Important Information for Non-Emergency Medical Transportation Providers
Healthy Louisiana (formerly Bayou Health) has transformed the Medicaid program and how health care is delivered for more than 900,000 recipients. There are a few things Medicaid non-emergency medical transportation (NEMT) providers need to know:
The information below answers common NEMT trip authorization and claims submittal questions.
How NEMT trips are authorized and claims processed for 1) Medicaid recipients not enrolled in a Health Plan who remain in regular Medicaid
The Louisiana Medicaid contractor for non-emergency medical transportation is Southeastrans, and this organization authorizes NEMT trips. Southeastrans authorizes non-emergency medical transportation for Medicaid recipients not enrolled in a Health Plan - those who are in "regular" Medicaid/fee for service.
Molina, the Medicaid fiscal intermediary, will receive and process (pay/deny) claims submitted by NEMT providers for these Medicaid recipients.
How NEMT trips are authorized and claims processed for members of the Managed Care Organizations.
The five Health Plans - Aetna Better Health, Amerigroup, AmeriHealth Caritas of Louisiana, Louisiana Healthcare Connections, and UnitedHealthcare Community Plan -- are responsible for authorizing trips and processing claims for non-emergency medical transportation provided to their members. Each Plan is responsible for establishing their own trip authorization and claims processes, and the Plans are required to share this information with providers contracted in that Plan. Therefore, the authorization and claims processes (and reimbursement policies) may be different than the NEMT processes and reimbursement policies for recipients in traditional Medicaid.
These Health Plans use a subcontractor for NEMT. LDH reviews and approves any subcontracts these Health Plans make for services-including NEMT-that are greater than $100,000. The Health Plans' NEMT subcontractors enter into the actual contracts with NEMT providers. Trip authorizations and claims will then be handled through that Health Plan's subcontractor. The details and processes likely differ among the Plans, and these should be fully addressed in the contractual agreements that the non-emergency medical transportation providers sign with the Health Plan subcontractors.
Each Health Plan will provide the subcontractor with a list of Medicaid recipients enrolled in that plan by the first day of each month.
NEMT Provider Responsibilities
The subcontractor that authorizes and arranges the transportation for members of a Health Plan may verify Medicaid eligibility and Health Plan membership prior to arranging for the non-emergency trip. However, verifying Medicaid eligibility and Health Plan membership prior to providing non-emergency services is ultimately the responsibility of the NEMT Medicaid provider. Healthy Louisiana recipients will receive a card from their Health Plans that contains a hotline number for verifying membership, similar to those used for commercial insurance patients. This number will be clearly printed on the cards so NEMT providers can quickly contact a Health Plan and verify a patient's Medicaid eligibility and Health Plan membership.
NEMT providers can discuss the verification issue during their contract negotiations with the Health Plans and/or their NEMT subcontractors to address any concerns they have. NEMT providers can email firstname.lastname@example.org if they have questions or want more information about Healthy Louisiana.