1. ©2010 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice 1 HP Provider Relations October 2010 TRANSPORTATION GUIDELINES

2. 2 Transportation Guidelines October 2010 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

3. 3 Transportation Guidelines October 2010 At the end of this session, providers will understand: Session Objectives –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

4. 4 Transportation Guidelines October 2010 Learn Enrollment Requirements

5. 5 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: 260 – Ambulance 261 – Air ambulance 262 – Bus 263 – Taxi 264 – Common Carrier ambulatory services (CAS) 265 – Common Carrier Non ambulatory services (NAS) 266 – Family member

6. 6 Transportation Guidelines October 2010 260 – Ambulance 261 – Air Ambulance Enrollment Responsibilities –A copy of the Emergency Medical Services (EMS) Commission certificate, based on certificate end date, is needed for enrollment and for the annual recertification

7. 7 Transportation Guidelines October 2010 262 – Bus Enrollment Responsibilities –The Motor Carriers Services (MCS) certificate issued by the Indiana Department of Revenue is required for both enrollment and annual recertification in the IHCP

8. 8 Transportation Guidelines October 2010 263 – Taxi Enrollment Responsibilities –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

9. 9 Transportation Guidelines October 2010 264 – Common Carrier Ambulatory Services (CAS) 265 – Common carrier Non Ambulatory Services (NAS) Enrollment Responsibilities –For profit Motor Carrier Services certificate from the Indiana Department of Revenue –Not-for-profit Certification of not-for-profit status from the Internal Revenue Service (IRS) Proof of insurance Copy of a Valid drivers license

10. 10 Transportation Guidelines October 2010 266 – Family Member Enrollment Responsibilities –Approval from the local office of the Division of Family Resources (DFR) –Proof of insurance –A copy of a valid drivers license

11. 11 Transportation Guidelines October 2010 Perform Billing for Services

12. 12 Transportation Guidelines October 2010 260 – Ambulance Billing Codes CodeDescription A0427Advanced Life Support (ALS) Emergency Transport, Level 1, one or more interventions A0426ALS Non-Emergency Transport, Level 1, one or more interventions A0428 Basic Life Support (BLS), Non-Emergency Transport A0429BLS, Emergency Transport A0225Neonatal 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.

13. 13 Transportation Guidelines October 2010 260 – Ambulance Billing Codes CodeDescription T2003 ALS non-emergency transport; level 1 (Common Carrier ambulatory) A0130 ALS non-emergency transport; level 1 (Common carrier Non-ambulatory) T2003 BLS non-emergency transport; (Common Carrier ambulatory) A0130 BLS non-emergency transport; (Non-ambulatory) 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 U1 Ambulance service - waiting time BLS one-half (1/2) hour increments

14. 14 Transportation Guidelines October 2010 261 – Air Ambulance Billing Codes CodeDescription A0431Ambulance Service, conventional air service, transport, one way (rotary wing) A0430Ambulance service, conventional air service transport, one way (fixed wing) A0436Rotary wing air mileage, per statute mile A0431 QL Ambulance service, conventional air service, transport, one way (rotary wing); if the member is pronounced dead after takeoff to point of pickup

15. 15 Transportation Guidelines October 2010 261 – Air Ambulance, A0431, A0431 QL, A0436 Billing Guidelines –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 scheduleIHCP fee schedule –Refer to BT200935 for the policy updateBT200935

16. 16 Transportation Guidelines October 2010 262 – Bus Billing Codes CodeDescription A0110Nonemergency transportation and bus, intrastate or interstate carrier

17. 17 Transportation Guidelines October 2010 263 - Taxi Billing Codes CodeDescription A0100 U4Non-emergency transportation – taxi, suburban A0100 UATaxi – 0-5 miles A0100 UBTaxi – 6-10 miles A0100 UCTaxi – 11 miles and up A0100 TT UATaxi – 0 to 5 miles, multi-passenger A0100 TT UBTaxi – 6 to 10 miles, multi-passenger A0100 TT UCTaxi – non-regulated, multi-passenger, 11 miles or more A0100 TK UATaxi – 0 to 5 miles, accompanying parent or assistant A0100 TK UBTaxi – 6 to 10 miles, accompanying parent or assistant A0100 TK UCTaxi – non-regulated, accompanying parent or assistant, 11 miles or more

18. 18 Transportation Guidelines October 2010 263 – Taxi Billing Guidelines –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

19. 19 Transportation Guidelines October 2010 264 – Common Carrier Ambulatory Service (CAS) Billing Codes CodeDescription T2003 Common Carrier Ambulatory Service – base rate T2004 Common Carrier Ambulatory Service – multiple passenger T2001 Common Carrier Ambulatory Service – accompanying parent or assistant, base rate A0425 U3 CAS Mileage T2007 U3Level 3 CAS Waiting time - in one-half (1/2) hour increments

20. 20 Transportation Guidelines October 2010 265 – Common Carrier Non Ambulatory Services (NAS) Billing Codes CodeDescription A0130Wheelchair – Common Carrier Non-ambulatory, base rate A0130 TTWheelchair – Common Carrier Non-ambulatory, multiple passenger, base rate A0130 TKWheelchair – Common Carrier Non-ambulatory, accompanying parent or attendant, base rate A0425 U5NAS Mileage T2007 U5Waiting time in one-half (1/2) hour increments

21. 21 Transportation Guidelines October 2010 266 – Family Member Billing Codes CodeDescription A0090Mileage for family member automobile transportation

22. 22 Transportation Guidelines October 2010 Qualified Medicare Beneficiary (QMB) Billing Guidelines –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

23. 23 Transportation Guidelines October 2010 Destination Modifiers Billing Guidelines –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 4IHCP Provider Manual in Chapter 8 –Refer to BT200811 for additional published modifiersBT200811

24. 24 Transportation Guidelines October 2010 Destination Modifiers Billing Guidelines ModifierDescription DDiagnostic or therapeutic site, other than P or H EResidential, domiciliary, or custodial facility (nursing home, not SNF) GHospital-based dialysis facility (hospital or hospital- related) HHospital I Site of transfer between types of ambulance J Non hospital-based dialysis facility N Skilled nursing facility (SNF) PPhysician Office RResidence S Scene of accident or acute event

25. 25 Transportation Guidelines October 2010 Understand Prior Authorization Requirements

26. 26 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

27. 27 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 Providers may use signature stamps on the PA request form

28. 28 Transportation Guidelines October 2010 Traditional Medicaid Fee-for-service PA Contacts –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 interChange PA Submission for fastest way of obtaining PA

29. 29 Transportation Guidelines October 2010 Care Select PA Contacts –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 ADVANTAGE Health Solutions P.O. Box 80068 Indianapolis, IN 46280 1-800-784-3981 1-800-689-2759 (Fax)

30. 30 Transportation Guidelines October 2010 Risk-based Managed Care (RBMC) PA Contacts –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

31. 31 Transportation Guidelines October 2010 Dialysis and Nursing Home Patients PA Guidelines –The IHCP does not require PA for the 20-trip limit for these 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

32. 32 Transportation Guidelines October 2010 Collect Copayments

33. 33 Transportation Guidelines October 2010 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

34. 34 Transportation Guidelines October 2010 Exemptions Copayment –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 24H –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)

35. 35 Transportation Guidelines October 2010 Interpret Common Denials

36. 36 Transportation Guidelines October 2010 Ten Miles Not Reimbursable Per One-way Trip Edit 4080 –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

37. 37 Transportation Guidelines October 2010 Possible Duplicate Edit 5000 –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 Maintain documentation for the two separate round trips

38. 38 Transportation Guidelines October 2010 Transportation: One-way trips in excess of Twenty Edit 6803 –Cause Member has already had 20 trips paid –Resolution 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

39. 39 Transportation Guidelines October 2010 Clarify Frequently Asked Questions

40. 40 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 24H of the CMS-1500 claim form. – Question: Why is a copayment deducted when I transport a patient to the hospital for admission? Answer: Indicate the appropriate place of service in form field 24B of the CMS-1500 claim form.

41. 41 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 V70.5 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 24G. Maintain documentation for the two separate trips. –Question: Why are 10 miles of each one-way trip deducted from my mileage? Answer: The initial 10 miles are built into the base rate. Mileage is only reimbursed for 11 miles or more.

42. 42 Transportation Guidelines October 2010 Helpful Tools –IHCP Provider Web site at www.indianamedicaid.comwww.indianamedicaid.com –IHCP Provider Manual (Web, CD-ROM, or paper) –Bulletin BT200505 –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 Contact information is available on the IHCP Provider Web site

43. 43 Transportation Guidelines October 2010 Q & A