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Date ArticleType
8/28/2018 Payment/Reimbursement
Medicaid Transportation Carve Out

Indiana Medicaid released the long-awaited bulletin formally announcing a temporary carve out, effective September 4th, from the brokered non-emergency medical transportation program run by SoutheasTrans (SET).  The carve out will allow nursing facilities, assisted living facilities serving Medicaid waiver residents, and a few other facility types, to arrange transportation with any Medicaid enrolled transportation provider, not just those contracted with SET.  If a facility desires to continue using SET to broker transportation, the facility may do so.

The carve-out process requires facilities to perform several steps. 

  • Facilities will need to interface with SET to get a Trip Leg ID for each trip (both the outgoing and return trip) and provide that Trip Leg ID to the transportation provider so they get paid.  The transportation provider must submit claims to SET to get paid using that Trip Leg ID.
  • To get the Trip Leg ID number, information about the resident, addresses, appointment details, and special needs are required to be given to SET.
  • Trips over 50 miles must be Prior Authorized by SET.
  • If the resident requires a stretcher or ambulance for the transportation, then the facility needs to obtain a medical necessity form of the medical provider that the resident is seeing.

The nursing home dispatch line with SET is what should continue to be used by nursing facilities and assisted living facilities, which is dedicated to these facility types.  Trips already scheduled with SET will continue to be run by SET unless the facility cancels that trip.  This need to be considered particularly with residents requiring renal dialysis or any other resident with a standing order with SET for transport.

Click here to read the full bulletin.

It is important that this bulletin be read thoroughly. If you have any questions, please contact Elizabeth Eichhorn at eeichhorn@ihca.org.