Welcome to Southeastrans! - Indiana...Southeastrans Confidential Material How to Schedule a Trip -...

Welcome to Southeastrans!

• Southeastrans Mission and Vision

• SET Portals (Facility, Provider, Member)

• Call Center Overview

• Provider Expectations, Provider Credentialing, and Provider Agreement

• PA Eligibility

• FSSA Updates

Southeastrans Confidential Material

Overview

Who is Southeastrans?

Southeastrans is a minority-owned, non-emergency medical transportation (NEMT) management company based in Atlanta, Georgia. We provide comprehensive NEMT administrative and related services to our state Medicaid and HMO clients, including verification of eligibility utilizing proven gatekeeping processes, claims management, provider credentialing, utilization review,

and quality management.

VisionMission




Vision

To provide transportation management solutions that deliver the highest levels of quality and satisfaction to our consumers and partners, while offering exceptional value, performance, and responsiveness to our contracting agencies.

Mission




Vision

To be the leader in transportation management through the integration of specialized information technologies, innovative business practices, and a consistent emphasis on quality and consumer satisfaction.

Mission

Broker, Client and Provider Relationship

Member

Southeastrans

(Broker)

FSSA

(Client)

Provider

• Southeastrans contracts with private companies (providers). Our responsibility is to administer and oversee the NEMT process which includes all gate-keeping for eligible individuals.

• FSSA is responsible for assuring that Indiana Medicaid members have the opportunity to request and receive Medicaid services, including non-emergency transportation (NEMT), and that providers of these services are reimbursed.

• The provider is responsible for transporting members safely to their medical appointments in a timely manner.

The Broker, Client and Provider work together to provide NEMT services to Indiana Medicaid Members.

Facility Portal

Provider Portal

Member Portal


PROVIDER Portal Access

Request Access via email to: [email protected]

PROVIDER PORTAL

https://provider.southeastrans.com/iportal

Facility Portal

Provider Portal

Member Portal


FACILITY Portal Access

Request an Account: www.southeastrans.com/facilities


FACILITY PORTAL

Facility Portal

Provider Portal

Member Portal


MEMBER Portal Access

Request an Account: https://member.southeastrans.com/Account/Login


MEMBER PORTAL


Scheduling A Trip

• Southeastrans will determine coverage eligibility for a member each time a trip is scheduled.

• The appointment reason and provider will be verified as an IHCP approved healthcare provider and service.

• Non-IHCP approved services or providers will be denied, and a letter will be sent to the member stating the reason for the denial.


ELIGIBILITY

• Southeastrans will complete and submit all required Prior Authorizations on behalf of the member.

• Prior Authorizations for trips in excess of 50 miles one-way, outside the State of Indiana, or modes of travel by commercial air, bus, or train must be submitted prior to the trip’s date of service!


PRIOR AUTHORIZATION PROCESS


How to Schedule a Trip - Member

• Non-urgent trips can be scheduled by calling the Reservation Line at 1-855-325-7586 Monday – Friday 7am – 6pm EST.

• Scheduling for urgent trips occurring in less than 48 hours can be completed by calling the Reservation Line 24 hours/7 days a week, Fax (facility only), Member Portal, Facility Portal and the Provider Portal.


How to Schedule a Trip - Facility

• Non-urgent trips can be scheduled by calling the Facility Line at 1-855-325-7588 Monday – Friday 7am – 6pm EST.

• Scheduling for urgent trips occurring in less than 48 hours can be completed by calling the Facility Line 24 hours/7 days a week.

• Non-urgent trips can be faxed utilizing the Nursing Home Form to 317-642-0913.

• If the facility has identified the provider in advance and gained the provider’s acceptance, the trip can be scheduled by calling the Facility Dispatch Line at 1-888-822-6124 Monday – Friday 7am-6pm EST .– www.southeastrans.com/facilities

PROVIDER EXPECTATIONS

Southeastrans has high performance standards and requires each provider to meet and/or exceed those standards. Southeastrans monitors all providers to ensure compliance with the required standards.


Operational Performance Quality Compliance

Ratio of demand to subscription trips Percentage of late trips Number of accidents

Service Availability Percentage of Provider no-shows Number of incidents

Utilization of mobile technology Number of complaints Vehicle inspection results

Participant satisfaction survey results Compliance related liquidated damages

The Provider Scorecard assesses each provider’s performance on a monthly basis in the following key areas:

PROVIDER SCORE CARD

• Signed by all provider types with the exception of EMS at the time of credentialing

• Roadmap to performance and service standards

• Trip acceptance and send back guidelines


PROVIDER AGREEMENT

PROVIDER SEND BACKS

21

• If providers are unable to provide transportation for a Member, the provider must decline the trip using the Provider Portal.

• Send backs are due two (2) business days prior to date of service.

Day of Service(Member’s Travel Day)

Send Backs due(two business days prior to Day

of Service)

Monday Thursday at 12:30pm

Tuesday Friday at 12:30pm

Wednesday Monday at 12:30pm

Thursday Tuesday at 12:30pm

Friday Wednesday at 12:30pm

Saturday Thursday at 12:30pm

Sunday Thursday at 12:30pm

Example:A Member’s scheduled day of service is

Monday, July 16th.

Send backs are due Thursday, February 12th

at 12:30 pm.

• Nationally Accredited Driver Training for all non-EMS providers

• Background checks, Motor Vehicle Report (MVR), and drug screens

• Vehicle Inspections

• Review of Insurance coverage

• Office of Inspector General (OIG)/System

for Award Management (SAM) Exclusion List

• Verification of IHCP active status

• Business Documents – EIN, W9, etc.Southeastrans Confidential Material

PROVIDER CREDENTIALING for Non-EMS Providers

• Review of Insurance coverage

• OIG/SAM Exclusion List

• Verification of IHCP active status

• EMS License

• Business Documents – EIN, W9, etc.

• NO driver training or vehicle inspections


PROVIDER CREDENTIALING for EMS Providers (ambulances only)

CLAIMS

Southeastrans’ goal in processing provider payments is to provide accurate and timely payment to NEMT providers for services rendered while minimizing or eliminating the potential for billing fraud. All claims should be submitted

via the iPortal.


PROVIDER IPAD USAGE

• Trip assignment via provider web portal• Electronic signature capture (driver and member)• Real time trip status• Pick-up and drop-off verification

– Geo coordinates– Time stamps

• Auto generated electronic claim• Vehicle locator feature – NET Notes• Mapping functions• Messaging options


PROVIDER IPAD USAGE

• Minimum trips required for iPad use

• Effective December 1, 2018, all current providers must be credentialed with Southeastrans

• Effective January 1, 2019, all providers must use iPads

• New providers MUST be credentialed within 60 days of signing a provider agreement

• Contact Kristy Swoveland at 765-602-6004 or [email protected] with any questions.

mailto:[email protected]

IMPORTANT CLAIMS REMINDER

Eligibility for payment for trips is dependent upon the provider’s active status with IHCP.

Should a Provider become inactive with IHCP, they will be ineligible to receive payment

from Southeastrans.

SUBMITTING A PAPER REIMBURSMENT FORM

The paper Trip Reimbursement Form (TRF) is only to be used by a provider in the event that the iPad is down.

Completed original forms should be bundled by driver and vehicle date and submitted to Southeastrans on a weekly basis for processing provider payments. Payments for trips with illegible or incomplete information may be denied and returned to the NEMT Provider for correction and resubmission. All information recorded on the Trip Reimbursement Form is required or is essential for accurate payment of trips rendered. All information recorded must be true and accurate under penalty of violation of State or Federal Medicaid laws and regulations.

• The provider, driver, and vehicle information is complete and accurate

• The driver and vehicle are authorized by Southeastrans

• The form or e-form is signed by the driver

• Each trip must include a valid Southeastrans pre-authorized trip leg ID number

• The Member’s name must match Southeastrans trip confirmation information

• The provider must be the assigned NEMT provider for the member as listed on the manifest

• The member signed the form or e-form (or if the member is unable to sign, a healthcare provider representative’s signature is present). If

the Member and/or the healthcare provider refuse to sign, the driver should record the name of the person refusing to sign and the

reason given for refusal to sign.

• Pick-up and drop-off times and mileages are present

• If there is an escort, the escort’s name, signature, and relationship to the member is provided

• NET provider is requesting reimbursement for the authorized mode of transport, unless a change in the mode of transportation was pre-

approved by Southeastrans.

• Any required special rate documentation is attached with prior authorization included in the trip notes

SUBMITTING CLEAN CLAIMS

All Trip Reimbursement Forms (TRFs) must meets the following requirements:

SUBMITTING CLEAN CLAIM CONT.

Do not use white out/correction tape/correction fluid, etc.

Usage will cause a final denial with no rights to an appeal.

Illegible claims could lead to a potential claim denial.

To resubmit a trip to the Reconciliation Department for review and payment:

• Print the Virtual Trip Reimbursement Form (VTRF) from the iPortal or pull the paper Trip Reimbursement Form (TRF) for the trip.

• Review the TRF, make the necessary corrections, and initial the changes before resubmitting.

• Fill out the claims review Cover Sheet for Indiana (shown here).

– Note: Be sure to include the driver input error and provide an explanation in the “Issue Comments” section.

• Submit the VTRF or TRF and the Cover Sheet by fax or email as indicated on the Claims Review Cover Sheet.

RESUBMITTING A CORRECTED CLAIM AFTER DENIAL

For detailed instructions, review the Indiana Reimbursement Guide.

• Actual Pick-up Time

• Actual Pick-up Odometer Readings

• Actual Drop-off Time

• Actual Drop-Off Odometer Readings

• Southeastrans Trip Leg ID- provided in Box 23

• Explanation of Benefit (EOB) - only if applicable*

This information may be written/placed on the actual 1500 Form, or you can provide a Patient Care Report (PCR). The Patient Care Report is not required however some find it more easier to send.

*Please note: If Box 11-D is checked yes or it is found that the member has another health insurance plan you must include the EOB (Explanation of Benefits). IF Box 11-D is checked no or it is found the member has no other insurance plan, the PCR (Patient Care Report) is not required.

1500 FORM REQUIREMENTS

In addition to the standard CMS-1500 requirements, providers are required to submit the following:


FSSA UPDATES

• BT201835 - Dually Eligible Members

• BT201845 - Revised process for scheduling NEMT (Temporary Return to Non-Brokered Status)

• BT201844 - Hospital to Hospital Transport

• BT201842 - 9-1-1 Dispatch

• BT201848 - Credentialing Requirements

• BT201847 - Gas Reimbursement Program Update

Phone Line Contact Person Phone Number

Facilities Outreach Manager Jodie Little 317-671-2249

Provider Relations Manager Kristy Swoveland 765-602-6004

Member Reservation Line 1-855-325-7586

Where’s My Ride 1-855-325-7586 (Option 2)

Facility Reservation Line 1-855-325-7588

Provider Dispatch Line 1-855-325-7511

Facility Dispatch Line (for Trip Leg ID’s with preferred provider EMS relationship)

1-888-822-6104

Questions

Welcome to Southeastrans! - Indiana...Southeastrans Confidential Material How to Schedule a Trip -...

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