford, we provide comprehensive medical billing services across all 120 Kentucky counties.

Eastern Kentucky Coalfield:

Bath, Bell, Boyd, Breathitt, Carter, Clay, Elliott, Estill, Fleming, Floyd, Greenup, Harlan, Jackson, Johnson, Knott, Knox, Laurel, Lawrence, Lee, Leslie, Letcher, Lewis, Magoffin, Martin, McCreary, Menifee, Morgan, Owsley, Perry, Pike, Powell, Pulaski (partially), Rockcastle, Rowan, Wayne (partially), Whitley, Wolfe

The Knobs Region:

Bullitt (partially), Estill (partially), Greenup (partially), Jefferson (partially), Lincoln (partially), Nelson (partially), Powell (partially), Rockcastle (partially)

Bluegrass Region:

Anderson, Boone, Bourbon, Boyle, Bracken, Campbell, Carroll, Clark, Fayette, Franklin, Gallatin, Garrard, Grant, Harrison, Henry, Jefferson (Louisville metro), Jessamine, Kenton, Lincoln (partially), Madison, Mason, Mercer, Montgomery, Nicholas, Oldham, Owen, Pendleton, Robertson, Scott, Shelby, Spencer, Trimble, Woodford

Western Kentucky Coalfield:

Breckinridge, Butler, Christian (partially), Crittenden (partially), Daviess, Hancock, Henderson, Hopkins, McLean, Muhlenberg, Ohio, Union, Webster

Pennyroyal Plateau:

Adair, Allen, Barren, Bullitt (partially), Caldwell (partially), Casey, Christian (partially), Clinton, Cumberland, Edmonson, Grayson, Green, Hardin, Hart, Jessamine (partially), LaRue, Logan, Marion, Metcalfe, Monroe, Nelson (partially), Pulaski (partially), Russell, Simpson, Taylor, Todd, Trigg (partially), Warren, Washington, Wayne (partially)

Jackson Purchase:

Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall, McCracken

Savings Estimation Calculator

Practice Type/Speciality

No. of Physicians

Monthly Patient Volume

% of Insurance Pay Patient

% of Self Pay Patient

Frequently Asked Questions

FAQs about Medical Billing Services in Kentucky

Q1. How do providers verify eligibility when patients switch between CHFS, waivers, and MCO plans mid-month?

Providers can check the status of their patients benefits through the following portals online:

• KYMMIS (state-level eligibility)
• The patient’s MCO portal
• Waiver status in KLOCS
• Kynect Benefits (if the patient has recently reapplied)

If there is a conflict between the systems, the KYMMIS date-of-service record is the final authority.

Q2. Does all Kentucky MCOs follow the same telehealth billing rules?

No. Every MCOs have their own sets of rules and code preferences. Modifiers usage differs across plans while most plans prefer Modifier 95, some plans still accept GT, some require POS 02 and while others use POS 10 for home-based telehealth. Always check the plan specific coding edits before submitting the telehealth claims.

Q3. What is the timely filing limit for Kentucky Medicaid and its MCOs?

Medicaid FFS Claims	Within 12 months from the DOS
Most MCOs	Within 90-180 days

Q4. Do Kentucky MCOs require separate credentialing?

Yes. Enrolling in KYMMIS does not automatically credential you with the individual MCOs. Each plan has its own credentialing process and timeline (usually 30–120 days).

Q5. How can Shoreline Healthcare Technologies help providers in Kentucky?

We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

Kentucky Licensed

Licensed to operate in Kentucky

Medical Billing Glossary

Essential Terms for Understanding the Kentucky’s Medical Billing Landscape

Cabinet for Health and Family Services (CHFS)

The state agency of Kentucky that provides Medicaid, public health, behavioral health, child welfare, and other human service programs. They set the rules for eligibility, waivers, reporting, and Medicaid operations.

Kentucky Level of Care System (KLOCS)

An assessment portal to determine the patient’s medical eligibility for long-term services and supports (LTSS). If a provider is billing for a service that requires a level-of-care approval, KLOCS is the system where that approval comes from.

Kentucky Online Gateway (KOG)

The single login/identity management portal used for accessing Kentucky Medicaid systems, including KLOCS, KyMMIS, and CHFS services. Every provider needs a KOG account to access Medicaid tools in the state.

Kentucky Medicaid Management Information System (KyMMIS)

The state’s Medicaid “central hub” for checking medicaid claims, eligibility data, provider enrollment, and payment information. Providers can use KYMMIS to verify patient’s eligibility, view fee schedules, monitor claim status, and confirm policy requirements.

Kynect Benefits

The secure online portal where residents of Kentucky can apply for Medicaid, KCHIP, SNAP, and other state programs.

Medicaid Eligibility Update Processing System (MEUPS)

The system used to manage eligibility updates and corrections. When a patient’s eligibility changes mid-month or gets updated retroactively, MEUPS makes this adjustment. It’s important for providers because eligibility changes might impact as to which payer (MCO/FFS) they should bill the claim.

Our Services

Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

Testimonials

My first time in solo practice I was very concerned about my ability to manage "the business side" of medicine. The personalized care and guidance this group provided to me and my staff were really a life saver. They always had quick turnaround on any questions I sent in, and were very knowledgeable for problem solving on the fly! I never feel like just a number, as I might have with a large corporation.

★ ★ ★ ★ ★

Family Medicine Centre in Maine

“We use Shoreline Medical Billing for all our billing needs, the support is second to none! They are always up to date with coding updates which helps to ensure timely billings and prompt payments. I highly recommend Shoreline Medical Billing for your billing needs.”

★ ★ ★ ★ ★

Nephrology Group in New Hampshire

I have been using Shoreline Medical Billing for almost 2 years, and I could not be more pleased with their service. They really care about my business. With all the complexities of medical billing, we needed a professional partner to help us. Shoreline delivered.

★ ★ ★ ★ ★

Pain Management in New Jersey

We switched to Shoreline Medical Billing. Our claims are getting paid, and we are getting friendly, knowledgeable service. We highly recommend Shoreline.

★ ★ ★ ★ ★

Internal Medicine & Nephrology in Georgia

I’m a small pediatric OT practice and have been with Shoreline for several years now. They have made it so easy for me to keep my focus on patient care by being so knowledgeable and so efficient with all aspects of my billing. When I do have questions, they are always available and able to help quickly. Couldn’t be happier!

★ ★ ★ ★ ★

Peds OT Clinic in Maine

Thanks so much for working so hard to help my company:) It sound cheesy, but having a biller I could trust changed my life by giving me the headspace/time to focus on clinical work, scale my business and sleep better at night. I've had quite a few people ask about you on Facebook Messenger from my posts. Overall, the feedback I've heard back from everyone is that you guys are very responsive and helpful.

★ ★ ★ ★ ★

Nurse Practitioner Group in Washington

Hi, following up on our conversation about Shoreline. I did let them know that I had some concerns and they were very understanding. They have been very responsive and proactive in their billing process, reports and communication. It has been very good. Thank for recommending them.

★ ★ ★ ★ ★

Nurse practitioner in Delaware

Before Shoreline, billing was a constant headache. Now, our reimbursements are faster, and I’m no longer chasing unpaid claims. Their team handles everything so efficiently, it’s one less thing I need to worry about.

★ ★ ★ ★ ★

Internal Medicine in Arizona

We Care

From electronic health records, billing services and practice management tools-Shoreline has you covered! In addition to being an industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in Kentucky understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

Get your free consultation and discover how much you could save with our Kentucky -specialized billing services.

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Contact Information

445 Main Street, 2nd Floor, #1, Saco, ME 04072
1-855-838-1370
info@shorelinemb.com
M-F, 9am - 5pm EST

Why work with us?

✔ 40% average denial rate reduction
✔ Local billing expertise
✔ 24-48 hour claim turnaround
✔ Dedicated Kentucky support team

The Reliable Medical Billing Company in Kentucky - Shoreline

Best In the Industry

Kentucky Billing Challenges we solve

Fixing the MCO Corrected Claim & Appeal Chaos

Managing the CHFS Program Layering

Managing Six Different MCO Rulebooks Without Confusion

Comprehensive Medical Billing Services for Kentucky

Medical Billing Resources for Kentucky

Medicaid Billing Guide

Managed Care Organizations Billing rules and guidelines

Revenue Cycle Optimization

Telehealth and Remote patient Monitoring in Kentucky

Serving Healthcare Providers Across Kentucky

Eastern Kentucky Coalfield:

The Knobs Region:

Bluegrass Region:

Western Kentucky Coalfield:

Pennyroyal Plateau:

Jackson Purchase:

Savings Estimation Calculator

Frequently Asked Questions

Q1. How do providers verify eligibility when patients switch between CHFS, waivers, and MCO plans mid-month?

Q2. Does all Kentucky MCOs follow the same telehealth billing rules?

Q3. What is the timely filing limit for Kentucky Medicaid and its MCOs?

Q4. Do Kentucky MCOs require separate credentialing?

Q5. How can Shoreline Healthcare Technologies help providers in Kentucky?

Compliance & Certifications

HIPAA Compliant

AAPC Certified

Kentucky Licensed

Medical Billing Glossary

Cabinet for Health and Family Services (CHFS)

Kentucky Level of Care System (KLOCS)

Kentucky Online Gateway (KOG)

Kentucky Medicaid Management Information System (KyMMIS)

Kynect Benefits

Medicaid Eligibility Update Processing System (MEUPS)

Our Services

Testimonials

Family Medicine Centre in Maine

Nephrology Group in New Hampshire

Pain Management in New Jersey

Internal Medicine & Nephrology in Georgia

Peds OT Clinic in Maine

Nurse Practitioner Group in Washington

Nurse practitioner in Delaware

Internal Medicine in Arizona

We Care

Ready to Optimize Your Medical Billing?

Get Your Free Consultation

Contact Information

Why work with us?