Transportation..

the right way

HP Provider Relations/October 2013

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
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Transportation Services

Types of Transportation Services

Advanced Life Support ALS
Care given at the scene of an accident, act of terrorism, or illness; care given during
transport; care given at the hospital by a paramedic or emergency medical
technician-intermediate; and care that is more advanced than the care usually
provided by an emergency medical technician or an emergency medical technicianbasic advanced

Basic Life Support BLS

BLS services do not include invasive medical care techniques or advanced life
support

Commercial or Common Ambulatory Service CAS

Transporting ambulatory members to or from an IHCP covered service
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Types of Transportation Services

Commercial or Common Ambulatory Service CAS
Transporting ambulatory members to or from an IHCP covered
service

Non-ambulatory Service NAS

Transporting non-ambulatory services (member must travel in a
wheelchair) to or from an IHCP-covered service

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)
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October 2013

Enrollment

Enrollment Meet the Requirements

Reference the IHCP Provider Type and Specialty Matrix to determine
documentation requirements
http://provider.indianamedicaid.com/media/27745/matrix.pdf

Transportation

October 2013

Enrollment Always Use the Most Recent Forms

Enrollment Always Use the Most Recent Forms

Enrollment Reminders
Review the matrix:
Choose the correct provider specialty
Prepare the documentation requirements

Motor Carrier Certificate

Proof of auto insurance

Copy of drivers license for all drivers

Fingerprint and background checks; surety bond

BT201315 requirements

Application fee
IHCP Affordable Care Act requirements
IHCP Bill Pay site
***Additional documentation my be required

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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

Valid and current licenses

Certificates
Proof of insurance
If a provider fails to recertify before their eligibility end date, the provider must
reenroll with the IHCP by submitting a new IHCP Provider Packet in its
entirety

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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 will receive notification letters with instructions for revalidating 90

and 60 days before their revalidation deadline

Providers should not take any steps to revalidate until they receive their
notification letters

Providers that fail to submit revalidation paperwork in a timely manner will be

deactivated from participation in the IHCP as of the deadline date

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Eligibility

Verify Eligibility Web interChange, AVR, Omni swipe

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Verify Eligibility Key Areas

Member is eligible
Member has a nursing facility (NF) level of care
Member is a Qualified Medicare Beneficiary (QMB)
ALSO Have all Medicaid benefits
ONLY Only have coverage for Medicare coinsurance and deductible

Spend-down
NEVER collect spend-down in advance

Enrolled in Hoosier Healthwise risk-based managed care (RBMC)

Follow guidelines for the appropriate managed care entity

Third-party liability (TPL) insurance

Medicare and TPL are primary

Benefit limits exhausted

Prior authorization may be required
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October 2013

Billing Guidelines

Billing Guidelines What Is a Trip?

For billing purposes, a trip is defined as transporting a member
from the initial point of pickup to the drop-off point at the final
destination
Cancelled transportation appointments or no show by the member is
NOT a billable fee to the IHCP and the member can NOT be billed

Transportation must be the least expensive type of

transportation available that meets the medical needs of the
member
Trips must be billed according to the level of service rendered
and not according to the vehicle type

Billing Guidelines What Is a Trip?

Provider transports a member on the same date of service, but different trip
levels (for example the to trip was a CAS trip, and the return trip was a NAS
trip, with mileage for each base), these base trips must be billed on two different
claim forms with the corresponding mileage for each base
The provider makes a round trip, or two one-way trips for the same member,
same date of service, and same level of base code, both runs should be
submitted on the same detail with two units of service
All mileage for the trip must be billed on the one detail with the total number of
miles associated for the roundtrip to include the first 10 miles

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Billing Guidelines Mileage

Mileage does not start until the member is in the vehicle (loaded mileage)

Transportation providers are expected to transport members along the

shortest, most efficient route to and from a destination

Mileage must be documented on the trip sheet using odometer readings or

mapping software programs

Mileage is reimbursed, in addition to the base rate, under the following

circumstances:

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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

Billing Guidelines Mileage

Mileage does not start until the member is in the vehicle (loaded mileage

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

Total mileage should be billed including the first 10

Fractional miles are not allowed

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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

Billing Guidelines Multiple Passengers

When two or more members are transported simultaneously from the same
county to the same vicinity for medical services, the second and subsequent
member transported in a single CAS or NAS vehicle is reimbursed at one-half
the base rate

For example, no mileage should be billed in conjunction with T2004 - Nonemergency

transport; commercial carrier, multi-pass, individualized service provided to more than
one patient in the same setting

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
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Billing Guidelines Multiple Destinations

Member is transported to multiple points in succession, the provider may not bill for
a trip between each point of the destination
The following examples offer explanations of this concept:
Example 1: A vehicle picks up a member at home and transports the member to the
physicians office. This is a one-way trip.
Example 2: A vehicle picks up a member from home and transports the member to the
physicians office. The provider leaves, and later the same vehicle picks the member up
from the physicians office and transports the member back to the members home. This
is considered two one-way trips.
Example 3: A vehicle picks up the member from the physicians office and transports the
member to the laboratory for a blood draw, waits outside the laboratory for the member,
and then transports the member home. This is a one-way trip, even though there was a
stop along the way. A stop along the way is not considered a separate trip.
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Billing Guidelines Rotary Wing Air Ambulance

Requires a prior authorization
Providers are required to bill for both the
base rate and mileage codes
Claims no longer require an attachment for
a cost invoice
Can be submitted electronically

Each code is reimbursed at a specific rate

per the IHCP Fee Schedule

Refer to IHCP Provider Manual, Chapter 8,

Section 4
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October 2013

Billing Guidelines Taxi

Taxi providers cannot transport outside the jurisdiction designated by their
city taxi license
To transport outside the jurisdiction, the taxi provider must be enrolled as a
common carrier
If a taxi transports across county borders, the Indiana Department of
Revenues Motor Carrier Services Division must certify taxi transport as a
common carrier

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October 2013

Billing Guidelines Modifiers

Providers must include the origin and destination modifiers with the base rate
procedure codes
The first character of the two-digit modifier indicates the transports place of
origin
The second character indicates the destination
When a member is transported by more than one transportation company on
the same date of service, use of the modifiers helps to prevent one of the
claims from denying as a duplicate of the other providers claim
A list of appropriate modifiers can be found in the IHCP Provider Manual in
Chapter 8, Section 4

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October 2013

Billing Guidelines Modifiers

Modifier

Description

Diagnostic or therapeutic site, other than P or H

Residential, domiciliary, or custodial facility (nursing home, not SNF)

Hospital-based dialysis facility (hospital or hospital-related)

Hospital

Site of transfer between types of ambulance

Nonhospital-based dialysis facility

Skilled nursing facility (SNF)

Physician office

Residence

Scene of accident or acute event

Billing Guidelines Diagnosis

Dialysis

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

Will not bypass 20 oneway trip limitation

Required on all claims
except dialysis and
nursing home

Billing Guidelines Attendant

An additional attendant may be needed in situations where the driver cannot
load the member without help, such as when wheelchair-bound member lives
upstairs and the residence has no wheelchair ramp
In this situation:
The additional attendant who assists must be an employee of the billing
provider and is not required to remain for the trip
Providers must document the need for an additional attendant on the drivers
ticket

Claims must include the appropriate procedure codes and modifiers

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October 2013

Billing Guidelines Accompanying

Parent/Attendant
Accompanying parent

Members younger than 18 years of age need an adult to

accompany them to a medical service

The provider should bill the appropriate accompanying

parent or attendant code

Accompanying attendant

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When adult members need an attendant to travel with

them for a medical service, the provider should bill the
appropriate accompanying parent or attendant code

Transportation

October 2013

Billing Guidelines Accompanying

Parent/Attendant
The following guidelines are for billing the accompanying parent or attendant
codes:

The procedure code for the base rate and the accompanying parent or
attendant is billed under the IHCP member identification number (RID)

Additional reimbursement is not available for accompanying parent or

attendant when the billing provider does not bill non-IHCP customers for
like services

The provider must maintain documentation on the drivers ticket to support

that the accompanying parent or attendant was transported with the IHCP
member
This documentation must include the name, signature, and relation of the
accompanying parent or attendant
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October 2013

Billing Guidelines Wait Time

Wait time in excess of 30 minutes is reimbursable when:

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)

Documentation, including start and stop times, must be maintained on the

drivers ticket to support the wait time billed
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October 2013

Billing Guidelines Web interChange

Bill the correct code and modifier for the level and type of service provided
IHCP Provider Manual, Chapter 8, Section 4

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Billing Guidelines Web interChange

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Billing Guidelines Web interChange

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October 2013

Billing Guidelines Web interChange

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October 2013

Member Copayments

Member Copayment Amounts

IHCP requires a copayment for transportation services

The copayment shall be made by the recipient and collected by the provider at the time
the service is rendered
Medicaid reimbursement to the provider shall be adjusted to reflect the copayment
amount for which the recipient is liable
Members cannot be denied services for inability to pay copay at the time of service
The member may be billed
Copayment

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Description

$0.50

Services for which the IHCP pays $10.00 or less

$1.00

Services for which the IHCP pays $10.01 to $50.00

$2.00

Services for which the IHCP pays $50.01 or more

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

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Prior Authorization

Prior Authorization Requirements

Trips exceeding 20 one-way trips per
rolling 12-month period require prior
authorization (PA)
Other services that require PA:
Air ambulance transportation
Bus transportation

Interstate transportation or
transportation services rendered by a
provider located out-of-state in a
nondesignated area

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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

Accompanying parent or attendant or additional

attendant

Signature stamps

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Providers may use signature stamps on the PA

request form; see IHCP Provider Manual,
Chapter 6, Section 1

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

Members on renal dialysis

V56.0, V56.1, or V56.8 (required to bypass PA)

Members in nursing homes

V70.5 (required to bypass PA)

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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)

PA submission available on Web

interChange

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October 2013

PA Contacts
Care Select

Each care management entity (CME) is responsible for processing PA

requests for its respective Care Select members:
MDwise Care Select
P.O. Box 44214
Indianapolis, IN 46244-0214
1-800-356-1204
1-877-822-7186 (Fax)
ADVANTAGE Health Solutions
P.O. Box 80068
Indianapolis, IN 46280
1-800-784-3981
1-800-689-2759 (Fax)
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PA Submission Web interChange

Insert screen shot of pa submission

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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

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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

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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

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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

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October 2013

Frequently Asked Questions

Frequently Asked Questions

Why is the copayment deducted from my claim twice?
Do not deduct copayment amount when submitting claims
The IHCP systematically deducts the copayment from the claim payment

Why is a copayment deducted when the patient is pregnant?

To bypass the copayment edit, indicate yes in pregnancy field on paper claim field
24H and on an electronic claim pregnancy button

Why is a copayment deducted when I transport a patient to the hospital for

admission?
Indicate the appropriate two-digit place of service code

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October 2013

Frequently Asked Questions

Why do I receive denials for the 20-trip limit when I transport a nursing facility
patient?

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

Why are 10 miles of each one-way trip deducted from my mileage?

The initial 10 miles are built into the base rate
Mileage is only reimbursed for 11 miles or more
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Find Help

Helpful Tools
IHCP Provider website at indianamedicaid.com
IHCP Provider Manual (web, CD, or paper)

IHCP Provider Manual, Chapter 8, Section 4

Customer Assistance

1-800-577-1278 or
(317) 655-3240 in the Indianapolis local area

Provider field consultant

Locate area consultant map on:

indianamedicaid.com (provider home page> Contact
Us> Provider Relations Field Consultants) or
Web interChange > Help > Contact Us

HP Written Correspondence

P.O. Box 7263

Indianapolis, IN 46207-7263

Q&A