TIPS TO SUBMIT Non-Emergency Medical Transportation Billings, and ENSURE NO PAYMENT DELAYS
| Date: | August 10, 2021 |
| To: | Health Plan of San Joaquin (HPSJ) NEMT Providers |
| From: | Health Plan of San Joaquin |
| Subject: | TIPS TO SUBMIT Non-Emergency Medical Transportation Billings, and ENSURE NO PAYMENT DELAYS |
| Business: | Medi-Cal Managed Care |
Health Plan of San Joaquin has developed a guide that solves for some frequent errors and helps non-emergency medical transportation (NEMT) providers accurately submit EDI transport claims. These meet Department of Health Care Services (DHCS) guidelines.
Ensure that the following required fields are populated:
MORE TIPS FOR PROVIDERS
Night Calls
NEMT transportation between 7:00 pm and 7:00 am may be reimbursed in any of the
following scenarios:
- Transport starts during the day and ends at night (after 7:00 pm)
- Entire transport occurs at night
- Transport starts at night and ends during the day (after 7:00 am)
Claim Documentation for Night Calls
All Night Call claims must include:
- Appropriate HCPCS Code with
Modifier UJ - BOTH start and stop times in
Additional Claim Information Field (Box 19) - Pick-Up City
- Pick-Up State
- Pick-Up Zip code
- Drop-off name
- Drop-off Address/Location
- Drop-Off City
- Drop-Off State
- Drop-Off Zip code
Tip for ELECTRONIC NEMT claim submissions
- For transportation claims, HPSJ strongly recommends providers first contact their
Clearinghouse. - Then gather information about their transmission and configuration options to
make sure these will be correct, successful claim submissions.
For complete information
Find more, including the complete billing guide for transportation services, on the
Medi-Cal website, follow this link:
https://files.medi-cal.ca.gov/pubsdoco/publications/mastersmtp/part2/mctrangnd.pdf
All claims must be submitted with a valid diagnosis code. The diagnosis pointer(s) are in
box 24E on the paper claim form and Loop 2400/Segment SV107 (1-4) for the 837, for
each CPT code billed.
A denial will be issued for any instance of missing required information. Please pass along this information to your billing company if applicable.
If you have questions, please do not hesitate to contact our Customer Service
Department at 1.888.936.PLAN (7526).