Medical Transportation Program - TMHP MTP_UserGuide.pdf · The Medical Transportation Program (MTP), under the direction of HHSC, arranges Non-Emergency Medical Transportation (NEMT)

User guide

Medical Transportation Program

v2018_0531

Medical Transportation Program - Quick Reference Guide

MTP User Guide | v2018_0531

Contents

Prior Authorizations ...................................................................................................................................................................4

Provider Types and Enrollment Options ...............................................................................................................................4Individual Transportation Participant (ITP) .......................................................................................................................4

Claims, Remittance and Status (R&S) Reports, and Appeals .......................................................................................... 5

Ways to File a Claim .................................................................................................................................................................... 7TexMedConnect ......................................................................................................................................................................... 7Paper Claims Submission ....................................................................................................................................................... 7

Tips on Expediting Paper Claims .............................................................................................................................................8General requirements .............................................................................................................................................................8Data Fields .................................................................................................................................................................................8Attachments ..............................................................................................................................................................................8Important Codes for All MTP providers ..............................................................................................................................8

Delegation of Signature Authority ..........................................................................................................................................9

TMHP Resources ..........................................................................................................................................................................9



The Medical Transportation Program (MTP), under the direction of HHSC, arranges Non-Emergency Medical Transportation (NEMT) and travel-related services for eligible Medicaid, Children with Special Healthcare Needs (CSHCN) Services Program, and Transportation for Indigent Cancer Patients (TICP) clients who have no other means of transportation to their covered health-care services. NEMT services include non-ambulance transportation or travel-related services provided to eligible clients who need to get transported to and from covered heal-care services. MTP is responsible for the prior authorization of all NEMT services within Region 4, and partners with Texas Medicaid & Healthcare Partnership (TMHP) to administer and process claims, provide technology support, software maintenance, program management, etc. Under contract with HHSC, TMHP is responsible for enrolling certain MTP providers and for processing their claims.

Prior AuthorizationsMTP clients are required to contact MTP to request NEMT services before they can begin receiving these services. If the client meets all eligibility requirements, MTP will issue a prior authorization for the requested NEMT services.

Clients can be referred to MTP to get more information on NEMT services at:

MTP Contact Center1-877-MED-TRIP (1-877-633-8747)TTY: 1-800-735-2989Available Monday through Friday, 8:00 a.m. to 5:00 p.m.

For NEMT services within the county or Managed Care service delivery area where the client lives, clients or their advocates must call the MTP office at least two (2) business days before the scheduled appointment for the covered health-care service. For clients who need to travel beyond the county where they live, or the Managed Care service delivery area, clients or their advocates must call the MTP office at least five (5) business days before the scheduled appointment for the covered health-care service.

Provider Types and Enrollment Options

Individual Transportation Participant (ITP)

• Self (ITP-Self) are individuals who volunteers the use of their personal vehicle to drive themselves, a friend, or family member safely to the covered health-care services.

• Other (ITP-Other) are individuals who volunteer to drive any Texas Medicaid, TICP, or CSHCN client safely to their covered health-care services.

All ITPs must register or enroll (depending on whether they are considered ITP-Self or ITP-Other) with MTP through TMHP. ITPs begin the registration/enrollment process when an MTP client contacts them to request a ride. If the ITP agrees to provide transportation for the MTP client, the MTP client will contact MTP and identify the ITP as their driver. TMHP will then send an application to the ITP via mail.

The application asks the ITP if they are related to the MTP client or not. Marking yes or no to this question will indicate whether the ITP is ITP-Self or ITP-Other. Once the ITP fills out the application and all supporting documentation, they will mail it to:

Texas Medicaid & Healthcare PartnershipProvider EnrollmentPO Box 200795Austin, TX 78720-0795



If the application is approved, TMHP will mail a welcome letter to the ITP, which will include their Atypical Provider Identifier (API). The API is required for processing claims, so the ITP must wait until they receive their API before they can submit any claims. The API is also critical for identifying providers, so it’s highly important that the ITP stores it securely for future use.

Demand Response (DR) Providers are common carriers (such as taxis and wheelchair vans) who provide curb-to-curb rides to eligible clients, using dispatched vehicles. DR providers transport clients and their attendant to their covered health-care service, when authorized by MTP, and are contracted by HHSC.

Claims, Remittance and Status (R&S) Reports, and AppealsWhen filing a claim, providers should review the instructions on the form carefully and complete all requested information. A correctly completed claim form is processed faster. Claims submitted by MTP providers must be received within 95 days of the date of service (DOS). TMHP will reject all claims until an API is issued; however, MTP providers can use the TMHP rejection report or Return to Provider (RTP) letters as proof of meeting the filing deadline, and submit an appeal.

All claims for services rendered to MTP clients are subject to the following filing deadlines from the DOS:

• 95 days for in-state providers

Because Texas Medicaid cannot make payments to clients, the ITP or DR provider who performs the service must file all claims. Federal regulations prohibit providers from charging clients a fee for completing or filing Medicaid claim forms. Providers are not allowed to charge TMHP for filing claims. The cost of claims filing is part of the usual and customary rate for doing business. Providers cannot bill Texas Medicaid or Medicaid clients for missed appointments or failure to keep an appointment. Only claims for services rendered are payable.

Medicaid providers are also required to complete and sign authorized medical transportation forms (e.g., ITP Universal Claim Form [H3017]) or provide an equivalent (e.g., provider statement on official letterhead) to attest that services were provided to a client on a specific date. The client presents these forms to Medicaid provider, during their visit.

Medicaid claims are subject to the following procedures:

• TMHP verifies all required information is present.• Claims filed under the same API and program and are ready for disposition at the end of each week

are paid to the provider with an explanation of each payment or denial. The explanation is called the Remittance and Status (R&S) Report, which may be received as a printout via mail or is downloadable as a portable document format (PDF) document, depending on the MTP provider type.

An R&S Report is generated for providers who have weekly claim or financial activity with or without payment. The report identifies pending, paid, denied, and adjusted claims. If no claim activity or outstanding account receivables exist during the time period, an R&S Report is not generated for that week.

R&S Reports include the following sections:

• Banner Pages: Banner messages are used to inform providers of new policies and procedures.



• Claims – Paid or Denied: Claims in the “Claims - Paid or Denied” section were finalized during the week before the issuance of the R&S Report. Claims are sorted by claim status, claim type, and by order of client names. The reported status of each claim will not change unless further action is initiated by the provider, HHSC, or TMHP.

• Adjustment to Claims: Adjustments are listed by claim type, client name, and the client’s Medicaid identification number.

• Financial Transactions: The “Financial Transaction” section of the R&S Report describes any amounts that are added or taken out of the weekly payment. All accounts receivable, IRS levies, payouts, refunds, reissues, and voids appear here.

• Claims Payment Summary: The “Claims Payment Summary” section summarizes all payments, adjustments, and financial transactions that are listed on the R&S Report. This section has two categories: one for amounts “Affecting Payment This Cycle” and one for “Amount Affecting 1099 Earnings.”

• Claims in Process: The “Claims in Process” section can list up to five explanation of pending status (EOPS) codes per claim. The claims listed in this section are in process and cannot be appealed for any reason until they appear in either the “Claims Paid or Denied,” or “Adjustments Paid and Denied” sections of the R&S Report. TMHP is listing the pending status of these claims for informational purposes only.

• EOB: Explanation of Benefits - This page will list the EOB codes found in your R&S Report and give a description of the code.

Sample EOB Codes for MTP (Claim Type 060)EOB Description

01171 NO MTP AUTHORIZATION EXISTS FOR THE MTP CLAIM DATE OF SERVICE.

01172 VALID DRIVER’S LICENSE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE.

01173 VALID AUTOMOBILE INSURANCE FOR THE ITP WAS NOT ON FILE WITH TMHP ON THE MTP CLAIM DATE OF SERVICE.

01174 THE MTP SYSTEM WAS NOT AVAILABLE AT THE TIME THIS CLAIM WAS RECEIVED. THE CLAIM WILL BE PROCESSED WHEN THE MTP SYSTEM BECOMES AVAILABLE.

01175 THE MTP AUTHORIZATION SHOWS THE CLIENT HAS NO PROGRAM ELIGIBILITY FOR THE MTP CLAIM DATE OF SERVICE.

01176 THE PERSON RECEIVING TRANSPORTATION IS NOT ON THE LIST OF CLIENTS THE ITP IS APPROVED TO DRIVE ON THE MTP CLAIM DATE OF SERVICE.

01177 THE AMOUNT/NUMBER OF UNITS BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO EQUAL THEAMOUNT/NUMBER OF UNITS AUTHORIZED BY MTP FOR THIS SERVICE.

01180 THE REIMBURSED AMOUNT EQUALS THE LESSER OF THE MTP LEVEL 1 RATE MULTIPLIED BY THE AUTHORIZED UNITS OR THE BILLED UNITS.

01181 THE AMOUNT BILLED ON THE MTP CLAIM HAS BEEN REDUCED TO MEET THE AUTHORIZEDPERCENTAGE RATE.

Claims must contain the provider’s complete name, address, and provider identifier to avoid unnecessarydelays in processing and payment.



Ways to File a ClaimProviders who are eligible to submit electronic claims (DR providers) can access TMHP’s electronic services, using TexMedConnect on the TMHP website. Providers who are ineligible to submit electronic claims (ITPs) must submit original paper claims.

TexMedConnect

Providers who are eligible to submit electronic claims (DR providers) can participate in the most efficient and effective method of submitting requests to TMHP by submitting through TexMedConnect.

TexMedConnect is a free, Internet-based application used for claims submission, provided through the TMHP secure provider portal. Providers can submit claims, check MTP client eligibility, claim status inquiries, appeals, and download Electronic Remittance and Status (ER&S) Reports (in PDF format). TexMedConnect can interactively process individual claims that are adjudicated in seconds. To use TexMedConnect, providers must have:

• An Internet Service Provider (ISP)• One of the following Internet browsers: Microsoft® Internet Explorer® 11 Google Chrome Mozilla Firefox

Note: Providers who use TexMedConnect can find the online instruction manual on the homepage, and on the EDI Page of the TMHP website at www.tmhp.com.

More detailed information on creating a TexMedConnect account, for claims and appeals submissions can be found in the TexMedConnect for Acute Care Providers Computer-Based Training (CBT) .

Paper Claims Submission

ITPs can file paper claims using the original copy of the Universal Claim Form (H3017).Providers obtain copies of the Universal Claim Form from TMHP. Submit these paper claims to TMHP at thefollowing address:

Texas Medicaid & Healthcare Partnership ClaimsPO Box 200555Austin, TX 78720-0555

Submit appeals and adjustments to TMHP at the following address:

Texas Medicaid & Healthcare PartnershipAppeals/AdjustmentsPO Box 200645Austin, TX 78720-0645

More detailed information about submitting paper claims and appeals can also be found in the Medical Transportation Program (MTP) Computer-Based Training (CBT).

http://www.tmhp.com/Pages/EDI/EDI_TexMedConnect.aspx

http://www.tmhp.com/Pages/default.aspx

https://tmhp.exceedlms.com/student/path/353625



Tips on Expediting Paper ClaimsUse the following guidelines to enhance the accuracy and timeliness of paper claims processing.General requirements

• Use original claim forms. Don’t use copies of claim forms.• Detach claims at perforated lines before mailing.• Use 10 x 13 inch envelopes to mail claims. Don’t fold claim forms, appeals, or correspondence.• Don’t use labels, stickers, or stamps on the claim form.• Don’t send duplicate copies of claim information.• Use 8 ½ x 11 inch paper. Don’t use paper smaller or larger than 8 ½ x 11 inches.• Don’t mail claims with correspondence for other departments.

Data Fields

• Print claim data within defined boxes on the claim form.• Use black ink, but not a black marker. Don’t use red ink or highlighters.• Use all capital letters.• Print using 10-pitch (12-point) Courier font, 10 point. Don’t use fonts smaller or larger than 12 points

Don’t use proportional fonts, such as Arial or Times Roman.• Use a laser printer for best results. Don’t use a dot matrix printer, if possible.• Don’t use dashes or slashes in date fields.

Attachments

To expedite claims processing, providers must provide all information on the original claim form, itself,and limit attachments to those required by TMHP, or when necessary to supply information to properlyadjudicate the claim.

• Use paper clips on claims or appeals if they include attachments. Don’t use glue, tape, or staples.• Place the claim form on top when sending new claims, followed by any medical records or other

attachments.• Number the pages when sending attachments or multiple claims for the same client (e.g., 1 of 2, 2 of 2).• Don’t total the billed amount on each claim form when submitting multi-page claims for the same

client.• All paper claims must be submitted with an API.• Modifiers describe and qualify the services provided by Texas Medicaid. A modifier is placed after the

five-digit procedure code.

Note: It is strongly recommended that providers who submit paper claims keep a copy of the documentation they send.

Important Codes for All MTP providers

Benefit Code = MTP Provider Type = MT Diagnosis Code = Z753 Place of Service = 09 for paper claims, 99 for TexMedConnect claims Type of Service = 9



Below is the list of codes TMHP recommends for filing MTP claims. The codes are based on transportation provider type:

MTP ProviderDescription

ProviderSpecialty

TaxonomyCode

RecommendedProcedure Code

ModifierCodes

Individual Transportation Participant (ITP) T4 347C00000X S0215

Demand Response (DR)Provider T0 343800000X A0100

U1 In-countryU2 Out of countryU3 Reduced rate in-countryU4 Reduced rate out of country

Reimbursement may be recouped when the medical record does not document that the level of service provided accurately reflects the level of service claimed, or when TMHP is unable to verify that the service was rendered (i.e. if the client did not show up for the appointment). Furthermore, the level of service provided and documented must be medically necessary, based on the clinical situation and needs of the patient. HHSC and TMHP routinely perform retrospective reviews of all providers. HHSC is responsible for Texas Medicaid utilization review activities. This review includes verifying services billed to the client’s clinical record. Any mandatory requirement not present in the client’s medical record subjects the associated services to recoupment.

Delegation of Signature AuthorityA provider delegating signatory authority to a member of the office staff or to a billing service remains responsible for the accuracy of all information on a claim submitted for payment. A provider’s employees or a billing service and its employees are equally responsible for any false billings in which they participated or directed. If the claim is prepared by a billing service or printed by data processing equipment, it is permissible to print “Signature on File” in place of the provider’s signature. When claims are prepared by a billing service, the billing service must obtain and keep a letter on file that is signed by the provider authorizing claim submission.

TMHP ResourcesMTP providers and their clients can contact TMHP at:

TMHP Contact Center1-800-925-9126Available Monday through Friday, 7:00 a.m. to 7:00 p.m.For assistance with claims, appeals, enrollment, and more.

TMHP EDI Help Desk1-888-863-3638Available Monday through Friday, 7:00 a.m. to 7:00 p.m.For assistance with TexMedConnect or EDI technical issues.

Providers can also find additional resources in news articles, banner messages, program information, forms, and more on the MTP Home Page of www.tmhp.com.

http://www.tmhp.com/Pages/MTP/mtp_home.aspx

http://www.tmhp.com/Pages/default.aspx

Documents

Medical Transportation Program - TMHP MTP_UserGuide.pdf · The Medical Transportation Program (MTP), under the direction of HHSC, arranges Non-Emergency Medical Transportation (NEMT)