LCP Transportation. Your Partner in CARE Seminar Session for MHS. October PR.P.PP 09/14

Transcription

1 LCP Transportation Your Partner in CARE Seminar Session for MHS October PR.P.PP 09/14

2 Coverage for MHS Members Your Partner in getting CARE LCP, a long time partner with MHS, provides quality transportation services for all eligible MHS members per IHCP coverage guidelines The following Enhanced services are also offered as value added services No trip limits Additional rider availability Trips to and from Caseworker appointments Trips to the Pharmacy (after medical appointment only) Special MHS health related events Car seat options for members in need Mileage reimbursement options Public Bus Transportation

3 Scheduling Trips with CARE To Schedule Routine Transportation (between 8 a.m. and 8 p.m.) or for Return Trips call Monday through Friday After Hours / Urgent Care Trips/Holidays New Years/Memorial Day/4 th of July/Labor Day/Thanksgiving Day/Christmas Day Members can call LCP directly at

4 Transportation Options LCP Offers LCP will purchase Bus Passes Mileage reimbursement for self driven transportation Curb to Curb Door to Door Wheelchair Accessibility

5 Use of Indiana Public Transportation Bus Pass In Indianapolis, Anderson, Columbus, Elkhart, Evansville, Fort Wayne, Lafayette, Muncie, Richmond, Terre Haute, Tri-City Area (Clarksville-Jeffersonville- New Albany) and South Bend/Mishawaka Area, LCP offers MHS members the option to utilize Indiana s public transportation, instead of curb-to-curb service Members are required to call 3-5 days in advance in order to be eligible for bus passes. This is a voluntary option for members who live in these specific cities.

6 LCP Self- Driven Transportation LCP Transportation provides the insured Members the opportunity of locating general transportation, from a friend or family member to transport the Member. LCP will reimburse the individual up to $0.27 cents per mile for transit to the appointment(s). Scheduling Process for Self-Driven Transportation: Self-driven Member are required to call at least 1 hour prior to their appointment time. The insured member must follow scheduling guidelines. Trip is subject to verification/confirmation by a Customer Service Representative with the medical provider. For approval determination, the Member must adhere to the following and furnish the required information: Reference the confirmation number(s) for the appointment Odometer readings to and from the appointment(s) The name of the individual who transport the insured Member to and from their appointment(s) The detailed address to mail the reimbursement check once the appointment(s) have been verified The name of the individual you desire to appear on the reimbursement check

7 LCP Self- Driven Transportation Cont d Submit the above information on the Self-Driven Claim Submission form that will be mailed to the Member upon scheduling a self-driven trip and immediately returned to LCP. If the form has not been received before the appointment time(s), we request that you mail the required information so that LCP accounting department can begin the process of approving the claim(s). Please submit all requested information to: Attn: Self Driven 4310 Guion Road Indianapolis, IN LCP Transportation The insured Member has up to 90 days from the date of the trip(s) to submit the requested documentations for reimbursement. No claims submitted past 90 days will be accepted.

8 Specialty CARE Trips Wheelchair bound members Members receiving dialysis Cancer Treatment Substance abuse treatment Long distance trips (over 50 miles) Wound care.

9 Urgent CARE Trips Providers please encourage your patients when they schedule their next medical appointment with you, they also schedule their transportation needs for that appointment. Scheduled Urgent Care: when members request transportation within a 72 hour time frame Scheduled Urgent Care occurs when the member has scheduled their appointment with the provider prior to the 72 hours, but failed to schedule transportation prior to the 72 hours. Emergent Urgent Care: requests for same day or next day, and the provider wants to see the member ASAP

10 Scheduling Care Timeline Urgent Care Trips will have no longer than a 2 hour pick up wait time from members home before the appointment time Long Distance Urgent Care Trips- will have no longer than a 4 hour pick up wait time from members home before the appointment time. Urgent Care Return Trips will have no longer than a 2 hour return pick up from Doctor s appointment Long Distance Urgent Care Return Trips- will have no longer than a 4 hour return pick up from Doctor s appointment. Long Distance Trips pick up with calculated actual time in addition to 1 hour for travel time

11 Scheduling CARE Timeline Local Trips and Rural Trips pick up will be no longer than (2) two hours prior to appointment from members home Local Return Trips and Rural Return Trips - pick up will be no longer than (2) two hours after appointment from the doctor s office

12 Pick-up CARE Timeline Return Trips Local Trips pick up within 2 hours from point of call Return Trips Long Distance Trips (over 50 miles) pick up after the appointment will not exceed (4) hours from point of call

13 Safety/Accommodations Minor Children ages 0 thru 17 yrs old must be accompanied by a Parent or Guardian Escort or Authorized Representative Minor Children ages 16 thru 17 yrs old must have a signed waiver on file to ride alone Car Seats are Required by Law for Children Newborn to Four Years of Age LCP Provides Booster Seats for Children 4 to 8 Years of Age and Weighing at least 40 Pounds up to 80 Pounds if member calls in at least 72 hours prior to appointments.

14 Scheduling CARE Requirements Maximum time for scheduling transportation is up to 45 days before appointments Minimum time for scheduling routine transportation is 3 business days in advance Trips scheduled outside the 3 business days minimum are referred to as Urgent Care Trips

15 Special CARE Procedures Services for Culturally Diverse Members On site Interpreters Spanish Burmese Voiance- Interpreter Language Line (For Internal use only) Services for Special Needs Members Staff refers Members Language Line MCE for Sensitive/Unique Needs TTY

16 Business Requirements LCP only transports MHS members to Covered IHCP or MHS approved services. Prior Approval is Required for Out-of-State Trips to areas that are not considered In-State by the IHCP. Trips to the pharmacy to fill prescriptions are allowed when leaving provider s office. MHS Members being referred by their PMP to another facility or medical professional must have the Facility s Name, Address, and Phone Number in order to schedule the Trip.

17 Automatic Cancellation/Delay 1. County in state of emergency Vendors have issued notice to LCP they will not transport due to inclement weather conditions. Automatic cancellation of delay in the event LCP cannot locate other Vendors to provide support or transportation services in the region/county 2. Provider Office is closed due to weather MHS Provider Contacts LCP and states they are closing the office due to severe weather conditions. LCP will call the member to notify of office closure and request to reschedule appointment with the provider and LCP. 3. Early Morning Cancellation (prior to road crew activity) LCP may issue cancellation between 1AM-8AM pick up time prior to available assessment factors below (i.e. before school closure). If cancellation or delay needs to go beyond the 9:00AM pick up and an extension is needed, LCP may contact MHS PR.P.PP.5 10/11

18 Assessment Factors Assessment Findings- (LCP will use the indicators below when making decisions regarding closure or delay) No single one of these findings will result in cancellation/delay. 1. School closures in the county being affected- May warrant delay or cancellation due to the severity of the weather conditions 2. Test runs by drivers to assess the road conditions- Pending driver s professional assessment of the road conditions for transport, a delay or cancellation may be warranted. This will not be the sole deciding point as driver preference/opinion can affect judgment. 3. Police Report Potential closure or delay but not sole resource for determination. Please refer to other bullets outlined in this notification as other factors.

19 Member / Provider Satisfaction Customer Service is a Hallmark. To assess customer service and determine any necessary improvement activities, LCP employs the following: Secret Rider Program Member Surveys Provider Surveys Online Communication is available

20 Vendor Evaluation Program LCP has a vendor evaluation program that is used to help select vendors to provide transport. The system rewards those who rate the best in quality, complaints, and other related factors. This ensures that vendors are providing adequate service to our members This determines vendor priority level for trips by county This tool ensures each vendor follows the same trip policies as LCP

21 Categories Used For Priority Level Member Experiences with the Vendor Trip Quality Vendor Customer Service Efficiency in Providing Services

22 Customer CARE Services LCP has dedicated staff available to take incoming member and provider calls When Leaving a Message for LCP Staff, please include an Area Code with the Phone Number

23 NEMT Vendor Payment Processing LCP is required to conduct an audit of all vendor trips Member signatures are validated Driver signatures are validated Validation must be completed prior to approval and payment processing

24 Vendor (Claims)Trip Review Validation increases the required processing time LCP staff must assure that all signatures are received Signatures must be matched to corresponding trips Trips must be verified within the LCP s MILE software system Communication with vendors regarding claims discrepancies increases processing time as vendors must be contacted.

25 CleanClaim - Definition Electronically submitted clean claims Claims that are electronically submitted Submitted in a timely manner Submitted in the required format Do not require staff to investigate, develop or acquire additional information or substantiating documentation.

26 Vendor Assistance Vendors can assist in reducing processing time Assure that all signature sheets are submitted weekly with corresponding weekly invoices Assure that all requested information on the signature sheet logs is completed Assure that trip identification number is included on signature sheet logs Assure that all signature sheet logs contain the printed name of the driver and the signature of the driver

27 Vendor Assistance Cont d Vendors can assist in reducing processing time Assure that all signature sheet logs contain the printed name of the member the signature of the member Assure that the member signs the signature sheet log for each leg of the trip Under no circumstances should anyone other than the member complete the member signature. (Exception: member is a minor) Assure that the manifesting of trips is completed accurately

28 Vendor Assistance Cont d Vendors can assist in reducing processing time Assure that accurate mileage is provided for entire trip Assure that pick-up and drop-off time is provided for each trip Assure the accuracy of the Trip ID Number Assure that the loaded miles are entered as the actual miles on the trip manifest Assure that unloaded miles are identified in the notes section of your manifest and grand total invoice for each trip

29 Additional Processing LCP staff is required to apply various procedures to the submitted claims before they can be processed for payment Trip detail and signatures are validated Vendor rates must be verified Add-ons for unloaded miles must be verified Due to the additional processing these claims are not considered clean claims Processing will occur within 30 days of receipt of all required documentation Payments are processed twice monthly on the 6 th and 22 nd of the month

30 SUBMISSION INFORMATION

31 SUBMISSION INFORMATION Cont d

32 SUBMISSION INFORMATION

33 SUBMISSION INFORMATION

34 Contact Information Payment Inquiries Andrea King Claims Inquiries Portal Issues Vendor Inquires - Bruce Bowlin

35

36 Emergency Claim Information HHW/HIP/HCC Ambulance Claims should be submitted to P.O. Box , Indianapolis, IN Ambulance Inquiries for HHW/HIP/HCC claims can be obtained via fax or by phone. Fax # Phone # , ext. 122, ext. 105

37 Your Partners We are YOUR Dedicated Partners in providing CARE to Hoosiers MHS LCP