1. October 2009 Tracks to Transportation Presented by EDS Provider Field Consultants Insert photo here

2. Tracks to Transportation 2/ October 2009 Agenda Session Objectives Transportation Code Set Twenty One-Way Trip Limitation Transportation Billing Live Web Demo Prior Authorization Special Clients Copayments Top Denials Helpful Tools Questions

3. Tracks to Transportation 3/ October 2009 Session Objectives At the end of this session, providers will understand: Specific codes used by transportation providers Claim filing procedures for ambulance transportation and non-ambulance transportation Requirements for prior authorization Billing for dialysis and nursing home patients Billing for copayments

4. Tracks to Transportation 4/ October 2009 Providers must ensure that they are enrolled as the correct provider type and specialty The IHCP established a transportation code set to ensure appropriate reimbursement for transportation codes The code sets and specific instructions for Transportation providers can be found on the IHCP Web site at www.indianamedicaid.com under Provider Code Sets www.indianamedicaid.com Transportation Code Set

5. Tracks to Transportation 5/ October 2009 Twenty One-Way Trip Limitation The Indiana Health Coverage Program limits transportation to 20 one-way trips per member, per rolling 12-month period Providers must request prior authorization (PA) for members who exceed 20 one-way trips if the member requires frequent medical intervention

6. Tracks to Transportation 6/ October 2009 Ambulance Transportation A0427 (procedure code) –Advanced Life Support (ALS) Emergency Transport, Level 1, one or more interventions A0426 –ALS Non-Emergency Transport, Level 1, one or more interventions Provider Specialty 260

7. Tracks to Transportation 7/ October 2009 Ambulance Transportation A0428 –Basic Life Support (BLS), Non- Emergency Transport A0429 –BLS, Emergency Transport A0225 –Neonatal Transport –Ambulance service, base rate one way Provider Specialty 260

8. Tracks to Transportation 8/ October 2009 Ambulance Transportation The IHCP modified codes to allow providers to bill for ambulatory or non-ambulatory services when ALS or BLS services are not medically necessary Ambulance providers must continue billing mileage according to vehicle type Note: If an ambulance is not medically necessary for the trip and less expensive transportation is suitable, an ambulance code should not be billed Provider Specialty 260

9. Tracks to Transportation 9/ October 2009 Ambulance Transportation Use a single-character modifier to report the transport’s place of origin, and a second character modifier to indicate the destination When a member is transported by more than one transportation company on the same date of service, using these modifiers will help avoid having claims deny as duplicates A list of appropriate modifiers can be found in the IHCP Provider Manual in Chapter 8, Section 4

10. Tracks to Transportation 10/ October 2009 Ambulance Transportation Example of using modifiers: Patient is transferred from residence to hospital –Place of origin is residence shown by the modifier R –Place of destination is Hospital shown by the modifier H The modifiers on the Healthcare Common Procedure Coding System (HCPCS) code would be RH

11. Tracks to Transportation 11/ October 2009 Ambulance Transportation Transportation Code Sets Description T2003 ALS non-emergency transport; level 1 (Commercial ambulatory) A0130 ALS non-emergency transport; level 1 (Non-ambulatory) T2003 BLS non-emergency transport; (Commercial ambulatory) A0130 BLS non-emergency transport; (Non-ambulatory) Provider Specialty 260

12. Tracks to Transportation 12/ October 2009 Ambulance Transportation Code Description A0425 U1 U2 Ground mileage, per statute mile Level 1 (ALS) Level 2 (BLS) A0420 U1 Ambulance service - waiting time ALS one-half (1/2) hour increments A0420 U2 Ambulance service - waiting time BLS one-half (1/2) hour increments Provider Specialty 260

13. Tracks to Transportation 13/ October 2009 Ambulance Transportation Transportation providers may document mileage using mapping software programs or odometer readings Documentation must include the date the transportation service was performed and the specific starting and destination address If the provider uses mapping software, the documentation must indicate the shortest route Mapping Mileage

14. Tracks to Transportation 14/ October 2009 Air Ambulance Air ambulance code descriptions are defined as one- way trips Air ambulance providers do not submit for mileage reimbursement Air ambulance providers are reimbursed by the type of wing that is prior authorized Providers should submit a request for PA for the type of wing the member is being transported in: –A0430 fixed wing –A0431 rotary wing Attachments should be included to identify the destination and the procedure code included on the attachment

15. Tracks to Transportation 15/ October 2009 Non-Ambulatory Transportation Non-ambulatory transportation is not a covered benefit under Hoosier Healthwise Package C Provider Specialty 265

16. Tracks to Transportation 16/ October 2009 Non-Ambulatory Transportation Code Description A0130Wheelchair – Non-ambulatory, base rate A0130 TT Wheelchair – Non-ambulatory, multiple passenger, base rate A0130 TK Wheelchair – Non-ambulatory, accompanying parent or attendant, base rate Provider Specialty 265

17. Tracks to Transportation 17/ October 2009 Non-Ambulatory Transportation Code Description A0425 U5Mileage T2007 U5 Waiting time in one-half (1/2) hour increments Provider Specialty 265

18. Tracks to Transportation 18/ October 2009 Commercial Ambulatory Service Code Description T2003Commercial Ambulatory Service – base rate T2004 Commercial Ambulatory Service – multiple passenger T2001 Commercial Ambulatory Service – accompanying parent or assistant, base rate Provider Specialty 264

19. Tracks to Transportation 19/ October 2009 Commercial Ambulatory Service Code Description A0425 U3CAS Mileage T2007 U3 Level 3 CAS Waiting time - in one-half (1/2) hour increments Provider Specialty 264

20. Tracks to Transportation 20/ October 2009 Taxi Code Description A0100 TT UATaxi – 0 to 5 miles, multi-passenger A0100 TT UBTaxi – 6 to 10 miles, multi-passenger A0100 TT UC Taxi – non-regulated, multi-passenger, 11 miles or more Provider Specialty 263

21. Tracks to Transportation 21/ October 2009 Taxi Code Description A0100 U4Non-emergency transportation – taxi, suburban A0100 UATaxi – 0-5 miles A0100 UBTaxi – 6-10 miles A0100 UCTaxi – 11 miles and up Provider Specialty 263

22. Tracks to Transportation 22/ October 2009 Taxi Code Description A0100 TK UA Taxi – 0 to 5 miles, accompanying parent or assistant A0100 TK UB Taxi – 6 to 10 miles, accompanying parent or assistant A0100 TK UC Taxi – non-regulated, accompanying parent or assistant, 11 miles or more Provider Specialty 263

23. Tracks to Transportation 23/ October 2009 Family Member Transportation A0090 –Mileage for family member automobile transportation –Reimburses 28 cents per mile Provider Specialty 266

24. Tracks to Transportation 24/ October 2009 Additional Attendant Procedure code A0424 = additional attendant ALS or BLS An additional attendant may be necessary to help load a member Code is exempt from prior authorization and 20-trip limit Additional attendant must be employed by billing provider Additional attendant is not required to remain for the trip Provider must document need for this service This service and all services are subject to post-payment review A maximum of two units allowed (one attendant is usually sufficient) Providers may only use this code with ambulance and non- ambulatory base codes

25. Tracks to Transportation 25/ October 2009 Accompanying Parent Policy If medically necessary for the condition of the member, an adult may accompany members younger than 18 Procedure codes used for accompanying parent are exempt from the 20-trip limit When the base code requires PA, all related services also require PA.

26. Tracks to Transportation 26/ October 2009 Accompanying Assistant Policy The member must have a medical condition that substantiates the need for an assistant to travel with or remain at the site of medical service Procedure codes used for accompanying assistant are exempt from the 20-trip limit When the base code requires PA, and the provider has not requested or obtained approval for PA, the code will deny for the 20-trip limit

27. Tracks to Transportation 27/ October 2009 Example – Multiple Member Transport Member A is picked up at a member’s home and transported to a dialysis center Along the way member B is picked up at a nursing home; now member A and B are in the vehicle to be transported The stop at the nursing home is not considered a separate trip and the transportation of member A from home to the dialysis center is considered a one-way trip

28. Tracks to Transportation 28/ October 2009 Live Web Demo

29. Tracks to Transportation 29/ October 2009 Prior Authorization Trips exceeding 20 one-way trips per rolling 12- month period require PA Trips of 50 miles or more one way require PA Other services which require PA –Air Ambulance Transportation –Airline Transportation –Train Transportation –Bus Transportation Exceptions include: –Emergency ambulance services –Transportation to or from a hospital for the purpose of an admission or discharge –Dialysis and nursing home patients Requirements

30. Tracks to Transportation 30/ October 2009 Prior Authorization Transportation rendered by any provider to or from a non- designated, out-of-state area requires PA: –Initial requests may be made by telephone or in writing; however, telephone requests must be followed up in writing –Requests must include a description of anticipated care and a brief description of the clinical circumstances necessitating the need for transportation by air or to another state Requirements

31. Tracks to Transportation 31/ October 2009 Prior Authorization Traditional Medicaid fee-for-service PA requests are processed by ADVANTAGE Health Solutions ADVANTAGE Health Solutions (fee-for-service) P.O. Box 40789 Indianapolis, IN 46240 1-800-269-5720 1-800-689-2759 (Fax)

32. Tracks to Transportation 32/ October 2009 Prior Authorization Each care management organization (CMO) is responsible for processing PA requests for their respective Care Select members: Care Select MDwise – CMO P.O. Box 44214 Indianapolis, IN 46244-0214 1-866-440-2449 1-877-822-7186 (Fax) Care Select ADVANTAGE Health Solutions – CMO P.O. Box 80068 Indianapolis, IN 46280 1-800-784-3981 1-800-689-2759 (Fax)

33. Tracks to Transportation 33/ October 2009 Prior Authorization Providers must direct transportation service requests for risk-based managed care (RBMC) members to the appropriate managed care organization (MCO) Risk-Based Managed Care

34. Tracks to Transportation 34/ October 2009 Contacts for the following RBMC organizations’ transportation carriers: Managed Health Services (MHS) ―1-877-647-4848 ―LCP Company provides services, but providers must call MHS for PA and notification of transportation needs ―www.managedhealthservices.com MDwise ―1-800-356-1204 ―Call MDwise for PA and notification of transportation needs ―www.mdwise.org Anthem ―1-800-508-7230 LCP Company ―Or Anthem 1-866-408-6132 ―www.anthem.com Prior Authorization Risk-Based Managed Care

35. Tracks to Transportation 35/ October 2009 Prior Authorization Air ambulance transportation services rendered by a provider located in non- designated out-of-state area requires PA The Local Office of the Division of Family Resources in the county where the member resides, not the OMPP, prior authorizes in- state train or bus services Requirements

36. Tracks to Transportation 36/ October 2009 Prior Authorization If a transportation provider attempts to obtain the physician’s signature or member’s medical information and is unsuccessful, the provider may complete the PA form and sign it The PA Unit closely monitors this practice for misuse of policy PA Request Form Information

37. Tracks to Transportation 37/ October 2009 Prior Authorization Signature stamps –Providers may use signature stamps on the PA request form PA Request Form Information

38. Tracks to Transportation 38/ October 2009 Special Clients The IHCP does not require PA for the 20-trip limit for this member population when transportation providers file claims with the following diagnoses: –Nursing home residents = V70.5 –Dialysis patients = V56.0, V56.1, or V56.8 Dialysis and Nursing Home Patients

39. Tracks to Transportation 39/ October 2009 When billing for dialysis and nursing home patients, indicate the proper diagnosis in form field 21 on the CMS-1500 claim form and indicate a corresponding 1 in form field 24E Providers who do not use one of the previous diagnosis codes may experience claim denials for the 20-trip limit Special Clients Dialysis and Nursing Home Patients

40. Tracks to Transportation 40/ October 2009 Copayments Copayment Amount 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 Amounts

41. Tracks to Transportation 41/ October 2009 Copayments A member younger than 18 years old –Package C members are not exempt from copay requirements An assistant or accompanying adult traveling with a member younger than age 18 An emergency is indicated in form field 24C on the CMS-1500 claim form and the procedure code is defined as a copayment code, but the member’s condition requires emergency status Exemptions

42. Tracks to Transportation 42/ October 2009 Copayments Pregnancy indicated in form field 24H A place of service code indicates a medical institution (for example: acute care hospital, intermediate care facility for the mentally retarded, or other medical institution) Exemptions

43. Tracks to Transportation 43/ October 2009 Top Denials

44. Tracks to Transportation 44/ October 2009 Edit 558 Cause –Coinsurance and deductible amount is missing indicating this is not a crossover claim Resolution –Add coinsurance and/or deductible amount and/or Medicare paid Add coinsurance and/or deductible amount on the left side of field 22 Add the Medicare Payment amount on the right side in field 22 Coinsurance and Deductible Amount Missing

45. Tracks to Transportation 45/ October 2009 Cause –This member has Medicare denied detail line that must be rebilled separately on a separate claim form Resolution –Delete the denied Medicare line item off the crossover claim and bill it on a new claim Medicare Denied Detail Edit 0593

46. Tracks to Transportation 46/ October 2009 Cause –This member has private insurance, which must be billed prior to Medicaid Resolution –Add the TPL payment to the claim to field 29 Recipient Covered by Private Insurance Edit 2505

47. Tracks to Transportation 47/ October 2009 Cause –Two round trips made in one day; the second trip denies as a duplicate Resolution –Indicate four units on one line in form field 24G for the base code –Combine total mileage on one line Note: Maintain documentation for the two separate round trips Possible Duplicate Edit 5000

48. Tracks to Transportation 48/ October 2009 Cause –System is deducting first 10 miles from the claim Resolution –The initial 10 miles are included into 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 Ten Miles Not Reimbursable Per One-way Trip Edit 4080

49. Tracks to Transportation 49/ October 2009 Helpful Tools IHCP Web site at www.indianamedicaid.comwww.indianamedicaid.com IHCP Provider Manual (Web, CD-ROM, or paper) Customer Assistance –1-800-577-1278, or –(317) 655-3240 in the Indianapolis local area Written Correspondence –P.O. Box 7263 Indianapolis, IN 46207-7263 Provider Relations field consultant –View a current territory map and contact information online at www.indianamedicaid.comwww.indianamedicaid.com Avenues of Resolution

50. Tracks to Transportation 50/ October 2009 Questions

51. October 2009 EDS and the EDS logo are registered trademarks of Hewlett-Packard Development Company, LP. HP is an equal opportunity employer and values the diversity of its people. © 2009 Hewlett-Packard Development Company, LP. Office of Medicaid Policy and Planning (OMPP) 402 W. Washington St, Room W374 Indianapolis, IN 46204 EDS, an HP Company 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204