Logisticare Metrocard Disbursement Process

Transcription

1 Logisticare Metrocard Disbursement Process I. Metrocard Disbursement Policy a. Enrollees who live more than ten city blocks and used the bus or subway to attend their Medicaid covered service receive a roundtrip MetroCard fare. II. Calls from Medicaid Enrollees or Medical Practitioners a. Confirm three (3) day notice 1, enrollee s Medicaid eligibility, that destination is to a covered service, whether medically mass transit is appropriate and if the trip meets policy criteria. b. If the medical practitioner participates in the Human Resources Administration s Public Transit Automated Reimbursement (PTAR) system inform caller that the enrollee must get the Metrocard from the medical practitioner. i. If the medical practitioner participates in PTAR but the enrollee is unable to obtain a Metrocard through PTAR because they are not eligible under county 66 (NYC), LGTC will mail the member the Metrocard. 1. LGTC, DOH and medical practitioner will develop a method of dealing with this issue once the volume has been evaluated. c. If the medical practitioner does not participate in PTAR inform the caller that LGTC will mail the member the Metrocard until the medical practitioner purchases up front Metrocards to provide to its patients. i. LGTC will keep communications open with practitioner to know when the practitioner has purchased Metrocards. Once this status has been communicated to LGTC, LGTC will inform the caller/enrollee that he/she must now get the Metrocard from the practitioner. d. If the medical practitioner does not purchase Metrocards to provide to its Medicaid-enrolled patients then the enrollees should contact LGTC and LGTC will continue to mail them the Metrocard. i. After three months, LGTC and DOH will evaluate the volume of this issue and determine an appropriate resolution to be implemented in the summer of III. Communication with Non-PTAR Medical Practitioners Every managed care plan communicated to LGTC that members who travel via mass transit are not held to a pre-authorization standard. DOH and LGTC will monitor the process to determine whether stricter controls are necessary now that these managed care members receive transportation fee-for-service. a. LGTC will send the Request to Receive Reimbursement Form. 2 i. The Request to Receive Reimbursement form is used to provide non-ptar practitioners intending to enroll in PTAR a way to: 1 LGTC initially will be flexible on 3-days notice as it has been in each prior implementation 2 Including the Vendor Set-Up Form and the W-9

2 Logisticare Metrocard Disbursement Process 1. Continue to provide a Metrocard to Medicaid enrollees who attend their medical appointment without having previously called LGTC to have their trip pre-authorized. 2. Be reimbursed via check by LGTC for Metrocards they purchase and provide to eligible enrollees receiving Medicaid-covered service until practitioner is successfully enrolled in PTAR. ii. Completed forms will be faxed or mailed to Eric Stein, LGTC Director of Operations, for review for completeness and verification that the medical practitioner is not already a PTARenrolled provider. 1. Mr. Stein will forward properly complete forms to DOH with LGTC s recommendation to set up the medical practitioner for reimbursement. 2. Upon approval by DOH, Mr. Stein will notify the medical practitioner of the determination. b. LGTC will send the Form to all non-ptar medical practitioners that LGTC currently reimburses in the four (4) MCOs it manages and the seven (7) it does not. 1. LGTC will ask the MCOs to share it with their network medical practitioners. c. LGTC will actively converse with members of the medical community about PTAR and send the Form to any non-ptar medical practitioner that requests participation. IV. Reimbursement by LGTC to non-ptar Medical Practitioners It is believed the reimbursement process will take about six weeks from the date of submission of the log by the medical practitioner to LGTC mailing the check. a. LGTC will provide the Reimbursement Log to DOH-approved medical practitioners and submit the vendor and W9 forms to LGTC corporate Accounting. b. Confirm with LGTC Accounting that the practitioner has been set up as a vendor. c. Provide outreach via webinar and/or site visit to those medical practitioners who request assistance/instruction on completing the reimbursement log. d. Receive and review submitted logs. Reach out to the medical practitioner if there is an error that can be remedied by a telephone call. If not, request re-submission. e. Enter information from the reimbursement log into LCAD. i. Restrict data entry to information timely and properly submitted. ii. Use as the level of service Metrocard provided at the medical practitioner. iii. On or before the 15th of the month run the trip summary report by facility for the preceding month for level of service Metrocard provided at the medical practitioner.

3 Logisticare Metrocard Disbursement Process 1. LGTC will send to each medical practitioner a report detailing the amount of cards approved, denied, and where denied, the reason for denial. 2. LGTC will develop an appeals process, to be approved by DOH, for any medical practitioner who believes his reimbursement has been inappropriately denied by LGTC. iv. Calculate the amount to reimburse for each medical practitioner. v. Submit the amount by facility to senior LGTC staff for approval. vi. Submit the check request by facility to LGTC Accounting with stipulation that cut checks for all facilities are forwarded to LGTC NYC for final accuracy review. 1. LGTC Accounting cuts checks on the 8 th and 22 nd of each month. vii. Receive checks from LGTC Accounting. Review. If amount is correct mail to the medical practitioner out of the LGTC NYC Operations Center. viii. Consolidate the data on a form approved by DOH. ix. On or before the last business day of the month prepare the invoice to DOH requesting reimbursement with a report indicating Metrocards disbursed in the appropriate column and all medical practitioners having received such reimbursement. ROH \ C \ New York \ New York City \ Mass Transit \ Metrocard Process DOH approved docx

4 DOH Form PTR-731A (1/16/2013) Request to Receive Reimbursement from LogistiCare Solutions for Distribution of Public Transit Metrocards Medical practitioner name (Must match the name on the attached W-9 please also complete the W-9) Medical practitioner address NPI number 1. Is PTAR (Public Transit Automated Reimbursement) capability available at your office or elsewhere on your site or on your medical campus? Yes No (Stop if you answered Yes. You are not eligible to receive reimbursement from LogistiCare.) 2. Do you currently participate in the Medicaid program as a fee-for-service provider? Yes No (Stop if you answered No. You are not eligible to receive reimbursement from LogistiCare.) 3. Did you distribute Metrocards to your Medicaid patients prior to 1/1/2013? Yes No a. If you answered yes, what is the monthly volume of Metrocards distributed pursuant to #3 above? Metrocards 4. Your signature below indicates acceptance of the following: a. I, or my medical facility, intends to apply to the New York City Human Resources Administration to enroll in the PTAR system. b. Until I am, or my medical facility is, enrolled in the PTAR system, Metrocards must be purchased by me or my medical facility. c. Metrocards may be distributed only to those Medicaid enrollees who are eligible for Medicaid on the service date and who live greater than 10 city blocks from the medical destination and use/d the bus or subway to travel to the facility to receive a Medicaid-covered service. d. I will complete the Metrocard Disbursement Log and submit to Logisticare monthly by the 5 th business day of the following month. e. I understand that Logisticare remits reimbursement to me or my facility once per month by check, and only upon the basis of a properly completed log. Signature Date Please print your name Telephone ( ) - Your position Thank you. Please fax the completed form to Eric Stein at Or mail to LogistiCare Director of Operations, Northern Blvd., Suite 120, Long Island City, NY 11101

5 DO NOT SUBMIT FORM TO IRS - SUMBIT FORM TO REQUESTING AGENCY 9/07 Revision CITY OF NEW YORK SUBSTITUTE FORM W-9: REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION. Part I: Vendor Information 1. Legal Business Name:(As it appears on IRS EIN records, CP575, 147C - or - Social Security Admin records, Social Security Card, certified Form SSA7028) 2. If you use DBA, please list below: 3. Entity Type (Check one only): Church or Church-Controlled Organization Personal Service Corporation Non-Profit Corporation Corporation/ LLC Government City of New York Employee Individual / Sole Proprietor Trust Joint Venture Partnership/ LLC Single Member LLC (Individual) Resident/Non- Resident Alien Non-United States Business Entity Estate Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type 1. Enter your TIN here: (DO NOT USE DASHES) 2. Taxpayer Identification Type (check appropriate box): Employer ID No. (EIN) Social Security No. (SSN) Individual Taxpayer ID No. (ITIN) N/A (Non-United United States Business Entity) Part III: Primary 1099 Vendor & Remittance Address 1. Primary 1099 Vendor Address: Number, Street, and Apartment or Suite Number 2. Remittance Address: Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country City, State,and Nine Digit Zip Code or Country Part IV: Exemption from Backup Withholding For payees exempt from Backup Withholding, check the box below. Valid explanation required for exemption. See instructions. Exempt from Backup Withholding Part V: Certification The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number (TIN). Sign Here: Signature Phone Number Date Contact's Address: Print Preparer's Name Phone Number Submitting Agency Code: Contact's E- Mail Address: Contact Person: FOR SUBMIITTING AGENCY USE ONLY Telephone Number: ( ) Payee/Vendor Code: DO NOT FORWARD W-9 TO COMPTROLLER'S OFFICE. AGENCIES MUST FAX COMPLETED W-9 FORMS TO THE VALIDATION UNIT.

6 Form 731-B NYS Department of Health NEW YORK CITY MEDICAID TRANSPORTATION PROGRAM METROCARD DISBURSEMENT LOG Mass Transit Supervisor Northern Blvd., Ste. 120 Long Island City, NY Phone: (877) x 2144 Fax: (877) MO YR NPI # Medical Facility Name Medical Facility Address DATE OF SERVICE Medical Facility Address MEDICAID ID (EG. AB12345C) MEDICAID ENROLLEE NAME Check All That Apply MEDICALLY REQUIRED ESCORT FOR ENROLLEE FAMILY MEMBER ESCORT FOR ENROLLEE Number of cards distributed AMOUNT OF CASH DISTRIBUTED Signature of Medicaid member (or parent if member is a child) TOTAL $ - Certification Statement Signature Below Indicates Acceptance of the Following: I (or the entity making the request) understand that Medicaid-funded travel may result from the completion of this form. I (or the entity making the request) understand and agree to be subject to and bound by all rules, regulations, policies, standards and procedures of the New York State Department of Health, as set forth in Title 18 of the Official Compilation of Rules and Regulations of New York State, Provider Manuals and other official bulletins of the Department, including Regulation 504.8(2) which requires providers to pay restitution for any direct or indirect monetary damage to the program resulting from improperly or inappropriately ordering services. I (or the entity making the request) certify that the statements made hereon are true, accurate and complete to the best of my knowledge; no material fact has been omitted from this form. Signature of Medical Facility Personnel Print Name Date Please fax the completed form to Logisticare at