Kentucky flag

Radiology Billing Services in Kentucky

Kentucky Medicaid lost an MCO outright: Anthem stopped covering Kentucky Medicaid patients entirely on January 1, 2025, with members reassigned to Humana or UnitedHealthcare. Aetna, Molina, and WellCare round out the state’s five remaining plans. RBS rebuilt its Kentucky process around that MCO exit, Jurisdiction 15’s Kentucky-and-Ohio Medicare rules, and Anthem’s continuing hold on the commercial market.

Kentucky Lost a Medicaid Plan. Has Your Biller Noticed?

Kentucky didn’t just update a form, it watched Anthem walk away from Medicaid managed care entirely. As of January 1, 2025, every Anthem Medicaid member was reassigned to Humana or UnitedHealthcare, while Aetna, Molina, and WellCare kept their contracts. Add Jurisdiction 15’s narrower two-state Medicare footprint, and a claim built on last year’s payer list starts breaking fast.

Confirm every Kentucky Medicaid claim is billed to a current MCO, never Anthem

Track Jurisdiction 15's Kentucky-and-Ohio Medicare guidance apart from larger jurisdictions

Apply Kentucky's 30-day settlement deadline and 12% annual interest penalty correctly

Keep TC/PC splits accurate against Anthem's continuing commercial market lead

Processed Claim Value
$ M+
Avg. A/R Collection Time
0 Days
Turn Around Time (TAT)
0 Hours
Client Retention Rate
0 %
Annual Claims
0 M+
First-Pass Claim Rate
0 %
Avg. Revenue Growth
8- 8 %
Avg. Denial Reduction
0 %

Four Reasons Kentucky Claims Get Denied Now

A Medicaid exit this abrupt hides a lot of ways a clean claim goes sideways. Here’s exactly where it costs you.

Two States, Not a Bigger Footprint

CGS Administrators runs Jurisdiction 15, a Medicare contract covering only Kentucky and Ohio, a narrower footprint than many MACs that span four or more states. That narrower scope means CGS’s local coverage determinations lean more heavily on Kentucky-specific claim history. RBS reads Jurisdiction 15’s Kentucky guidance directly, rather than assuming rules built for a larger multi-state footprint apply.

Anthem Exits Kentucky Medicaid in 2025

Anthem stopped being a Kentucky Medicaid MCO entirely on January 1, 2025, with its members automatically reassigned to Humana or UnitedHealthcare. Aetna, Molina, and WellCare round out the state’s five remaining Medicaid MCOs. A claim still billed to Anthem after the cutover has nowhere to land. RBS verifies which of Kentucky’s five current MCOs actually covers a patient before anything goes out.

A Newer Compact Member Since 2019

Kentucky enacted the Interstate Medical Licensure Compact in 2019, five years after the compact’s first wave of states. That later start leaves Kentucky’s compact pipeline newer than many neighbors’ and still maturing. Out-of-state radiologists reading Kentucky studies under an expedited license still answer to Kentucky’s own board rules. RBS verifies compact status before billing any out-of-state read.

One Carrier, One Interest Penalty

Anthem Blue Cross and Blue Shield of Kentucky has long been the state’s largest commercial health insurer, by a wide margin. Kentucky Statute 304.12-235 requires insurers to settle a claim within 30 days or pay 12% annual interest on the balance, plus the claimant’s attorney’s fees. Humana, now absorbing former Anthem Medicaid members, runs its own separate timeline. RBS tracks both without missing either.

Complete Radiology Revenue Cycle Management

Certified CIRCC and CPC coders handle every CPT code, modifier, and global billing rule specific to diagnostic and interventional radiology — maximizing reimbursement on every encounter across all modalities and payer types.

What Changes When RBS Takes This Off Your Plate

Radiology billing isn’t generalist RCM. The TC/PC splits, the review clocks, the LCD churn are specialty-specific. Here’s the shift practices see once RBS steps in for a Kentucky group navigating a freshly-exited Medicaid MCO, a dominant commercial carrier, and a state where 6.8% of residents still carry no insurance at all (America’s Health Rankings, 2024).

Before RBS

Staffing costs run $60K to $90K a year, hard to justify for a small practice

Denial rates sit at 20 to 35%, often tied to a Medicaid MCO transition

One staff member's day off and claims processing grinds to a halt

Manual data entry mistakes cost more than the imaging scan itself

A missed Anthem-to-Humana handoff sends the claim back weeks later, unpaid

After RBS

Performance-based pricing, RBS earns only when your practice collects

98%+ first-pass clean claim rate, checked against active Kentucky payers

365 days a year, 24/7 revenue cycle coverage, with zero staffing gaps

AI-OCR reads every superbill, EOB, and ERA the moment it arrives

Every claim billed against Kentucky's current MCO roster, not last year's

Precision RCM & Coding Built for Radiology

Generic billing is the fastest way to a denied radiology claim. RBS delivers specialty-specific revenue integrity built for imaging’s TC/PC splits and modifier rules, so you capture every dollar you’re owed.

Diagnostic Radiology

CT Scan

MRI & MRA

Nuclear Medicine

PET / PET-CT

Ultrasound

Interventional Radiology

Teleradiology

Mammography

DEXA / Bone Density

Hospital Radiology

Radiation Oncology

Coverage Confirmed for Every Payer You Work With

From national carriers to regional Medicaid plans, coverage is checked against the exact payer, plan, and product type on file — never a generic match. Every result reflects current payer policy, not outdated data from months ago.
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana
medicare
Medicaid
Molina health
Ambetter health
cigna
Elevance Health (Anthem)
United healthcare
aetna
Blue cross Blue shield
OSCAR health
Health Net
Kaiser Permanente
tricare
wellcare
Humana

From Louisville to Lexington, Billed on Current Facts

A denial in the Bluegrass region and a denial in Eastern Kentucky rarely share a cause: different referral patterns, different distance to specialists, different local payer mix. RBS bills each Kentucky area the way its own provider network actually works, not a single statewide guess.

Louisville Metro

Cities
  • Louisville
  • Jeffersontown
  • St. Matthews
Counties
  • Jefferson County
  • Oldham County

Lexington Bluegrass

Cities
  • Lexington
  • Georgetown
  • Nicholasville
Counties
  • Fayette County
  • Scott County

Northern Kentucky

Cities
  • Covington
  • Florence
  • Newport
Counties
  • Kenton County
  • Boone County

Western Kentucky

Cities
  • Paducah
  • Owensboro
  • Bowling Green
Counties
  • McCracken County
  • Warren County

Eastern Kentucky

Cities
  • Ashland
  • Pikeville
  • Hazard
Counties
  • Boyd County
  • Pike County

South Central Kentucky

Cities
  • Somerset
  • London
  • Elizabethtown
Counties
  • Pulaski County
  • Hardin County

Wired Into Every System You Already Run

Your EHR, RIS, and PACS stay exactly as they are. We plug our coding workflow directly into what you already use — no migration, no new login for your radiologists, no disruption to how your team already works.

Kentucky Runs on Rules Built for Kentucky. So Does Every Other State We Bill.

A claims team working off last year’s Medicaid roster misses that Anthem is already gone and former members now sit with Humana or UnitedHealthcare. Our specialists train on Kentucky’s actual, current payer structure, not a generic script, so a stale-MCO mismatch is never the reason a claim gets denied.
us-map

Frequently Asked Questions

Which Medicare contractor processes radiology claims in Kentucky?

CGS Administrators, under Jurisdiction 15, which also covers Ohio rather than Kentucky alone.
Anthem stopped being a Kentucky Medicaid MCO on January 1, 2025. Its members were automatically reassigned to Humana or UnitedHealthcare, while Aetna, Molina, and WellCare kept their contracts.
Yes, since 2019, roughly five years after the compact’s earliest member states joined.
Kentucky Statute 304.12-235 requires insurers to settle a claim within 30 days or pay 12% annual interest on the unpaid balance, plus the claimant’s attorney’s fees.
Every claim is checked against the Medicaid MCO actually on file for that patient today, Humana, United, Aetna, Molina, or WellCare, never the plan that exited.

Whichever Kentucky Office Files It, RBS Gets It Paid

Somewhere in your outstanding claims right now, there’s a clean scan sitting unpaid because it was billed to a Medicaid MCO that no longer exists, or the wrong side of Anthem’s commercial dominance. Across the practices we review, that adds up to 5 to 10% of collectible revenue, aging quietly by the day. RBS finds it, recovers it, and builds a process that stops it from recurring. Start with a free audit, no commitment, just a clear answer on what’s actually recoverable before you decide anything.

No setup fee. No monthly minimum.

Cancel anytime.

Response within 24 hours.

Pay only a percentage of what we collect for you.

Free claims and A/R audit before you commit to anything.

Book Your Consultation

What Our Clients Say?

Rebecca Lawson

★★★★★

Radiology Practice Manager

Since partnering with your radiology billing team, our billing workflow has become much smoother. They understand imaging procedures, payer requirements, coding, and claim follow-ups. Their team is responsive, professional, and always stays on top of outstanding claims.

Dr. Christopher Bennett

★★★★★

Medical Director, Diagnostic Imaging Center

Your team truly understands the challenges of radiology billing. They handle claims accurately, follow up on unpaid accounts, and help resolve billing issues efficiently. Their expertise and communication have made our revenue cycle more organized and reliable.

Dr. Andrew Whitaker

★★★★★

Radiologist & Imaging Center Owner

Our team has been an excellent partner for our imaging center. They understand radiology billing, coding, claim submission, denials, and follow-ups. Their attention to detail and consistent communication have helped streamline our billing process and improve our revenue cycle.

Get In Touch