Ambulance Claims Notice

Date: 04/09/19

Beginning with dates of service May 1, 2019 and after, Managed Health Services (MHS) will process all Medicaid emergent and non-emergent ambulance claims, including air ambulance, which would have previously been processed by LCP Transportation.

For dates of service April 30, 2019 and prior, all ambulance claims will continue to be processed by LCP.

Claims for the following services should be sent to MHS starting with date of service May 1, 2019:

• 911 transports
• Medically necessary non-emergent hospital transports requiring an ambulance with advanced life support (ALS) or basic life support (BLS).
• Air ambulance

All other transportation claims will continue to be processed by LCP and are unaffected by this change.

Examples of what to continue to send to LCP:

• NEMT/taxi
• Scheduled non-emergent stretcher van regardless of date of service
• Ambulance claims with a date of service prior to May 1, 2019

Contracting

Providers do not have to be contracted to receive 100% of the IHCP fee schedule for reimbursement. Prior authorization requirements are the same for contracted and non-contracted providers. If you would like to contract, please visit our website at mhsindiana.com/providers/become-a-provider/become-contracted-provider

Prior Authorization

MHS will require prior authorization for fixed wing transfer, as well as non-emergent transfer by ambulance, regardless of contracted status. Emergent transports resulting from 911 calls will not require prior authorization regardless of contracted status.

A request for prior authorization should be faxed to 1-866-912-4245.

Claims Submission

Only providers enrolled with the Indiana Health Coverage Programs (IHCP) are eligible for reimbursement. Claims must be filed within 180 days of the Date of Service (DOS) for non-contracted providers and within 90 days of DOS for contracted providers.

Claims should be submitted to MHS via a CMS-1500 professional claim form. Claims may be submitted via EDI (preferred), MHS web portal or paper.

MHS Electronic Payer ID:  68069

MHS Paper claims address:

Managed Health Services

PO Box 3002

Farmington, MO 63640-3802

Billing requirements

MHS will follow IHCP billing guidelines for coding and reimbursement.

In addition to the required pricing modifiers, U1 – ALS and U2 – BLS, all claims require the use of a modifier to indicate the transportation origin and destination. The first character of the modifier indicates the transportation origin, and second letter of the modifier indicates the destination. For example, if the transportation begins at a skilled nursing facility and ends at a hospital, the modifier would be NH. The following modifiers are valid for use in claims submission.

Modifier	Description
D	Diagnostic or therapeutic site, other than P or H
E	Residential, domiciliary, or custodial facility (nursing home, not skilled nursing facility)
G	Hospital-based dialysis facility (hospital or hospital-related)
H	Hospital
I	Site of transfer between types of ambulance (for example, airport or helicopter pad)
J	Nonhospital-based dialysis facility
N	Skilled nursing facility (SNF)
P	Physician’s office – Includes health maintenance organization (HMO) nonhospital facility, clinic, etc.
R	Residence
S	Scene of accident or acute event
X	Intermediate stop at physician’s office en route to the hospital (can only be used as a designation code in the second position of a modifier)

For more information on Medicaid ambulance billing guidelines, please visit in.gov.

For more information on the Medicaid Outpatient Fee Schedule, please visit in.gov/medicaid/providers.

If you have questions regarding this notice, please call MHS Provider Services at 1-877-647-4848.