Kentucky PIP Medical Bills: 2026 Changes

Direct answer

Kentucky's 2026 Motor Vehicle Reparations Act changes apply to basic and added reparation benefits issued or renewed on or after July 15, 2026. For those benefits, a medical provider generally must submit its statement of charges within 180 days after the product, service, or accommodation is rendered. Medical payments are capped by the relevant workers' compensation fee schedule under KRS 342.035, subject to the statutory floor tied to the schedule in effect on July 15, 2026. Benefits generally become overdue 30 days after the obligor receives reasonable proof of the fact and amount of loss, with a statutory accumulation option.

Kentucky House Bill 627 became law on April 14, 2026 and took effect July 15, 2026. The General Assembly made the changes prospective at the policy level: the amendments apply to basic and added reparation benefits issued or renewed on or after the effective date. Provider teams therefore need to identify the applicable policy or renewal date before applying the new medical-fee and billing rules.

This guide addresses provider billing and payment operations under current Kentucky statutes available on September 26, 2026. It does not determine coverage, medical necessity, causation, patient responsibility, assignment rights, or entitlement in a particular claim.

What changed on July 15, 2026

Issue	2026 rule	Provider control
Policy applicability	Amendments apply to basic and added reparation benefits issued or renewed on or after July 15, 2026	Capture the policy effective or renewal date, not only the accident or service date
Medical-payment ceiling	Payment may not exceed the maximum fee allowed or listed on the relevant KRS 342.035 fee schedule in effect when the expense is incurred	Map the billed service to the correct schedule entry and date
Statutory floor	Payment may not be less than the maximum fee for that expense on the relevant schedule in effect July 15, 2026	Retain the baseline schedule and compare later versions
Other schedule rules	Other requirements, terms, or conditions associated with the workers' compensation schedule do not automatically apply to PIP	Use the fee amount without importing unrelated workers' compensation procedures
Bill submission	Statement of charges generally is due within 180 days after the product, service, or accommodation is rendered	Transmit early and preserve receipt evidence
Work-loss limit	The weekly limit for specified nonmedical loss elements increased from $200 to $500	Separate medical-payment operations from other loss elements
Funeral-related medical expense definition	The statutory limit increased from $1,000 to $5,000	Apply only in the defined circumstance and under the applicable policy

1. Determine which version of the law applies

The transition rule is easy to misapply because accident date, service date, and policy date may differ. HB 627 states that its amendments apply to basic and added reparation benefits issued or renewed on or after July 15, 2026. A claim arising after July 15 may still require analysis of an earlier policy term, while a renewal after that date may bring later services under the amended framework.

Obtain the declarations page or authoritative payer confirmation of the policy term.
Record the original issue date and the most recent renewal date.
Do not infer the governing version solely from the accident date.
Tie each billed date of service to the applicable policy term and statutory version.
Escalate conflicting payer explanations before repricing or billing a patient.

2. Apply the new medical-fee rule carefully

For covered benefits under the amended law, KRS 304.39-020 defines medical expense as reasonable charges for reasonably needed products, services, and accommodations. A medical expense paid by the reparation obligor or its administrator may not exceed the maximum fee allowed or listed for that expense on the relevant schedule established under KRS 342.035 that is in effect when the expense is incurred.

The statute also establishes a floor: the payment may not be less than the maximum fee allowed or listed for the expense on the relevant schedule in effect on July 15, 2026. This protects the statutory baseline if a later schedule amount is lower. Provider systems should preserve the July 15 baseline, the schedule version applicable on the date the expense was incurred, and the code-to-fee calculation.

The General Assembly expressly stated that other requirements, terms, or conditions imposed under or associated with the workers' compensation fee schedule do not apply to the motor-vehicle reparation subtitle. Operationally, the referenced fee amount should not be treated as wholesale incorporation of workers' compensation authorization, filing, or dispute procedures.

Do not balance bill above the statutory maximum

KRS 304.39-210 prohibits a provider from knowingly collecting or attempting to collect the part of a covered medical charge that exceeds the permitted maximum. It also prohibits impairing the insured's credit because the insured does not pay that excess balance.

3. Submit the charge within 180 days

A person providing a product, service, or accommodation generally must submit a statement of the charge within 180 days after it is rendered. The statute identifies an exception for charges submitted under KRS 304.39-241, which addresses a secured person's written direction of benefits among loss elements and reimbursement to specified health benefit payers.

Confirm the PIP or basic-reparation obligor and claim number as early as possible.
Transmit a complete bill and supporting records well before day 180.
Retain the clearinghouse acceptance, portal confirmation, fax record, certified-mail proof, or other receipt evidence.
Track corrected claims separately; do not assume a late correction cures a missing timely original submission.
Document any KRS 304.39-241 direction-of-benefits issue before relying on the statutory exception.
Keep patient statements and credit reporting controls aligned with the statutory fee limitation.

4. Build reasonable proof for the payment clock

Under KRS 304.39-210, basic and added reparation benefits are payable monthly as loss accrues. Benefits are overdue if not paid within 30 days after the obligor receives reasonable proof of the fact and amount of loss. If proof supports only part of a claim and that part totals at least $100, the supported part can become overdue on its own timetable.

The obligor may elect to accumulate claims for periods of no more than 31 days after receiving reasonable proof and then pay within 15 days after the accumulation period. A provider should not label a payment overdue without checking whether the obligor used this statutory option and when it received reasonable proof.

Proof element	Examples	Why it matters
Identity and coverage	Patient identifiers, claim number, accident information, policy or obligor confirmation	Connects the expense to the secured person and claim
Service and amount	Itemized statement, coding, date of service, rendering provider, charge, schedule calculation	Establishes the amount and supports repricing review
Medical relationship	Records, diagnosis, orders, treatment notes, and accident history appropriate to the service	Supports that the expense arose from the covered injury and was reasonably needed
Receipt	Portal, EDI, clearinghouse, fax, or mail confirmation	Starts the defensible timeline and resolves receipt disputes
Subsequent information	Payer request, provider response, and supplemental documents	Shows whether the original proof was complete and when any gap was cured

5. Audit denials, partial payments, and interest

An obligor rejecting a claim for basic reparation benefits must give the claimant prompt written notice that specifies the reason. If the rejection is for a reason other than ineligibility for the claimed benefits, the notice also must inform the claimant about filing with the assigned claims bureau and provide the bureau's name and address.

Overdue payments bear interest at 12 percent per year. If the delay was without reasonable foundation, the statutory rate is 18 percent per year. The higher rate is not automatic merely because a payment is late; the record must support the absence of a reasonable foundation. Maintain separate calculations for the underlying allowed amount, received date, due date, payment date, and asserted interest basis.

Compare the explanation of benefits with the correct fee-schedule version and July 15, 2026 floor.
Identify whether the payer disputes coverage, causation, reasonable need, documentation, coding, or price.
Confirm that a written rejection states a specific reason rather than a generic status.
Preserve the original proof packet and every supplemental submission.
Calculate the ordinary 30-day route and any claimed 31-day accumulation plus 15-day route.
Separate an excess-charge write-off from a disputed covered underpayment.
Do not pursue the insured for a covered amount above the statutory maximum.

6. Account for patient directions and negotiated reductions

KRS 304.39-241 allows a secured person to direct the payment of benefits among different elements of loss by a prospective written direction. The person also may direct reimbursement of a health benefit plan, Medicaid, Medicare, a Medicare supplement provider, or a provider agreement. A directed allocation can affect when or whether a medical provider receives payment even when the bill itself is supported.

KRS 304.39-245 permits an obligor and provider to negotiate a reduction of charges. A provider that agrees to the reduction may not bill the patient for the reduced amount. The statute permits billing the patient if basic or added reparation benefits are exhausted, subject to other applicable law and agreements. The account record should distinguish a negotiated reduction from benefit exhaustion and from the new statutory fee cap.

Provider quality-control checklist

Policy issue or renewal date supports use of the 2026 amendments.
Date of service is linked to the applicable policy term.
Correct KRS 342.035 fee-schedule entry and version are retained.
July 15, 2026 schedule amount is preserved as the statutory floor.
Bill is transmitted within 180 days with receipt evidence.
Reasonable-proof packet supports both the fact and amount of loss.
Thirty-day payment date and any accumulation election are calculated correctly.
Partial supported amounts of at least $100 are tracked separately.
Written rejection gives a specific reason and required bureau information when applicable.
Twelve-percent or 18-percent interest theory is supported by the record.
Excess balances above the statutory maximum are not collected from the insured.
Directions of benefits, negotiated reductions, and exhaustion are coded distinctly.

Related Millennova Legal resources

Use Millennova Legal's auto-accident medical-bill recovery services and Kentucky auto-accident guide for broader claim context. For documentation that may affect who can pursue reimbursement, see the assignment-of-benefits and medical-liens guide. The Oregon PIP and Massachusetts PIP guides illustrate why state-specific timing and payment rules should not be imported into a Kentucky claim.