TRANSPORTATION GUIDELINES HP Provider Relations October 2010 1 © 2010 Hewlett-Packard Development Company, L. P. The information contained herein is subject to change without notice
Agenda – Session objectives – Provider Enrollment responsibilities – Transportation specialties and billing codes – QMB Only/Also – Destination modifiers – Prior authorization – Dialysis and long term care members – Copayment amounts and exemptions – Frequently asked questions – Helpful tools – Questions and answers 2 Transportation Guidelines October 2010
Session Objectives At the end of this session, providers will understand: – Enrollment and recertification document requirements – Differences between transportation provider types – The impact of QMB-only – The importance of destination modifiers – Prior authorization requirements – Required copayments and copayment exemptions – How to resolve common claim denials 3 Transportation Guidelines October 2010
Learn Enrollment Requirements 4 Transportation Guidelines October 2010
Enrollment Responsibilities – Providers should reference the Provider Type and Specialty Matrix to determine the documentation required to enroll in, or recertify for the Indiana Health Coverage Programs (IHCP) – Once enrolled, transportation providers must recertify annually or based upon permits, certificates, and liability insurance coverage periods – Two reminder letters are sent to the providers, 60 and 30 days prior to the recertification date – Seven specialties are associated with transportation providers: • • 261 – Air ambulance • 262 – Bus • 263 – Taxi • 264 – Common Carrier ambulatory services (CAS) • 265 – Common Carrier Non ambulatory services (NAS) • 5 260 – Ambulance 266 – Family member Transportation Guidelines October 2010
Enrollment Responsibilities 260 – Ambulance 261 – Air Ambulance – A copy of the Emergency Medical Services (EMS) Commission certificate, based on certificate end date, is needed for enrollment and for the annual recertification 6 Transportation Guidelines October 2010
Enrollment Responsibilities 262 – Bus – The Motor Carriers Services (MCS) certificate issued by the Indiana Department of Revenue is required for both enrollment and annual recertification in the IHCP 7 Transportation Guidelines October 2010
Enrollment Responsibilities 263 – Taxi – A document showing operating authority from a local governing body; for example a city taxi or livery license – A copy of driver’s licenses for all drivers – Proof of insurance indicated by local ordinances or, if unspecified by local ordinance, a minimum of $25, 000/$50, 000 of public livery insurance covering all vehicles used in the business 8 Transportation Guidelines October 2010
Enrollment Responsibilities 264 – Common Carrier Ambulatory Services (CAS) 265 – Common carrier Non Ambulatory Services (NAS) – For profit • Motor Carrier Services certificate from the Indiana Department of Revenue – Not-for-profit • • Proof of insurance • 9 Certification of not-for-profit status from the Internal Revenue Service (IRS) Copy of a Valid drivers license Transportation Guidelines October 2010
Enrollment Responsibilities 266 – Family Member – Approval from the local office of the Division of Family Resources (DFR) – Proof of insurance – A copy of a valid drivers license 10 Transportation Guidelines October 2010
Perform Billing for Services 11 Transportation Guidelines October 2010
Billing Codes 260 – Ambulance Code Description A 0427 Advanced Life Support (ALS) Emergency Transport, Level 1, one or more interventions A 0426 ALS Non-Emergency Transport, Level 1, one or more interventions A 0428 Basic Life Support (BLS), Non-Emergency Transport A 0429 BLS, Emergency Transport A 0225 Neonatal Transport, Ambulance service, base rate one way CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. 12 Transportation Guidelines October 2010
Billing Codes 260 – Ambulance Code Description T 2003 ALS non-emergency transport; level 1 (Common Carrier ambulatory) A 0130 ALS non-emergency transport; level 1 (Common carrier Non-ambulatory) T 2003 BLS non-emergency transport; (Common Carrier ambulatory) A 0130 BLS non-emergency transport; (Non-ambulatory) A 0425 U 1 U 2 Ground mileage, per statute mile Level 1 (ALS) Level 2 (BLS) A 0420 U 1 Ambulance service - waiting time ALS one-half (1/2) hour increments A 0420 U 1 Ambulance service - waiting time BLS one-half (1/2) hour increments 13 Transportation Guidelines October 2010
Billing Codes 261 – Air Ambulance Code Description A 0431 Ambulance Service, conventional air service, transport, one way (rotary wing) A 0430 Ambulance service, conventional air service transport, one way (fixed wing) A 0436 Rotary wing air mileage, per statute mile A 0431 QL Ambulance service, conventional air service, transport, one way (rotary wing); if the member is pronounced dead after takeoff to point of pickup 14 Transportation Guidelines October 2010
Billing Guidelines 261 – Air Ambulance, A 0431 QL, A 0436 – Effective for Rotary Wing air ambulance: for dates of service on or after December 25, 2009, providers are to bill for both the base rate and mileage code – Rotary Wing Air Ambulance claims no longer require an attachment for a cost invoice after January 1, 2010 – Prior to January 1, 2010, rotary wing air ambulance claims still require an attachment – Each code is reimbursed at a specific rate per the IHCP fee schedule – Refer to BT 200935 for the policy update 15 Transportation Guidelines October 2010
Billing Codes 262 – Bus Code Description A 0110 Nonemergency transportation and bus, intrastate or interstate carrier 16 Transportation Guidelines October 2010
Billing Codes 263 - Taxi Code Description A 0100 U 4 Non-emergency transportation – taxi, suburban A 0100 UA Taxi – 0 -5 miles A 0100 UB Taxi – 6 -10 miles A 0100 UC Taxi – 11 miles and up A 0100 TT UA Taxi – 0 to 5 miles, multi-passenger A 0100 TT UB Taxi – 6 to 10 miles, multi-passenger A 0100 TT UC Taxi – non-regulated, multi-passenger, 11 miles or more A 0100 TK UA Taxi – 0 to 5 miles, accompanying parent or assistant A 0100 TK UB Taxi – 6 to 10 miles, accompanying parent or assistant A 0100 TK UC Taxi – non-regulated, accompanying parent or assistant, 11 miles or more 17 Transportation Guidelines October 2010
Billing Guidelines 263 – 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 (provider specialties 264 and 265). – If a taxi transports across county borders, the Indiana Department of Revenue’s Motor Carrier Services Division must certify as a common carrier 18 Transportation Guidelines October 2010
Billing Codes 264 – Common Carrier Ambulatory Service (CAS) Code Description T 2003 Common Carrier Ambulatory Service – base rate T 2004 Common Carrier Ambulatory Service – multiple passenger T 2001 Common Carrier Ambulatory Service – accompanying parent or assistant, base rate A 0425 U 3 CAS Mileage T 2007 U 3 Level 3 CAS Waiting time - in one-half (1/2) hour increments 19 Transportation Guidelines October 2010
Billing Codes 265 – Common Carrier Non Ambulatory Services (NAS) Code Description A 0130 Wheelchair – Common Carrier Non-ambulatory, base rate A 0130 TT Wheelchair – Common Carrier Non-ambulatory, multiple passenger, base rate A 0130 TK Wheelchair – Common Carrier Non-ambulatory, accompanying parent or attendant, base rate A 0425 U 5 NAS Mileage T 2007 U 5 Waiting time in one-half (1/2) hour increments 20 Transportation Guidelines October 2010
Billing Codes 266 – Family Member Code Description A 0090 Mileage for family member automobile transportation 21 Transportation Guidelines October 2010
Billing Guidelines Qualified Medicare Beneficiary (QMB) – QMB members are eligible for Medicare and Medicaid • The State pays the premium for Medicare Part B – Two Types: • QMB-Only – The IHCP “only” pays the Medicare coinsurance and deductible − QMB-Only members do not have transportation coverage for transportation services that are not covered by Medicare • QMB-Also – The IHCP “also” pays for Medicare non-covered services in addition to the coinsurance and deductible − Services must be covered by Medicaid to be reimbursed – Transportation providers must have QMB-Only members sign a waiver prior to furnishing services not covered by Medicare – The IHCP can pay for covered transportation services for QMB-Also members without a waiver 22 Transportation Guidelines October 2010
Billing Guidelines Destination Modifiers – Providers must include the origin and destination modifiers with the base rate and mileage 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 – Refer to BT 200811 for additional published modifiers 23 Transportation Guidelines October 2010
Billing Guidelines Destination 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 hospitalrelated) H Hospital I Site of transfer between types of ambulance J Non hospital-based dialysis facility N Skilled nursing facility (SNF) P Physician Office R Residence S Scene of accident or acute event 24 Transportation Guidelines October 2010
Understand Prior Authorization Requirements 25 Transportation Guidelines October 2010
Prior Authorization Requirements – Trips exceeding 20 one-way trips per rolling 12 -month period require prior authorization (PA) – Other services which require PA • Air Ambulance Transportation • Airline Transportation • Train Transportation • Bus Transportation – Transportation rendered by any provider to or from a non-designated, out-of-state area requires PA 26 Transportation Guidelines October 2010
PA Requirements – Trips of 50 miles or more one way require PA – When requesting PA for trips that are greater than 50 miles one way, providers need to make sure they request authorization for the • Base rate • Mileage • Wait time – Signature stamps • 27 Providers may use signature stamps on the PA request form Transportation Guidelines October 2010
PA Contacts Traditional Medicaid Fee-for-service – Traditional Medicaid fee-for-service PA requests are processed by ADVANTAGE Health Solutions. SM • ADVANTAGE Health Solutions (fee-for-service) P. O. Box 40789 Indianapolis, IN 46240 • 1 -800 -269 -5720 • 1 -800 -689 -2759 (Fax) – Submit PA requests on Web inter. Change PA Submission for fastest way of obtaining PA 28 Transportation Guidelines October 2010
PA Contacts Care Select – Each care management organization (CMO) is responsible for processing PA requests for their respective Care Select members: – MDwise • MDwise P. O. Box 44214 Indianapolis, IN 46244 -0214 • 1 -866 -440 -2449 • 1 -877 -822 -7186 (Fax) – ADVANTAGE Health Solutions • • 1 -800 -784 -3981 • 29 ADVANTAGE Health Solutions P. O. Box 80068 Indianapolis, IN 46280 1 -800 -689 -2759 (Fax) Transportation Guidelines October 2010
PA Contacts Risk-based Managed Care (RBMC) – Providers must direct transportation service requests for RBMC members to the appropriate managed care organization (MCO) – Managed Health Services (MHS) LCP Company provides services, but providers must call MHS for PA and notification of transportation needs • 1 -877 -647 -4848 • www. managedhealthservices. com • – MDwise Call MDwise for PA and notification of transportation needs • 1 -800 -356 -1204 • www. mdwise. org • – Anthem 1 -800 -508 -7230 LCP Company • Or Anthem 1 -866 -408 -6132 • www. anthem. com • 30 Transportation Guidelines October 2010
PA Guidelines Dialysis and Nursing Home Patients – The IHCP does not require PA for the 20 -trip limit for these member population when transportation providers file claims with the following diagnoses: • • 31 Nursing home residents: V 70. 5 Dialysis patients: V 56. 0, V 56. 1, or V 56. 8 Transportation Guidelines October 2010
Collect Copayments 32 Transportation Guidelines October 2010
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 33 Transportation Guidelines October 2010
Copayment Exemptions – Members younger than 18 years old • Package C members are not exempt from copayment requirements – An assistant or accompanying adult traveling with a member younger than age 18 years old – Pregnancy indicated in form field 24 H – A place-of-service code indicating a medical institution (for example, acute care hospital, intermediate care facility for the mentally retarded, or other medical institution) 34 Transportation Guidelines October 2010
Interpret Common Denials 35 Transportation Guidelines October 2010
Edit 4080 Ten Miles Not Reimbursable Per One-way Trip – Cause • System is deducting first 10 miles from the claim – Resolution • • Providers should bill the total miles traveled for each trip • 36 The initial 10 miles are included into the base rate; mileage is only reimbursed for 11 miles or more Indiana. AIM will automatically calculate the appropriate mileage reimbursement Transportation Guidelines October 2010
Edit 5000 Possible Duplicate – Cause • Two round trips made in one day; the second trip denies as a duplicate – Resolution • • Combine total mileage on one line • 37 Indicate four units on one line in form field 24 G for the base code Maintain documentation for the two separate round trips Transportation Guidelines October 2010
Edit 6803 Transportation: One-way trips in excess of Twenty – Cause • Member has already had 20 trips paid – Resolution • • 38 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 Transportation Guidelines October 2010
Clarify Frequently Asked Questions 39 Transportation Guidelines October 2010
Frequently Asked Questions – Question: Why is the copayment deducted from my claim twice? • Answer: Do not enter copayment amounts in Field 29 of the CMS-1500 claim form. The IHCP systematically deducts the co-payment from the claim payment. – Question: Why is a copayment deducted when the patient is pregnant? • Answer: To bypass the copayment edit, indicate P in form field 24 H of the CMS-1500 claim form. – Question: Why is a copayment deducted when I transport a patient to the hospital for admission? • 40 Answer: Indicate the appropriate place of service in form field 24 B of the CMS-1500 claim form. Transportation Guidelines October 2010
Frequently Asked Questions – Question: Why do I receive denials for the 20 trip limit when I transport a nursing facility patient? • Answer: To bypass the 20 -trip limit denial, you must use diagnosis code V 70. 5 when transporting a nursing facility patient. – Question: If I make two trips in one day, why does the second trip deny as a duplicate? • Answer: The IHCP will pay claims for both trips if you bill them on one detail line on the CMS-1500 claim form. Indicate four units in form field 24 G. Maintain documentation for the two separate trips. – Question: Why are 10 miles of each one-way trip deducted from my mileage? • 41 Answer: The initial 10 miles are built into the base rate. Mileage is only reimbursed for 11 miles or more. Transportation Guidelines October 2010
Helpful Tools – IHCP Provider Web site at www. indianamedicaid. com – IHCP Provider Manual (Web, CD-ROM, or paper) – Bulletin BT 200505 – Customer Assistance • 1 -800 -577 -1278, or • (317) 655 -3240 in the Indianapolis local area – Written Correspondence • HP Written Correspondence P. O. Box 7263 Indianapolis, IN 46207 -7263 – Provider Relations Field Consultant • 42 Contact information is available on the IHCP Provider Web site Transportation Guidelines October 2010
Q&A 43 Transportation Guidelines October 2010
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