Transportation & Accommodation: Travel Requests and Arrangements. June 2018

Transcription

1 Transportation & Accommodation: Travel Requests and Arrangements June 2018

2 Overview Covered Services Service Authorizations Travel Arrangements Provider Responsibilities Travel Arrangements Member Responsibilities Additional Information 2

3 Covered Services 3

4 Covered Travel Services Services could include: Air Ferry Railroad Taxi Bus Wheelchair Van Hotel/motel with or without meals Pre-Maternal Home Non-Emergency Ground Ambulance Escort Travel, Lodging, and Meals Emergency Transportation All travel be medically necessary. Services must be directly covered by Alaska Medicaid and provided by an Alaska Medicaid enrolled provider Coverage is limited to the nearest facility/provider capable of meeting medical needs, or, for Alaska Natives, the nearest Indian Health Services (IHS) facility When required, SA needed prior to travel for non-emergency services SAs are arranged by referring providers; members may not obtain their own authorizations Only necessary weekend travel/lodging permitted for nonemergency needs (such as early Monday morning appointment) In some cases, escorts may be authorized 4

5 Community to Community Transportation and Accommodation Services In general, transportation from one community to another will not be authorized if needed medical services will be available in local community within 3 months of need (includes services by traveling providers) Licensed provider must provide documentation justifying the medical necessity of the transport and explaining why: services cannot be provided in local community or with tele-medicine (for some services) within 3 months member cannot wait until services become available locally within 3 months Licensed providers include MD, ANP, PA, DMD, psychologists, social workers or mental health clinicians 5

6 Travel Services in Same Community Transportation within the same community is authorized under limited circumstances. Lodging and meals will not be authorized within member s community of residence Coverage is only authorized if: Member does not have access to public transportation Member does not have any other mode of transportation available to him/her such as local family members Members who are under 21 or pregnant should be referred to the EPSDT Well- Child Transportation Program 6

7 Non-Emergency Ground Transportation Non-emergent ground ambulance does not require prior authorization, but medical justification must be submitted with the non-emergent ground ambulance claim All other non-emergent ground transportation must be authorized in advance and documented on a travel voucher Possible available means of non-emergent transportation include: Non-emergency ambulance Wheelchair van Taxi/shuttle service Bus All medical appointments must be made during provider s normal business hours Ground transportation is only covered on weekends if authorized and absolutely necessary to accommodate medical provider s schedule Type of transportation authorized is based on need and availability Ground transportation is only covered for medical purposes, not personal travel Voucher forms are given to members for use while traveling 7

8 Accommodation & Meal Services Includes lodging and meals for the eligible member, their escort, or both Members and escorts are expected to share a room As of July 1, 2018, multiple hotel units will not be authorized for the member and escort during the same overnight stay Only authorized in conjunction with medical transportation while member is receiving medical care at a facility outside of their community of residence Not authorized if round-trip transportation is available and completed the same day Alaska Medicaid only covers the basic room rate Meals are reimbursed at actual cost per meal not to exceed a total of $36 per person per authorized day Not all lodging providers offer meals If meals are available, meal vouchers given to member are only redeemable at inhotel restaurant, not room service or outside facility Members Keep In Mind! Non-essential expenses (tips for services, phone calls, pay-per-view, room service, etc.) are not covered and are the member s responsibility Lodging providers may require credit card or deposit to secure room if that is the provider s policy 8

9 Pre-Maternal Home Accommodations Rate includes lodging, meals, and medically-related transportation (where available) for eligible pregnant Medical Assistance members Only authorized when member is receiving medical care at a facility outside of their community of residence Intended for members awaiting delivery of child or for short-term care of mother and infant as authorized Eligible members include pregnant women and children under 1 year of age All services require prior service authorization Pre-maternal home stays are not to exceed 30 days prior to delivery Any days beyond 30 require physician s medical justification 9

10 Emergency Services Emergency transportation methods include: Air Ambulance Ground Ambulance All emergency services travel must be urgent/emergent in nature to be covered. Emergency medical condition - the individual has, after sudden onset, a medical condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in: Placing the member's health in serious jeopardy Serious impairment to bodily functions Serious dysfunction of any bodily organ or part 10

11 Emergency Services Ground ambulance services do not require a service authorization As of 7/1/2018, Medevacs do not require a service authorization Emergency transport for the member is only covered to the nearest facility (or IHS facility for Alaska Natives) capable of providing necessary emergency medical care; additional mileage will not be reimbursed for any travel method Medical justification is required AK Medicaid does not reimburse for an escort on a ground or air ambulance Return transportation costs will not be paid for escorts that travel with the patient in an emergency ambulance Emergency ambulance will only be approved for a one-way trip; return transportation should be through less expensive methods Be sure to distinguish type of ambulance when billing for services by using Place of Service code 41 for ground ambulance and 42 for air/water ambulance 11

12 Service Authorizations 12

13 Member Eligibility - Transportation Benefits Transportation is only covered by Alaska Medicaid when members are eligible Medicaid coverage and have transportation benefits associated with their eligibility code. Referring providers must verify the member s transportation eligibility prior to any transportation authorization request. This can be done using the following methods: Call Conduent Provider Inquiry , option 1, (toll-free), option 1,1,1 Call Automated Voice Response System at Refer to member s DenaliCare card, Denali KidCare card, or Medicaid manual coupon for relevant eligibility code or Medicaid eligibility coupon for transportation statement related to condition under Special Information Provider Notice: Members new to Medicaid will be issued a new ID number starting with 200. If a member has been issued Medicaid in the past they will have the old ID stating with 060. If the member has both a 200 and 060 Medicaid ID, the 060 ID should be the one used for billing. When verifying transportation eligibility over the phone, you must use the member s 060 or 200, if possible, or you could be told that the member does not have eligibility when they actually do. If you do not know the member ID number, or are unsure if the member has been issued one yet, simply ask the Conduent representative to look the member up by SSN or name and DOB. 13

14 Transportation Benefits Eligibility 14

15 Non-Eligible Member Codes These member eligibility codes are not eligible for Alaska Medicaid transportation and accommodation benefits. * 19WD is coverage for Waiver Determinations. Transportation and Accommodation Services are only covered for the actual waiver determinations. Travel for physician visits, medical supplies and equipment is not covered. ** 25DE is coverage for disability exams and the tests (MRIs) that pertain to the actual disability exam 15

16 Escort Authorization Defined by the State of Alaska in 7 AAC as a person who accompanies the member to and/or from a source of medical care Members may be authorized an escort if: Minor under age 18 years Adult, as medically necessary Not required to be medically trained, but must be at least 18 years of age and mentally and physically capable of assisting member Not reimbursed for time Authorized travel, lodging and meals during specific evaluation and treatment window, although typically must share lodging with member Escorts may be transported home and then back again for member s return trip depending on trip duration and cost effectiveness of options, especially if trip extended For more information, reference the Medicaid Policy Clarification For Non-Emergent Out of Area Travel memorandum 16

17 Service Authorizations The referring healthcare provider obtains all necessary service authorizations for member s non-emergency travel needs. Travel SA requests are obtained by the referring provider from the appropriate agency: Conduent Services Travel Prior Authorizations at , option 5 or (toll-free), option 1, 2 YKHC Medicaid Patient Travel at ANTHC Travel Management Office TCC Patient Travel , Option 4 Have the following information available for processing the SA request: Member s Alaska Medicaid ID number Appointment Dates/Times Diagnosis Referring and receiving provider Origin and destination Escort information, if applicable Specific transportation and accommodation needs 17

18 Service Authorization Inquiry The requesting provider will receive confirmation of travel authorization approval or denial. Providers may also view the status of submitted authorization requests in Health Enterprise. 1. Once logged in, click on View/Edit Authorization Request under Authorizations tab 18

19 Service Authorization Inquiry 1. The View/Edit Authorization Request menu will appear 2. The easiest method to view the status of a submitted authorization is by Service Authorization ID Number 3. If the SA ID is unknown, searching by Member ID or Begin/End Date are also good methods for locating the desired SA 4. Once you have entered the desired search criteria, click Search on the bottom of the page 19

20 Travel Arrangements Provider Responsibilities 20

21 Referring Provider Responsibilities Referring (Local) Provider Once transportation authorization is approved: Referring Provider completes an AK-04, Transportation Authorization and Invoice, for each potential provider that will be billing for services Based on units requested/approved If authorized 6 taxi rides, then 6 separate AK-04 forms must be completed, each with 1 unit specified Lodging and meal units can be documented on one form because there is only one provider for these services Document only 1 unit for each night of stay, whether the stay is for the member, the escort, or both Must complete the entire top portion of the form, the patient s personal information, the escort s (if applicable) personal information, and the applicable unit for that form Leave all charges blank; this is for the transportation/accommodation provider Provide all original, authorized AK-04 forms to the member Do not give members blank vouchers 21

22 AK-04 - Referring Provider Check for Eligibility. Check the box, initial on the line, and enter date verified Check Emergency or Non Emergency, whichever applies Patient's Name (field 1): Enter the patient's first name, middle initial and last name Patient's Date of Birth (field 2): Enter the patient's date of birth in MM/DD/YYYY format Was Condition Related To (field 3): Check appropriate boxes for patient s condition Recipient Identification Number (field 4): Enter patient s 10-digit Alaska Medical Assistance identification number Patient s Sex (field 5): Select appropriate box indicating patient s gender 22

23 AK-04 - Referring Provider Address (field 6): Enter patient s address and telephone number EPSDT Referral (field 7): If travel arrangements are being made because of an EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) screening, select Yes Prior Auth Number (field 8): Enter the approved service authorization number Authorized By (field 10): Enter the name of the person at Conduent that authorized the telephonic authorization. If you submitted the request through Health Enterprise, enter the User ID next to A- Approved status Acknowledgment (field 9): The individual submitting the travel service authorization must sign and date in this field, whether called in or submitted via Health Enterprise * The Service Authorization number and Authorizing individual must be annotated for transportation/accommodation providers to get reimbursed! 23

24 AK-04 - Referring Provider Transportation (field 11): Enter the village or city where the patient will begin travel in the Origin field; enter the city the patient is travelling to in the Destination field Round Trip (field 12): If round trip, enter the departure date and return date; if one-way, use field 13 instead One Way (field 13): If one-way trip, enter departure date; if round trip use field 12 instead Procedure Code (column 17) and Description (column 18): These fields are preprinted; if the code you need is not on the form, enter the code on one of the blank lines in this column with the corresponding description in column 18 Units (column 19): Enter the unit(s) authorized for the specific service Remember that separate forms must be created for each unit, even if the same company provides the service The only exception is lodging and meals if the units will be rendered by the same provider continuously Provider Notice: Do not complete the Charges column, (column 20). This is reserved for the transportation/ accommodation provider after services have been rendered. 24

25 AK-04 - Referring Provider If an escort is authorized, fill in the Escort portion of the AK-04; otherwise, very clearly X out the entire escort portion rendering that section void. Transportation (field 14): Enter the escort s first and last name accurately Round Trip (field 15): May be different from patient depending on individual needs and circumstances. If round trip, enter the departure date and return date; if one-way, use field 13 instead One Way (field 16): If one-way trip, enter departure date; if round trip use field 12 instead Procedure Code, Modifier, and Description (column 21-23): All allowable codes are preprinted Units (column 24): Enter the unit(s) authorized for the specific service 25

26 Receiving Provider Responsibilities Receiving Provider If the receiving healthcare provider determines that the member needs to stay longer for medical reasons, they must contact the organization that originally authorized the stay to amend the request for additional lodging, meals, transportation, etc. Conduent Services Travel Prior Authorizations» , option 5 or (toll-free), option 1, 2» Fax Transportation Authorization Update Form YKHC Medicaid Patient Travel call ANTHC Travel Management Office call TCC Patient Travel , Option 4 Complete new AK-04 forms for additional transportation and accommodation services and give to the member or their escort Alaska Medicaid will not cover travel that is not medically necessary, to include weekend and extra time at any destination that is not related to medical care 26

27 Conduent Authorization Update Form When providers are updating travel for a member whose transportation and accommodations were originally authorized by Conduent, they may request an update using the Transportation Authorization Update Form, as an alternative to phoning the service authorization department Update Form Requesting provider must include name, contact person (if not provider), and contact phone number Include member s Medicaid ID, the current SA number, requested updates, and justification for change Make sure the information is legible 27

28 Travel Arrangements Member Responsibilities 28

29 Member Responsibilities The member is responsible for arranging travel (airline, accommodations, etc.) based on the specific transportation service authorization provided by the referring provider. Member must wait for authorization before making any travel arrangements Member must receive complete information regarding appointment dates, times, locations, and contact information to assist with arrangements Providers may assist in the process but member is ultimately responsible for their own transportation and accommodation Contact the Medicaid Travel Office (MTO) for all non-emergency airline and ferry travel The MTO will issue electronic tickets based on approved authorization and appointment dates/times Check into flight using provided confirmation number and proper ID Members can call for guidance on the booking process, but only the Medicaid Travel Office can make reservations. 29

30 Member Responsibilities Members may make their travel arrangements by contacting the MTO by phone at , Monday-Saturday 8:30 am 5:30 pm and Sunday 12:00 pm 4:00 pm (AST) Members may also use the MTO website, rather than calling, to make routine travel arrangements and review travel requirements, at In order to use the website to book travel, members must have an approved travel authorization the request must be for new travel arrangements travel request must be at least 48 hours in advance of requested travel date Members and escorts must have valid identification for travel. 30

31 Member Responsibilities 31

32 Member Responsibilities Lodging is booked by member A list of available accommodation (and other) providers in the area is available through the member helpline or Provider Inquiry (if provider is calling on member s behalf) Member should receive completed AK-04 forms from their provider for each applicable service, including forms for their escort There should be one completed form/voucher for every provider needed to complete the trip Must keep all vouchers on hand and provide to transportation/accommodation provider as service is received If air travel is delayed due to weather or mechanical problems, consult carrier to see if next available flight was automatically booked If new flight was booked and change does not affect lodging or meal needs, no action is required; if it does, you must contact your healthcare provider, referring or receiving, immediately; only they can amend the travel authorization If travel was not automatically booked for the next available flight, contact Medicaid Travel Office to obtain updated travel arrangements 32

33 Member Responsibilities If member or escort does not travel and has unused tickets, the member must notify the Medicaid Travel Office to void tickets If appointment is delayed prior to the trip, the referring provider will need to amend or reestablish the travel authorization Travel authorizations and arrangements are for medical necessity only If a member uses tickets for reasons other than the intended purpose, they will be asked to reimburse Alaska Medicaid For example, using tickets before they are voided after an appointment has been cancelled For more helpful travel tips, members may refer to the Travel Tips for Alaska Medicaid Members and/or the Travel Tips for Alaska Medicaid Escorts both flyers are available on on the Members page 33

34 No-Show Airline Policy When a member and/or escort s travel plans change or they cannot make a scheduled flight, the patient or escort must call the entity that originally arranged the travel before the flight departs Alaska Medicaid Travel Office at YKHC Medicaid Patient Travel at ANTHC Travel Management Office If a flight is not cancelled prior to departure, the remainder of the itinerary will be cancelled and Alaska Medicaid may not pay to rebook their missed flight(s) 34

35 Additional Resources 35

36 Additional Resources Alaska Medicaid Health Enterprise website at Information necessary for successful billing Includes provider-specific Medicaid billing manuals and fee schedules You may also call: Eligibility only , Option 1,2 or (toll-free), Option 1,1,2 All other inquiries , Option 1,1 or (toll-free), Option 1,1,1 36

37 Transportation & Accommodation Authorizers Travel SA requests are obtained by medical providers from the appropriate agency: Conduent Services Travel Prior Authorizations at , option 5 or (toll-free), option 1, 2 YKHC Medicaid Patient Travel at ANTHC Travel Management Office TCC Patient Travel , Option 4 37

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