IHCP Transportation

Transportation.. the right way

HP Provider Relations/October 2013

Transportation October 2013 2

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


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

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 technician-

basic 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


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)

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

http://provider.indianamedicaid.com/media/27745/matrix.pdf

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 driver’s 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

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

http://provider.indianamedicaid.com/ihcp/ProviderServices/redirect_hp_pay.aspx

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

http://provider.indianamedicaid.com/become-a-provider/complete-an-ihcp-provider-packet.aspx


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

Eligibility


Verify Eligibility – Web interChange, AVR, Omni swipe


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

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


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:

− 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


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

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


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


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

physician’s office. This is a one-way trip.

− Example 2: A vehicle picks up a member from home and transports the member to the

physician’s office. The provider leaves, and later the same vehicle picks the member up

from the physician’s office and transports the member back to the member’s home. This

is considered two one-way trips.

− Example 3: A vehicle picks up the member from the physician’s 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.

Billing Guidelines – Multiple Destinations


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

http://provider.indianamedicaid.com/ihcp/Publications/MaxFee/fee_schedule.asp


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

Revenue’s Motor Carrier Services Division must certify taxi transport as a

common carrier


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 transport’s 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 provider’s claim

• A list of appropriate modifiers can be found in the IHCP Provider Manual in

Chapter 8, Section 4

http://provider.indianamedicaid.com/ihcp/manuals/chapter08.pdf

http://provider.indianamedicaid.com/ihcp/manuals/chapter08.pdf

Billing Guidelines − Modifiers Modifier Description

D Diagnostic or therapeutic site, other than P or H

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

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

H Hospital

I Site of transfer between types of ambulance

J Nonhospital-based dialysis facility

N Skilled nursing facility (SNF)

P Physician office

R Residence

S 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 one-

way 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 driver’s

ticket

− Claims must include the appropriate procedure codes and modifiers


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

− 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


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 driver’s 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


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 driver’s ticket to support the wait time billed


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







Member Copayments


• 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

Member Copayment − Amounts

Copayment 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


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

Prior Authorization


• 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

Prior Authorization Requirements


PA Requirements

• When requesting PA, providers should include codes for all services:

− Base rate

− Mileage

− Wait time

− Accompanying parent or attendant or additional attendant

• Signature stamps

− Providers may use signature stamps on the PA

request form; see IHCP Provider Manual,

Chapter 6, Section 1

Trips of 50 miles or more one way require PA


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)


• 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

PA Contacts Traditional Medicaid fee-for-service

http://images.search.yahoo.com/images/view;_ylt=A2KJkewtARNS3QQAgGKJzbkF;_ylu=X3oDMTFxNXI1cnBwBHNlYwNzcgRzbGsDaW1nBG9pZANmMDhhNDY4YjIzMjQzNDE0ZDhhZDA3YzkwMjE2M2U0YgRncG9zAzM-?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Dperson%2Bat%2Bcomputer%26n%3D30%26ei%3Dutf-8%26y%3DSearch%26fr%3Dyfp-t-900%26tab%3Dorganic%26ri%3D3&w=288&h=287&imgurl=sirensong.sireninteractive.com%2Fwp-content%2Fuploads%2F2008%2F12%2Fperson-at-computer.jpg&rurl=http%3A%2F%2Fsirensong.sireninteractive.com%2Ftag%2Fcrm%2F&size=34.2KB&name=%3Cb%3EPerson+at+computer%3C%2Fb%3E&p=person+at+computer&oid=f08a468b23243414d8ad07c902163e4b&fr2=&fr=yfp-t-900&tt=%3Cb%3EPerson+at+computer%3C%2Fb%3E&b=0&ni=48&no=3&ts=&tab=organic&sigr=11e3sgc7t&sigb=13m0a3fvd&sigi=12g2k2k2c&.crumb=1rCZEYfuFcM&fr=yfp-t-900


• 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)

PA Contacts Care Select


PA Submission – Web interChange

Insert screen shot of pa submission

Common Denials


Edit 4080

• 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

Mileage is not reimbursable unless the recipient is transported 11

miles or more one way – please verify and resubmit


Edit 6803

• 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

Prior authorization required for one-way trips in excess of 20


Edit 5000

• 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

Possible duplicate


Edit 2007

• Cause:

− Member enrolled in Medicare

• Resolution:

− Verify eligibility and review QMB Only versus Also to see if member eligible for

service

QMB recipient

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



• 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

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

http://www.indianamedicaid.com/

Q&A

Documents

IHCP Transportation