IHCP corrects claim submission process for FFS NEMT

The Indiana Health Coverage Programs (IHCP) previously issued billing guidance for transportation providers rendering nonemergency medical transportation (NEMT) services to fee-for-service (FFS) members brokered through Southeastrans (SET). Initial billing guidance was published in IHCP Bulletin BT201816. Guidance for the implementation transition period from June 1, 2018, through June 30, 2018, was issued in IHCP Bulletin BT201822. The billing guidance previously published regarding requirements for transportation providers not contracted with SET included errors and is being corrected by this publication. (The corrected information is bolded for emphasis.)

Claim submission instructions for noncontracted providers

To receive reimbursement, providers that are not contracted with SET must submit a Trip Reimbursement Form completed at the time of the transport and signed by the member, along with a completed Trip Detail Log. The completed Trip Detail Log is required whenever a member is transported without first obtaining a SET trip authorization number. The required forms are available on the Southeastrans website at southeastrans.com. Emergency medical services (EMS) providers should submit a paper CMS-1500 claim form. (Note: Providers other than EMS providers, should NOT bill using a CMS-1500 claim form, as previously instructed.)

All claim forms should be mailed to:

Southeastrans
Attn: Claim Processing
4751 Best Road, Suite 300
Atlanta, GA 30337

Electronic funds transfer payments to noncontracted providers

Transportation services rendered will be reimbursed through SET by electronic funds transfer payments. Providers that render transportation services, but are not yet contracted with SET, must provide SET with the following information to facilitate payment:

  • The provider's taxpayer identification number (tax ID) used for IHCP enrollment (either an employer identification number supported by a letter from the Internal Revenue Service or a Social Security number)
  • W-9 tax form
  • An automated clearing house (ACH) deposit form and a voided check to support the electronic payments (NOTE: Voided check cannot be a starter check.)

Required documents should be sent by fax to 1-678-510-1351 or securely emailed to: electronicpayment@southeastrans.com.

Other guidance included in earlier publications remains unchanged. Providers can refer to the SET Policy and Procedures Manual for more information.