Provider Notice issued 05/04/04

Non-Emergency Transportation Billing- Origin and Destination Codes

On April 15, 2004, the list of origin and destination codes for non-emergency transportation services was shortened from ten codes to four codes. This notice provides clarification for billing origin and destination codes posted before and after April 15, 2004. Please note providers should not contact First Transit to change the origin/destination codes on approvals posted prior to April 15, 2004.

In order to avoid billing problems with the origin/destination codes, please follow the instructions provided below and refer to Tables 1 and 2, which are attached to this notice.

Paper Claims

Always use the origin and destination code that is on the approval letter issued by First Transit. Transportation providers using a paper claim form to bill the department should Not use the HCPCS modifiers.

National Standard Format (NSF) Electronic Claims

The origin/destination codes will continue to be billed in the Origin Place Code field (FAO Record, Field 10.0) and Destination Place Code field (FAO Record, Field 11.0). This has not changed. Transportation providers using the NSF to bill should Not use the HCPCS modifiers.

For approval letters posted before April 15, 2004, use the information under the NSF column in Table 1, to crosswalk the code found on the approval letter to the appropriate two-digit numeric value.

For approval letters posted on and after April 15, 2004, use the information under the NSF column in Table 2 to crosswalk the code found on the approval letter to the appropriate two-digit numeric value.

Please note if the origin or destination code on the approval letter is "D," you must use the numeric value for "C," which is 22.

HIPAA 837P Electronic Claims

When the new HIPAA 837P format is available, providers will be required to convert the origin/destination code to the required HCPCS modifier code.

For approval letters posted before April 15, 2004, use the information in the 837P electronic claims column in Table 1 to crosswalk the code found on the approval letter to the appropriate HCPCS modifier code.

For approval letters posted on and after April 15, 2004, use the information in the 837P electronic claims column in Table 2 to crosswalk the code found on the approval letter to the appropriate HCPCS modifier code

Once the new HIPAA 837P transaction is implemented, the department will continue to accept the NSF format for a limited time period. Providers are encouraged to regularly check the department's Web site for updates on the implementation status.

It is the responsibility of each provider to ensure that all materials related to changes in the department's billing procedures, handbooks, etc., are shared with their software vendor, corporate help desk or information systems area.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 217-782-5565.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs

Table 1: First Transit Approvals Posted Prior to, April 15, 2004

*Please note: For the purpose of non-emergency transportation, a Renal Dialysis Center is designated with the letter value of "E" by First Transit, an NSF value of "23" and a HCPCS modifier value of "D".

Table 2: First Transit Approvals Posted On and After April 15, 2004