Provider Notice issued 10/27/14

Billing Changes for Fixed Wing Transportation Services

 This notice advises providers that effective with dates of service on, and after November 1, 2014, fixed wing transportation services will no longer be processed manually. Providers must bill using HCPCS code A0430, air ambulance, conventional air services, transport, one way (fixed wing).

Providers may submit charges on the HFS 2209 (pdf), Transportation Invoice; electronically through the MEDI system; or submit an 837P through a vendor. Billing instructions for the HFS 2209 can be found in the Handbook for Providers of Transportation Services, Appendix 1 (pdf). Billing instructions for electronic claim submittals can be found in Chapter 300, Electronic Processing. Reimbursement rates are posted on the department’s website.

Prior approval is required for non-emergency fixed wing transports. To request a prior approval, providers should contact First Transit Inc. at 1-866-503-9040. Requests for approval must be made at least seven (7) business days prior to the date the transportation service is needed. “Business days” means Monday through Friday and does not include Saturdays, Sundays or holidays.

Prior approval is not required for emergency fixed wing transports. However, providers still have the responsibility for verifying the appropriate mode of transportation, the participant’s eligibility and the origin and destination prior to accepting the participant for transport.

This notice also serves as a reminder that for payment to be made, the transportation service must be to the nearest available appropriate provider, by the least expensive mode that is adequate to meet the individual's need.

Special Information Regarding Care Coordination Billing and Eligibility

The prior approval instructions in this notice apply to patients enrolled in traditional fee-for-service, Accountable Care Entities (ACEs) and Care Coordination Entities (CCEs) and do not apply to patients enrolled in Managed Care Organizations (MCOs) and Managed Care Community Networks (MCCNs). Should a participant become enrolled in an MCO or MCCN during a period of time for which a prior approval has been previously granted, the prior approval will no longer be applicable effective with the participant’s managed care enrollment date.

It is imperative that providers check HFS electronic eligibility systems regularly to determine beneficiaries’ enrollment in a plan. Electronic Data Interchange vendors (formerly the Recipient Eligibility Verification (REV) System), the Automated Voice Response System (AVRS) at 1-800-842-1461, and the Medical Electronic Data Interchange (MEDI) system will identify any care coordination plan in which the beneficiary is enrolled. Plan contact information for questions related to coverage and billing requirements as well as information regarding the way each plan is displayed in the department’s electronic eligibility systems may be located in the June 24, 2014 informational notice titled, Revised - Care Coordination Enrollment for Children, Families and ACA Adults .

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary

Services at 1-877-782-5565 option 3 and then option 3.

Theresa A. Eagleson, Administrator

Division of Medical Programs