NON-EMERGENT TRANSPORTATION BENEFIT Medicaid Transportation Benefit Update As part of the work of the Medicaid Redesign Team under the New York State Department of Health, the non-emergency medical transportation benefit (NEMT) for Medicaid members is phasing out of the managed care benefit package by region. Effective December 1, 2015, non-emergency transportation for Fidelis Care Medicaid members will be transitioned from Fidelis Care to fee-for-service Medicaid in Nassau and Suffolk county. Fidelis Care will continue to manage non-emergency transportation services for Dual Advantage Flex and Fidelis Care at Home members residing in these areas. Prior authorization requests and claims for non-emergency services for these members should be directed to Logisticare Solutions, LLC, the NEMT manager for Nassau and Suffolk counties. Additionally, providers should contact Logisticare at the county-specific numbers below to arrange for NEMT services. On and After December 1, 2015 Logisticare Solutions, LLC Nassau County 844-678-1106 Logisticare Solutions, LLC Suffolk County 844-678-1106 TRANSPORTATION BENEFIT OVERVIEW Medicaid and HealthierLife Benefit Non-emergency medical transportation (NEMT), including transport by means of bus, taxi, ambulette and other forms of public transportation, is a covered Medicaid benefit. Based on the member s county of residency, transportation is managed by Fidelis Care or the designated NEMT Manager for that county. Please call our Member Services Department at 1-888-FIDELIS (1-888-343-3547) for more information. Medicaid Managed Care members and providers who need to arrange for non-emergency transportation for members who reside in a county where this benefit is not managed by Fidelis Care should contact their NEMT Manager based on county of residency. A listing of NEMT Managers by county can be found at: http://www.fideliscare.org/portals/0/documentlibrary/providers/provider%20manual/nemt%20m anagers%20by%20county.pdf In addition to NEMT services, HealthierLife members are also eligible for non-medical transportation to certain events and/or services. Please see the section titled Non-Medical Transportation Benefits for examples of allowable and non-allowable events and services. Dual Advantage Flex Benefit Fidelis Care s Dual Advantage Flex product provides forty-eight (48) one-way trips per calendar year to plan approved locations. After the forty-eight (48) trips have been exhausted, the member may use their flex benefit by paying out of pocket and submitting a receipt to Fidelis Care within ninety (90) days of service. Transportation services may be arranged through the NEMT vendor for the member s county of residence. Dual Advantage Fidelis Care will cover routine transportation services to medical providers. This includes ambulette, livery, public transportation, or other means appropriate to the enrollee s medical condition. 1
Medicare Advantage Flex / Medicare $0 Premium Non-emergency transportation is covered under the member s Flex Benefit. The member must pay for the transportation services up front and submit a receipt to Fidelis Care for reimbursement within ninety (90) days of service. Medicare Advantage without Rx Routine medical transportation is not covered. NY State of Health Routine medical transportation is not covered. Fully Integrated Duals Advantage (FIDA) Fidelis Care will cover routine transportation services to medical providers. This includes ambulette, livery, public transportation, or other means appropriate to the enrollee s medical condition. In addition, transportation for certain non-medical events or services is also covered. Please see the section titled Non-Medical Transportation Benefits for examples of allowable and non-allowable events and services. Non-Medical Transportation Benefits Non-medical transportation is available under certain plans for a variety of services and events. Below are examples of allowable and non-allowable events and services: Allowable Places of Worship Wake/Shiva/Burial Supermarkets Warehouse Stores (Costco, BJs, et. al.) Food Outlets Soup Kitchens/Community Food Banks Senior Centers Recreation Centers Other Community Centers/Workshops Hair Salons/Barber Shops (once every 30 days) * Providers must allow room for transporting bags when applicable (i.e. grocery bags) Not-Allowable Retails Stores/Outlets/Malls Restaurants Movie Theaters Casinos Family/Friend Places of Residence Nail Salons Other Retail Entertainment Outlets PROCESS AND PROCEDURES A. Scheduling Transportation Fidelis Care members eligible for transportation benefits covered by Fidelis can schedule transportation by calling 1-888-FIDELIS (1-888-343-3547) and following the appropriate prompts: press #1 - English, press #1 - Member, press #1 -Transportation and press #2 - all other. Should it be necessary, transportation providers can also call this number and should follow the same prompts to reach the Transportation Unit if the call is related to a current or future trip. Calls for questions regarding billing and claims should be directed to the Provider Call Center. 2
Please note: Fidelis Care Transportation Dispatch will be available from 8:30AM until 6:00PM Monday through Friday. After hours and holidays calls will be handled by an answering service. The Fidelis Care recognized holidays are: New Year's Day, Martin Luther King Jr.'s Birthday, Good Friday, Memorial Day, Independence Day, Labor Day, Thanksgiving and the day after Thanksgiving, ½ day on Christmas Eve and Christmas Day. In the event that a holiday falls on a weekend, we will send out a notification to inform you of the day that the office will be closed in observance of that holiday. B. Email Notification System Fidelis Care will notify you of transportation requests by email at least one (1) business day prior to the transportation date. Dispatch will organize these requests and email you a daily report at 4:00PM via secure email. The first section of the report will contain new trips - which can be either trips scheduled for the next business day or trips scheduled for a future date. The second section of the report will contain updated trips - which are trips scheduled for future service dates that have been changed since the date they originally appeared on the report. A sample daily report can be found in Appendix A. Fidelis Care uses a secure mail transfer system. In order to access this system you must have been sent a [secure] email link. This process will explain how to access your secure mail, as well as how to obtain help if needed. Q: How do I know if I was sent a secure email? A: Upon opening, a secure email will look similar to the one below: Clicking on the box will take you to the secure Fidelis Care Mail System where you will be asked to setup your account. The screen shot below displays the Create User 3
Account screen: It is important that you enter all of the requested information, especially the Password Hint Phrase. Should you forget your password on your next login, you can request that it be reset, but only if all of the above information is completed. Simply click the link to have your hint mailed to you. 4
Should the hint not help or if you did not provide a hint, then an account reset would be required. To reset your password, please contact The Transportation Unit at -888-FIDELIS (1-888-343-3547) and ask to speak with the Transportation Supervisor. C. Transportation Requests A sample copy of the transportation requests that will arrive by email can be viewed under Appendix A. D. Transportation Standards Transportation orders will be sent to the Provider on the business day before the requested transportation services are required. Fidelis Care will schedule pick-up times forty-five (45) minutes, to one hour prior to appointment times. This will allow for a fifteen (15) minute window for pick-up and a thirty (30) minute window for transport. Provider shall ensure that a minimum of 90% of pick-ups occur within twenty (20) minutes of the scheduled pick-up time. Unless otherwise specified, return trips will be provided on demand, with a maximum wait time of fortyfive (45) minutes for pick-up once the request has been received. Provider should wait eight (8) to ten (10) minutes for a member. If a member cannot be located ("no show") the provider should report this by calling the Transportation Unit at 1-888-FIDELIS (1-888-343-3547). Provider shall provide same-day service for urgent (non-emergent) appointments as requested by Fidelis Care or Fidelis Care's after-hours answering service. With respect to same-day requests, Provider will be required to render services within two hours of receiving notice. Fidelis Care will make every effort to prevent same-day cancellations, however for those times that same-day cancellations occur; we will attempt to notify you as soon as possible. Provider shall provide pharmacy stops for members when a prescription pick up is needed. Members are advised to have prescriptions called in or are instructed to drop off their prescriptions as the car will only wait five (5) minutes. Please note that the pharmacy stop should be on the way to the member's home or next scheduled destination. Provider must comply with all applicable requirements of Article 19-A of the Vehicle & Traffic Law and the Commissioner s Regulations Part 6 issued by the New York State Department of Motor Vehicles. 5
An escort is allowed for members who are blind, deaf, or for those who have behavioral health disabilities, as well as to accompany members under the age of twenty-one (21). Personal Assistance, Escorts and Carry-Downs (Medicaid) Personal assistance by the staff of the transportation company is required by the Medicaid Program and consists of the rendering of physical assistance to the ambulatory and nonambulatory (wheelchair-bound) Medicaid enrollees in: Walking, climbing or descending stairs, ramps, curbs, or other obstacles; Opening and closing doors; Accessing an ambulette vehicle; and The moving of obstacles as necessary to assure the safe movement of the Medicaid enrollee. There is no separate reimbursement for the escort of a Medicaid enrollee. Necessary escorts are to be provided by the ambulette service at no additional or enhanced charge. The Medicaid Program does not limit the number of stairs or floors in a building that a provider must climb in order to deliver personal assistance to a Medicaid enrollee. The ambulette provider is required to provide personal assistance and door-to-door service at no additional or enhanced charge. This means the staff must transport the enrollee from his/her front door (including apartment door, nursing home room, etc.) no matter where it is located; to the door of the medical practitioner from whom the enrollee is to receive Medicaid-covered medical services. CLAIMS SUBMISSION GUIDELINES A. Overview and Getting Started Billing for services is to be completed electronically through MD On-Line. MD On-Line has created an easy-to-access web portal for billing. You can choose to data-enter claims individually, or if you have billing software you may submit batch claims. Please note: There is no fee for this service. In order to set up your online billing account with Fidelis Care, simply go to http://www.fideliscare.org/en-us/providers/electronicsubmissions.aspx. You may also call MD On-Line for assistance with this process at 888-499-5465. Simply mention the Fidelis Care promotion. Representatives are available from 8:30AM - 6:00PM EST.B. Procedure Codes and Authorization Fidelis Care will only pay claims that are billed using the accepted NYS Medicaid procedure codes, for the specific county in which our member resides. These codes will be reimbursed at the rate set forth by NYS Medicaid. Please call Fidelis Care if you are unsure of the codes you are permitted to bill or reference the New York Medicaid Programs Provider Manual under transportation at: https://www.emedny.org/providermanuals/transportation/index.aspx Prior authorization from Fidelis Care is required for all Ambulette Transports and for any trips that are to/from non-contiguous counties. C. Submitting Claims Prior to submitting a claim to Fidelis Care, you must have the following information: 6
Member Information Requirements: Member ID Member Last Name Member First Name Member Date of Birth Member Address street, city, state, zip Provider Information Requirements Transportation company name Transportation Provider ID# (there is a unique ID# for each county serviced) Company Address - street, city, state, zip Claim Information Requirements Patient Account # - (Invoice Number if there is one) Diagnosis Code - Fidelis Care will accept a generic ICD9 or ICD 10 diagnosis code, as long as it is a valid code, if the exact ICD9 or ICD 10 code is unknown Units - 1 = 1 way, 2=round trip, 3= second stop at a provider's office, 4= two round trips on the same date of service and number of miles (enter total miles traveled) Total Charges Procedure Code D. Submitting Corrected Claims Prior to submitting a corrected claim to Fidelis Care, you must have the following information: Claim Number that is located on Medical Remittance Advice that you received along with your check from Fidelis Care. The corrected information for the rejected claim Please refer to Appendix B for step-by-step instructions. E. Provider Access Online: Fidelis Care wants to make sure you have the tools and resources you need to provide your customers and our members with the transportation services they deserve. The recent debut of our enhanced provider portal, Provider Access Online, is a critical part of Fidelis Care's efforts to increase efficiency and expand services to our providers. Provider Access Online benefits include: Download capabilities for your Remittance Advice Statements Perform claims status inquiries Member eligibility search capabilities Go to https://portal.fideliscare.org/provider/. If you have trouble logging into your account, please contact our Provider Call Center at 1-888-FIDELIS (1-888-343-3547). F. Timely Filing Claims must be submitted for payment no later than the 10 th (tenth) day of the month for services rendered in the preceding month. Fidelis Care will pay claims submitted electronically within thirty (30) days after receipt. 7
REIMBURSEMENT Fidelis Care will reimburse for transportation trips based on your Provider Contract. For additional information, please contact our Provider Call Center at 1-888-FIDELIS (1-888-343-3547). USEFUL PHONE NUMBERS AND EMAIL ADDRESSES Fidelis Care Transportation Scheduling: 1-888-FIDELIS (1-888-343-3547) for all Dual Advantage Flex, as well as Medicaid members with transportation benefits not residing in one of the counties listed below. For Medicaid member residing in a county listed below, please contact your countyspecific NEMT manager to authorize transportation. A listing of NEMT Managers by county can be found at: http://www.fideliscare.org/portals/0/documentlibrary/providers/provider%20manual/nem T%20Managers%20by%20County.pdf To Register for Online Billing: http://www.fideliscare.org/enus/providers/electronicsubmissions.aspx For Assistance with Online Billing: MD On-Line at 888-499-5465 Additional questions, please contact Julie McKay at 518-445-3950 or email at jmckay@fideliscare.org 8
Appendix A Report Run Date: 08/18/2014 Report Run Time: 01:24:50PM Transportation Provider: Plan ID Member ID# Member Information Transportation # of Riders Authorization Destination Information Comments User Name Date and Time Number New Trips LTCP0000 12345678 John Smith 08/18/2014 2 987654321 ABC Hospital amb, mbr has w/c, lift jks 123 Main St 9:00AM 456 Long Road (718) 123-4567 Bronx, NY 9 V15.0 9/1/2015
Appendix A Report Run Date: 08/18/2014 Report Run Time: 01:24:50PM Transportation Provider: Plan ID Member ID# Member Information Transportation # of Riders Authorization Destination Information Comments User Name Date and Time Number Updated Trips LTCP0000 12345678 John Smith 08/18/2014 2 987654321 ABC Hospital amb, mbr has w/c, lift jks 123 Main St 9:00AM 456 Long Road (718) 123-4567 Bronx, NY 10 V15.0 9/1/2015
Appendix B TIP Sheet MD On-Line LINK1500 Field Requirements for HCFA (CMS-1500) claim form (Fidelis Care Non-Medical Transportation) Payer: 11315 Fidelis Care (choose from drop down menu) Field Information 1) Check the insurance type (choose other) 1a Input member id 2) Enter patient name 3) Patients DOB 4) Insured name (same as patient) 5) Patients address 6) Patients relationship to insured (always choose self) 7) Insured address same as patient 8) Patient status (ok to choose other if not known) 9) All a,b,c,d ( Not applicable ) 10) a,b,c (choose no ) 11) a,b,c ( Not applicable ) 11d) Choose No - Always 12) Signature on file, choose yes (date section) input date of transport 13) Signature on file chose yes 14-20) 14 thru 20 Not applicable 21) Enter diagnosis code (Fidelis Care will accept a generic ICD9 or ICD 10 diagnosis code, as long as it is a valid code, if the exact ICD9 or ICD 10 code is unknown) 22) Not applicable 23) Not applicable 24) a) Enter date of service b) Enter place of service 99 c) Not applicable d) Enter transportation codes example (A0100, S0209 list available) e) Enter diagnosis pointer as A f) Enter complete charges g) If using the A0100 (or other trip code) in 24D must enter 1 unit per trip. Use 2 units for round trip. If using S0215 or other mileage code in 24D you must enter complete mileage by rounding up to the next mile (Example - 3.6 mi = 4 miles) h) Not applicable i) Not applicable j) Populated when EIN is selected in field 25 25) Enter federal tax id 26) Enter patient account (MD On-Line generates this number for you) 27) Check yes to accept assignment 28) Total charges (populated by system) 29) Not applicable 30) Not applicable 31) Name of Transportation Company (this is input automatically) 32) Not applicable 33) Populated when EIN is selected in field 25 11 V15.0-9/1/2015
How to correct and resubmit a claim to Fidelis Care: Providers submitting through MD On-Line: 1) The corrected information for the rejected claim 2) The Fidelis Care original claim number assigned Log on to www.mdon-line.com 1) Click on Submit to Fidelis 2) Place the mouse over the blue LINK1500 tab (a dropdown menu will appear) 3) Scroll down to Resubmit/Edit Transmitted Claims 4) Find patient, click on blue claim number (Copy of original claim will open) 5) In box 19 enter the following under REMARKS : CRTD # # # # # # # # (the assigned Fidelis Care Claim Number) CRTD - tells Fidelis Care it is a corrected claim. Then enter the assigned Fidelis Care's claim number. 6) Make corrections to claim 7) Scroll to bottom of the page and click Modify. 8) Click OK to resubmit 9) Transmit as normal Provider who have an NPI and are not submitting through MD On-Line: Fidelis Care is pleased to announce corrected claims can now be submitted electronically. The original claim number must be submitted and the claim frequency type code must be a 7 (replacement of prior claim). Corrected claims must be submitted with sixty (60) days of the Remittance Advice. 2300 Loop, CLM Claim Information Segment, CLM05-3 Claim Frequency Type Code Element must be set to a 7 and 2300 Loop, REF Original Reference Number (ICN/DCN) Segment where REF01Element equals F8, REF02 Element must contain Fidelis Original Claim Number. How to Submit Claims for Same Member, Multiple Trips, Same Day When multiple trips are scheduled for the same member for the same day, please add up the trips and mileage and submit one service line for total trips and a second service line for total miles. If tolls are included, add up the tolls for a 3 rd service line. 12 V15.0-9/1/2015