IHCP will implement a transition period for brokered NEMT services

As announced in Indiana Health Coverage Programs (IHCP) Provider Bulletin BT201816, the IHCP is working with Southeastrans Inc. to streamline the way fee-for-service (FFS) members arrange covered non-emergency medical transportation (NEMT) services effective June 1, 2018. Beginning May 14, 2018, eligible fee-for-service (FFS) Medicaid members have been able to call Southeastrans (SET) to reserve NEMT trips on or after June 1, 2018.

To ensure a smooth execution of the program, the IHCP will implement a 30-day transition period from June 1, 2018, to June 30, 2018. During this time, IHCP-enrolled transportation providers that accept ride requests directly from members can work with SET to obtain reimbursement. Transportation providers will continue to be responsible for verifying member eligibility and for obtaining prior authorizations for these transports, if required. Transportation services rendered will be reimbursed through SET through electronic funds transfer payments. Providers that render transportation services during the 30-day transition period, 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 to support the electronic payments

Required documents should be sent by FAX to 1-770-669-7483 or securely emailed to: electronicpayment@southeastrans.com.

For dates of service (DOS) of June 1, 2018, through June 30, 2018, in order receive reimbursement, providers that are not contracted with SET must submit a paper CMS-1500 claim form by FAX to 1-770-669-7483 or via mail to:

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

For nonurgent rides on or after July 1, 2018, members need to call SET at 1-855-325-7586 at least two business days in advance to arrange for transportation and should not contact the provider directly. Members may request that rides be arranged with their preferred provider as long as that provider is enrolled with the IHCP and in the process of being credentialed with SET, and the provider's level of transportation is suitable for the member. Members will also have the option to book trips online at https://member.southeastrans.com. Urgent trips requiring fewer than two business days of advance notice will need to be confirmed by the member's healthcare provider.

The IHCP is also issuing the following clarifications to assist providers with the transition and to understand how to work with SET:

  • NEMT services occur when needs are not immediate, such as scheduled appointments, dialysis, chemotherapy, physical therapy, and picking up prescriptions:
    • Hospital discharges to home are considered an NEMT service. Southeastrans will work closely with the hospital to find the closest, most appropriate provider to provide the transport and will respect current preferred provider relationships. SET will also work within set hospital discharge metrics and quality measures.
    • Non-emergent interfacility transfers are considered NEMT services; emergent interfacility transfers would be considered emergency transportation services.
      • Interfacility transports handled by the broker will be considered an urgent transport. Urgent transports are required to be served within three hours from the notice, and SET will make arrangements accordingly.
      • Facilities should call the SET reservation line to request interfacility transports. SET can arrange rides with the preferred provider; however, SET still has to ensure that the provider is IHCP-enrolled and meets member requirements.
      • July 1, 2018, and after, all providers must be IHCP-enrolled and in the process of being credentialed with SET in order to be reimbursed.
  • Emergent transports are not included as NEMT services and instead should be managed via standard 9-1-1 protocols. Emergency transportation occurs when needs are immediate, such as heart attack, stroke, serious injury, or other life-threatening situations. Emergency transports are not brokered through Southeastrans, and as such, billing and reimbursement for emergency transportation services remain unchanged.
    • Southeastrans will follow current billing and reimbursement policy regarding downgrading a 9-1-1 transport, with the exception that claims must be sent to SET.
      • EMS providers will submit 9-1-1 downgrades on the Health Insurance Claims Form (CMS-1500), identifying these claims by placing "911 Downgrade" in box 23 of the form.
      • SET will retroactively book these downgraded EMS rides into the system and process the claim.
    • Neonatal transports are considered emergency transports.
      • The IHCP makes reimbursement available for specialized neonatal ambulance services especially equipped for inter-facility transfers of high-risk or premature infants only when the member has been discharged from one hospital for admission to another hospital. Providers must use procedure code A0225 - Ambulance service, neonatal transport, base rate, emergency transport, one way only for neonatal ambulance transport

Beginning July 1, 2018, transportation providers will need to be in the process of being credentialed with SET in order to accept rides arranged by SET and be reimbursed. Providers will also need to file their clean transportation claims with SET within 90 days to be considered timely.

Southeastrans' NEMT rate schedule is based on the IHCP fee schedule. Each NEMT provider will need to sign a SET rate agreement detailing these rates. Contact the Southeastrans Indiana Provider Relations Team if you have specific questions about contracting as a network provider. Their contact information is below.

Andrew Tomys atomys@southeastrans.com cell - 770-362-4839

Tammie Sanford tsanford@southeastrans.com cell - 404-977-8666

A policy manual for SET will be posted soon.