Transportation Services Fee-For-Service (FFS) · 2018-11-30 · Professional Claim: Step 3 MODIFIERS ‒ required For a complete list of modifiers, see the Transportation Services

Indiana Health Coverage Programs

DXC Technology

October 2017

Transportation Services

Fee-For-Service (FFS)

Agenda

• Provider Healthcare Portal overview

• Verify Member Eligibility

• Prior Authorization

• Billing Guidelines

• Submitting professional CMS-1500 claims

• Searching for claims

• Updates

• Helpful tools

• Q&A


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Provider Healthcare Portal




Site Key is selected

when registering for

the Portal


Home Page


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Verify Eligibility

Verify Eligibility

Is transportation a covered service?• Member is eligible for a FFS benefit package that includes

transportation

• Package A Standard plan

• Full Medicaid

• Presumptive Eligibility Package A Standard Plan

• Qualified Medicare Beneficiary and Full Medicaid (QMB-Also)

• Specified Low Income Medicare Beneficiary and Full Medicaid (SLMB-Also)

• QMB-Only and SLMB-Only if Medicare allows the charge

– Coinsurance and deductible

Verify Eligibility – Benefit Limitations

– Benefit limitations are 20 one-way trips per rolling 12-month period

• Prior authorization is required for trips outside of the covered benefit limit.

Verify Eligibility

To verify eligibility, the Effective From date is required, in addition to one of the following:– Member ID

– SSN and birth date

– Last name, first name, and birth date


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Prior Authorization

Prior Authorization

When PA is required

– Trips exceeding 20 one-way trips per rolling 12-month period

• Common Ambulatory Service (CAS) – transportation of ambulatory members (able to travel without a wheelchair) to or from an IHCP covered service

• Non Ambulatory Service (NAS) – transportation of non ambulatory members (must travel in a wheel chair) to and from an IHCP covered service

– Ambulance – ALS/BLS – Air ambulance transportation

– Bus transportation

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

– Trips of 50 miles or more one way

Exception – Dialysis and nursing home transports do not require prior authorization

Prior Authorization – Information

When requesting PA, list all codes for all services to be rendered:

–Base rate, if over 20 one way trips

–Mileage, if over 50 miles one way

–Wait time, if over 50 miles one way

–Accompanying parent or attendant, if applicable

For a complete list of codes and when PA is required, see the

transportation code tables at indianamedicaid.com. (Code

Sets/Table > Launch Provider Code Table > Accept

Agreement > Service- and Provider-Specific Codes >

Transportation Service Codes)

Prior Authorization

Prior Authorization

Prior Authorization

FFS PA requests are processed by:

Cooperative Managed Care Services (CMCS)P.O. Box 40789Indianapolis, IN 46240

1-800-269-5720

1-800-689-2759 (Fax)


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Billing Guidelines

Billing Guidelines - Trip

Definition of 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 shows” by the

member, are NOT billable to the IHCP, and the member may 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 - Diagnosis Codes

–Diagnosis R69 - Illness, unspecified

– Services that are exempt from the 20 trip limitation and PA requirements include:

• Nursing home transports - diagnosis Z02.89

• Renal dialysis transports - diagnosis Z49.01, Z49.31, or Z49.32

Billing Guidelines - Mileage

Mileage does not start until the member is in the vehicle (loaded mileage) –Providers must bill the base rate code for all trips regardless of distance

–The first 10 miles of all trips are included in the base rate reimbursement

–All trips in excess of 10 miles should be billed with the additional mileage code

– Total mileage should be billed – including the first 10 miles

– Fractional miles are not allowed. Provider will round up/down for correct billing

Note: The IHCP does not require the provider to bill the mileage code in addition to the base rate code on trips of less than 10 miles. If the provider does bill the mileage code, it is processed as a denied line item, because the first 10 miles are reimbursed in the base rate.

Billing Guidelines - Mileage

• Example:

If the provider drives 10 miles both ways (to and from) you will bill total of 20 miles

If the provider transports a member between 15.5 miles and 16.0 miles, the provider must bill 16 miles.

If the provider transports the member between 15.0 and 15.4 miles, the provider must bill 15 miles.


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Submitting Professional

CMS-1500 Claims

Two ways to access claim submission

Professional Claim: Step 1



Add the diagnosis in the Diagnosis Code field.

Once the diagnosis is located, click





For a complete list of codes, see the transportation code tables at

indianamedicaid.com. (Code Sets/Table > Launch Provider Code Table >

Accept Agreement > Service- and Provider-Specific Codes >

Transportation Service Codes)


MODIFIERS ‒ required

For a complete list of modifiers, see the Transportation Services

provider module at indianamedicaid.com (Provider Reference

Materials > Service- and Provider-Specific Modules >

Transportation)

http://www.indianamedicaid.com/


Add Medicaid ID

(if not added at

Header Level)

Choose “Provider

ID” from ID Type Choose “unit”

from Unit Type


Once information is entered, click


When a documentation is required to support the

services, it can be added to the electronic claim on

the Portal. The file limit is 5 MB.


Confirm Professional Claim

Submit Professional Claim: Confirmation


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Search CMS-1500 Claims

Two ways to Search for Claims

Search Claims

When

searching

for claims,

you have

the option

to choose

which type

of claim to

search.

Search by

Claim ID,

Member

ID, or

Service

Dates, and

click

Search Claims: Results

Search Claims: Results

Claim Search Results

Click the plus sign (+) to expand

information

Click Claim ID to view the claim

Copying and Correcting Claims

Copying and Correcting Claims

Two ways to Search Payment History

OR

Search Payment History


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Updates

Red-and-white claim form requirement

• Effective January 1, 2018 the IHCP will require the below claim types to be submitting for processing on the appropriate red and white forms.

– CMS-1500 (02-12) – professional claims

– UB-04 (CMS-1450) – institutional claims

• The IHCP will no longer accept copied (black and white) claim forms on or after January 1, 2018.

• Claims not received on the red-and-white claim form on or after January 1, 2018, will be returned to the provider.


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Helpful Tools

52

Helpful Tools

• IHCP website at indianamedicaid.com

– IHCP Provider Reference Modules

– Medical Policy Manual

• Customer Assistance available 8am-6pm EST Monday – Friday

– 1-800-457-4584

• IHCP Provider Relations Field Consultants

– See the Provider Relations Field Consultants page at indianamedicaid.com

• Secure Correspondence via the Provider Healthcare Portal

• Written Correspondence

– DXC Technology Provider Written CorrespondenceP.O. Box 7263Indianapolis, In 46207-7263

http://provider.indianamedicaid.com/general-provider-services/provider-reference-materials.aspx

http://provider.indianamedicaid.com/media/156320/medical policy manual.pdf

http://provider.indianamedicaid.com/about-indiana-medicaid/contact-us/provider-relations-field-consultants.aspx

QuestionsFollowing this session please review your schedule for the next session you

are registered to attend

Documents

Transportation Services Fee-For-Service (FFS) · 2018-11-30 · Professional Claim: Step 3 MODIFIERS ‒ required For a complete list of modifiers, see the Transportation Services