Date: July 9, 2021
To: Enrolled Transportation Providers
Re: Transportation Policy Clarification Regarding Dual Medicare-Medicaid Beneficiaries and Specialty Care Transports (SCT)
This notice provides transportation reimbursement policy clarification for participants who are eligible under Illinois Medicaid, including but not limited to, those enrolled in Managed Long-Term Services and Supports (MLTSS).
The managed care plan MLTSS covers the non-emergency transportation categories of service listed below:
· 051 Non-Emergency Ambulance
· 052 Medicar
· 053 Taxi
· 054 Service Car
· 055 Private Auto
· 056 Other Transportation
If Medicare or a Medicare replacement plan adjudicates a non-emergency transportation service in a payable status, then the provider should submit a secondary claim to the applicable MCO for adjudication.
If Medicare or a Medicare replacement plan adjudicates an emergency transportation service in a payable status, then the provider should submit a Medicare crossover claim to the Department for secondary adjudication.
Medicare and Medicare replacement plans do not cover certain HCPCS codes and modifiers. These include Medicar (A0130), Service Car (A0120), and non-emergency ambulance transports to or from a physician office (P modifier in the to or from location). In addition, Medicare will not cover any ambulance transportation that does not meet its medical necessity criteria. These are defined as statutorily non-covered services. The HealthChoice Illinois managed care plans will serve as the primary payer in these instances without requiring the Medicare explanation of benefits.
All providers of Medicaid covered services, including cost-shared services, must be enrolled with Illinois Medicaid via IMPACT.
As a reminder, all claims for persons covered under the Medicare-Medicaid Alignment Initiative (MMAI) should be billed to the applicable managed care plan.
Specialty Care Transport (SCT) Claims Information
Only one procedure code (A0434) is used to bill both emergency and non-emergency Specialty Care Transports. Therefore, providers must use an emergency indicator "Y" for emergency trips or "N" for non-emergency trips when submitting claims. Emergency SCT trips must be billed to the Department. All non-emergency claims, including SCT transports, should be billed to the HealthChoice Illinois plan in which the participant is enrolled.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, option 4, then option 4.
Kelly Cunningham, Administrator
Division of Medical Programs