Section 210-RICR-20-00-2.13 - Claims Billing GuidelinesA. NEMT: The State's transportation management authority is responsible for claims and billing for NEMT.B. Emergency Transportation: Providers will bill the health plans for emergency transportation provided to Medicaid managed care beneficiaries. Providers will bill the Medicaid fee-for-service program for emergency transportation provided to Medicaid beneficiaries enrolled in the State's fee-for-service delivery system.2.13.1Medicare/Medicaid Crossover ClaimsA. Emergency Transportation 1. Medicare is the primary payer for emergency transportation. The Medicaid FFS Program will not make any additional payment on claims where the Medicare payment is equal to or more than the Medicaid allowable amount.2. Payment of cross-over claims for Medicaid managed care recipients is handled and directed by the managed care plans.B. Non-Emergency Transportation 1. Certain forms of non-emergency transportation may be covered by Medicare. This may include basic life support and advanced life support (both of which are provided by ambulance) as well as transportation provided to/from hospitals and dialysis centers. The transportation management authority may be responsible for payment of Medicaid-covered NEMT services that were denied by Medicare, subject to prior approval and verification by the broker.2.13.2Patient LiabilityA. The NEMT payment is considered payment in full. The transportation provider is not permitted to seek further payment from the Medicaid beneficiary in excess of any payment received from the State's transportation management authority.B. Emergency Transportation: Transportation providers are not permitted to seek further payment from the participant in excess of any payment received for emergency transportation from either the health plan or the Medicaid FFS Program.210 R.I. Code R. 210-RICR-20-00-2.13
Amended effective 1/1/2019
Amended effective 7/22/2020