IHCP revises reimbursement policy for emergency transports in response to 9-1-1 dispatches

Effective immediately, the Indiana Health Coverage Programs (IHCP) is revising its policy regarding emergency transports resulting from 9-1-1 dispatches. The IHCP considers all transports to an emergency room in response to 9-1-1 dispatches to be emergent. For 9-1-1 dispatched trips to an emergency room, ambulance providers should bill the appropriate procedure codes for emergency advanced life support (ALS) or basic life support (BLS) services, based on the types of services provided during the transport. This coverage policy applies to all IHCP programs, subject to limitations for certain benefit plans.

If an ambulance dispatched by 9-1-1 transports a member to a destination other than the emergency room, the transport is considered nonemergent, and reimbursement is subject to the billing rules of the transportation broker associated with the member's benefit plan and/or managed care entity (MCE) assignment.

Existing policies regarding other types of transports are unaffected by this revision. Please refer questions about this news item to Southeastrans or to the transportation broker for the MCE with which the member is enrolled.