Effective July 1, 2023, the Indiana Health Coverage Programs (IHCP) is changing nonemergency medical transportation (NEMT) policy to carve out all NEMT services for Basic Life Support (BLS) and Advanced Life Support (ALS) ambulance transportation from the fee-for-service (FFS) Medicaid NEMT brokerage (see IHCP Bulletin BT202353).
Summary of Changes
All FFS NEMT services for Basic Life Support (BLS) and Advanced Life Support (ALS) ambulance services will be non-brokered services.
NEMT ALS and BLS transports should be scheduled directly with the transportation providers and not arranged through the FFS NEMT broker, Verida (formerly Southeastrans Inc.).
This change applies to all transports for dates of service on or after July 1, 2023.
Existing policies regarding other types of transports are not impacted.
For example, wheelchair van transports provided by Emergency Medical Services (EMS) providers for FFS Medicaid members will continue to be scheduled through Verida after the policy change.
Claim Submission
Ambulance providers should bill the appropriate procedure codes for nonemergency ALS and BLS ambulance services based on the types of medically necessary services provided during the transport. Claims for these nonemergency transports must be submitted to Gainwell Technologies for adjudication for the following codes:
After July 1, 2023, the published rates of reimbursement will apply to these transports, not the rate Verida currently pays the providers.
With nonemergency ALS and BLS carved out of the NEMT brokerage, claims for oxygen during a transport (Procedure Code A0422) can now be submitted to Gainwell on the same claim as the transportation, and the claim process outlined in Provider Bulletin BR202247 is no longer necessary.
Prior Authorization
NEMT ALS and BLS ambulance services may require prior authorization under 405 IAC 5-30-4, such as:
All out of state pick-ups and destination locations, except designated sister cities; and
Interstate transportation or transportation services rendered by a provider located out-of-state in a non-designated area.
Effective July 1, 2023, all prior authorization requests for FFS NEMT ambulance services should be submitted to Kepro, the IHCP’s new FFS prior authorization and utilization management (PA-UM) vendor for the IHCP nonpharmacy services also beginning July 1, 2023.
IHCP bulletin BT202339 includes information on accessing Kepro’s provider portal, Atrezzo, and lists provider training sessions dates.
Federal and State Requirements
Federal regulations state that transportation includes expenses for transportation (e.g., NEMT) and other related travel expenses determined to be necessary by the State Medicaid agency to secure medical examinations and treatment for a beneficiary (42 CFR § 440.170). Indiana Administrative Code requires that transportation services provided be the least expensive form of available transportation that meets the medical needs of the member. Providers must bill all transportation services according to the level of service rendered and not according to the provider’s level of response or vehicle type. (405 IAC 5-30-1). The level of services rendered must be based on the medical condition of the member being transported and properly documented as such. As always, State and federal audits will be conducted to ensure program integrity.
What can ambulance transportation providers do now to prepare for the policy change?
Indiana Medicaid has many members that reside in their home and require ambulance transports to care and services. If you are transporting these members today, please feel free to discuss the changes with them so you can work together to ensure their access continues. It is important that we all work to ensure member access to nonemergency ambulance transportation is successful with these changes. If you have a contract to serve nursing facilities, please reach out to them now to discuss how to ensure you are able to continue transporting their members with ease. This may include amending a current contract.
For more information
Please register for IHCP webinars at on June 8, 2023 and June 12, 2023 at https://www.in.gov/medicaid/providers/provider-education/ihcp-live/. Recordings of these webinars will be posted on this site.