transportation services fee-for-service (ffs) · 2018-11-30 · professional claim: step 3...
TRANSCRIPT
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
Indiana Health Coverage Programs
DXC Technology
Provider Healthcare Portal
Provider Healthcare Portal
Provider Healthcare Portal
Provider Healthcare Portal
Site Key is selected
when registering for
the Portal
Provider Healthcare Portal
Home Page
Indiana Health Coverage Programs
DXC Technology
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
Indiana Health Coverage Programs
DXC Technology
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)
Indiana Health Coverage Programs
DXC Technology
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.
Indiana Health Coverage Programs
DXC Technology
Submitting Professional
CMS-1500 Claims
Two ways to access claim submission
Professional Claim: Step 1
Professional Claim: Step 1
Professional Claim: Step 2
Add the diagnosis in the Diagnosis Code field.
Once the diagnosis is located, click
Professional Claim: Step 2
Professional Claim: Step 3
Professional Claim: Step 3
Professional Claim: Step 3
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)
Professional Claim: Step 3
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)
Professional Claim: Step 3
Add Medicaid ID
(if not added at
Header Level)
Choose “Provider
ID” from ID Type Choose “unit”
from Unit Type
Professional Claim: Step 3
Once information is entered, click
Professional Claim: Step 3
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.
Professional Claim: Step 3
Confirm Professional Claim
Submit Professional Claim: Confirmation
Indiana Health Coverage Programs
DXC Technology
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
Indiana Health Coverage Programs
DXC Technology
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.
Indiana Health Coverage Programs
DXC Technology
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
QuestionsFollowing this session please review your schedule for the next session you
are registered to attend