TIPS TO SUBMIT Non-Emergency Medical Transportation Billings, and ENSURE NO PAYMENT DELAYS

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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:

Non-Emergency Medical Transportation Billings

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:

  1. Transport starts during the day and ends at night (after 7:00 pm)
  2. Entire transport occurs at night
  3. 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).

Posted on August 11th, 2021 and last modified on August 11th, 2021.

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