Professional Documents
Culture Documents
Agenda
Session objectives
Transportation services
Provider enrollment
Member eligibility
Billing guidelines
Copayment amounts and exemptions
Prior authorization
Common denials
Frequently asked questions
Helpful tools
Q&A
Transportation
October 2013
Objectives
At the end of this session, providers will
understand:
Enrollment, recertification, and revalidation
Eligibility verification
Correct billing practices
Copayments and copayment exemptions
Prior authorization
Common claim denials
Helpful tools
3
Transportation
October 2013
Transportation Services
Transportation
October 2013
Taxi
Taxi providers transport members to or
from an IHCP covered service
May operate under authority from a
local governing body (city taxi or
livery license)
6
Transportation
October 2013
Enrollment
Transportation
October 2013
Enrollment Reminders
Review the matrix:
Choose the correct provider specialty
Prepare the documentation requirements
Application fee
IHCP Affordable Care Act requirements
IHCP Bill Pay site
***Additional documentation my be required
11
Transportation
October 2013
Download the
most recent
version of the
Provider
Enrollment form
****Enrollment with
Traditional Medicaid does
not automatically enroll a
provider with the managed
care entities
Enrollment Recertification
Enrollment Recertification
When a provider is required to recertify, a notification is sent to the provider
90 and 60 business days prior to the end date of a provider's eligibility to
participate in the IHCP
13
Transportation
October 2013
Enrollment Revalidation
Under the Affordable Care Act (ACA), the Indiana Health Coverage
Programs (IHCP) is required to revalidate all provider enrollments
The ACA screening criteria apply during revalidation
Providers should not take any steps to revalidate until they receive their
notification letters
14
Transportation
October 2013
Eligibility
16
Transportation
October 2013
Spend-down
NEVER collect spend-down in advance
Transportation
October 2013
Billing Guidelines
20
Transportation
October 2013
21
Ambulance providers are reimbursed for loaded mileage of the trip regardless of the
type or level of service being billed
Taxi providers are not reimbursed for mileage and are not required to submit mileage
with their claim; however, the mileage must be documented
Transportation
October 2013
The first 10 miles of a CAS or NAS trip are billed into the base rate with no
separate reimbursement for mileage
For trips less than 10 miles, the IHCP does not require the provider to bill mileage;
however, if the provider does bill mileage, the IHCP processes the mileage as a denied
line item
CAS and NAS providers must bill for all mileage when travel exceeds 10 miles one way
22
If the provider transports the member between 15.0 and 15.4 miles, the provider
should bill 15 miles; if the trip is between 15.5 miles and 16.0 miles, the provider
should bill 16 miles
Transportation
October 2013
The full base code, mileage, and waiting time are reimbursed for the first
member only
The IHCP does not provide reimbursement for multiple passengers in
ambulances or family member vehicles
Additional reimbursement is not available for multiple passengers when the
billing provider does not bill non-IHCP customers for these services
23
Transportation
October 2013
Transportation
October 2013
Transportation
October 2013
26
Transportation
October 2013
27
Transportation
October 2013
Description
Hospital
Physician office
Residence
Nursing Home
General
V560
V561
V568
V705
7999
Required to bypass 20
one-way trip limitation
Required on all dialysis
claims
Required to bypass 20
one-way trip limitation
Required on all nursing
home
Transportation
October 2013
Accompanying attendant
31
Transportation
October 2013
The procedure code for the base rate and the accompanying parent or
attendant is billed under the IHCP member identification number (RID)
Transportation
October 2013
The vehicle is parked outside the medical service provider, awaiting the return
of the member to the vehicle and if the member is transported 50 miles or more
one-way
PA is obtained for all codes associated with trips of 50 miles or more one-way,
including waiting time
The first 30 minutes of wait time is not covered; however, the total wait time
must be included on the claim, or the claim will not be paid appropriately
One unit of service is billed for each 30 minutes of wait time (round to nearest unit)
Transportation
October 2013
34
Transportation
October 2013
35
Transportation
October 2013
36
Transportation
October 2013
37
Transportation
October 2013
Member Copayments
39
Description
$0.50
$1.00
$2.00
Transportation
October 2013
Copayment Exemptions
Copayments are not required for:
Members younger than 18 years old
An assistant or accompanying adult traveling with a member younger than
age 18 years old
Pregnancy (indicated by checking yes or no radio button or entering Y in
field 24H on a paper claim)
Services furnished to individuals who are patients in:
Inpatient hospital
Nursing facilities
Intermediate care facility for individuals with intellectual disability
40
Transportation
October 2013
Prior Authorization
Interstate transportation or
transportation services rendered by a
provider located out-of-state in a
nondesignated area
42
Transportation
October 2013
PA Requirements
Trips of 50 miles or more one way require PA
When requesting PA, providers should
include codes for all services:
Base rate
Mileage
Wait time
Signature stamps
43
Transportation
October 2013
PA Requirements Exceptions
Emergency ambulance services
Hospital admission or discharge
Transportation to a hospital for admission or from a hospital to home after
discharge is exempt from 20 one-way trip limitation
44
Transportation
October 2013
PA Contacts
Traditional Medicaid fee-for-service
Traditional Medicaid fee-for-service PA
requests are processed by:
ADVANTAGE Health Solutions
P.O. Box 40789
Indianapolis, IN 46240
1-800-269-5720
1-800-689-2759 (Fax)
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Transportation
October 2013
PA Contacts
Care Select
Transportation
October 2013
47
Transportation
October 2013
Common Denials
Edit 4080
Mileage is not reimbursable unless the recipient is transported 11
miles or more one way please verify and resubmit
Cause:
System is deducting first 10 miles from the claim
Resolution:
The initial 10 miles are included in the base rate; mileage is only reimbursed for 11
miles or more
Providers should bill the total miles traveled for each trip
IndianaAIM will automatically calculate the appropriate mileage reimbursement
49
Transportation
October 2013
Edit 6803
Prior authorization required for one-way trips in excess of 20
Cause:
Member has already had 20 trips paid
Resolution:
Make sure to check for benefit limits reached on eligibility prior to transporting
member
Submit a PA request for more trips then resubmit claim after approved PA is received
50
Transportation
October 2013
Edit 5000
Possible duplicate
Cause:
Two round trips made in one day; the second trip denies as a duplicate
Resolution:
Indicate four units on one line
Combine total mileage on one line
Maintain documentation for the two separate round trips
51
Transportation
October 2013
Edit 2007
QMB recipient
Cause:
Member enrolled in Medicare
Resolution:
Verify eligibility and review QMB Only versus Also to see if member eligible for
service
52
Transportation
October 2013
54
Transportation
October 2013
To bypass the 20-trip limit denial, you must use diagnosis code V70.5 when
transporting a nursing facility patient
If I make two round trips in one day, why does the second round trip deny as
a duplicate?
Maintain documentation for the two separate trips
The IHCP will pay claims for both trips if you bill them on one detail line indicating 4
units of service
Transportation
October 2013
Find Help
Helpful Tools
IHCP Provider website at indianamedicaid.com
IHCP Provider Manual (web, CD, or paper)
1-800-577-1278 or
(317) 655-3240 in the Indianapolis local area
HP Written Correspondence
Q&A