Non-Emergency Medical Transportation Billing Requirements
| Date: | May 7, 2020 |
| To: | Health Plan of San Joaquin (HPSJ) NEMT Providers |
| From: | HPSJ Claims Department |
| Subject: | Non-Emergency Medical Transportation Billing Requirements |
| Business: | Medi-Cal Managed Care |
In accordance with Medi-Cal and California Department of Health Care Services (DHCS) guidelines, the following information outlines the billing requirements for all Non-Emergency Medical Transportation (NEMT) providers.
- Name of Referring Provider & NPI (Boxes 17a & 17b)
- Pick-up & Drop-Off Location with times (Box 19)
- Prior Authorization Number (Box 23)
Night Calls (transportation between 7pm and 7am) may be reimbursed in any of the following scenarios:
- Transport starts during the day and ends at night (after 7pm)
- Entire transport occurs at night
- Transport starts at night and ends during the day (after 7am)
Night Call Claim Documentation must include:
- Appropriate HCPCS Code with Modifier UJ
- Indicate start and stop time in Additional Claim Information Field (Box 19)
For additional information and the complete billing guide for transportation services, please visit the Medi-Cal website and follow the link below. https://files.medi-cal.ca.gov/pubsdoco/outreach_education/workbooks/mc-trans_2018.pdf
If you have questions, please contact our Customer Service Department at 209-942-6320.