FAQs for Non-Emergency Transportation

What does AHCCCS cover for Non-Emergency Transportation?
AHCCCS covers medically necessary non-emergency ground and air transportation to and from a required medical service for most recipients. Non-emergency transportation is not covered for Federal Emergency Services (FES) Members.

How do Non-Emergency Transportation Providers Bill?
Non-emergency transportation providers must bill the number of trips and the number of loaded miles as units of service on the CMS 1500 claim form. Loaded mileage is defined as the distance traveled, measured in statute miles, with a recipient on board the vehicle and being transported to receive medically necessary covered services.

Here is the link for online claims submission:
https://azweb.statemedicaid.us/Home.asp

If multiple transports are authorized for the same day, providers must bill the second trip (and any subsequent trips) as follows:

  • Two units of the authorized base rate should be billed on Line 1 of the claim form.
  • The total mileage for both trips should be billed on Line 2.

When does Non-Emergency Transportation require Prior Authorization?

Roundtrip Ground Transportation over 100 miles

  • Non-emergency ground roundtrip transportation of 100 miles or less WILL NOT require Prior Authorization for services rendered June 1, 2006 and after.
  • Providers may bill without obtaining prior authorization as long as the total mileage billed on any one CMS 1500 (837P for electronic claims) does not exceed 100 miles.

Roundtrip transports OVER 100 miles will continue to require authorization from either the AHCCCS Prior Authorization (acute care recipients) or a case manager (ALTCS recipients). Only codes for base and mileage will be authorized, unless billed by an IHS or Tribally Operated 638 Provider.

Prior Authorization requests for Fee For Service Acute Care recipients should be entered online at https://azweb.statemedicaid.us/Home.asp

How do Providers know where to submit claims?

Non-IHS/638, if billing for an Acute NEMT service Bill the appropriate health plan.
IHS/638, if billing for Acute NEMT service Bill AHCCCS.
Non-IHS billing for an ALTCS NEMT service Bill the appropriate health plan.
IHS/638, if billing for ALTCS NEMT service Bill AHCCCS.
Behavioral Health for NEMT service Bill the appropriate TRBHA/RBHA.
Tribal ALTCS for NEMT service Bill AHCCCS.

 

What documentation must NEMT Providers maintain?
AHCCCS will conduct retrospective audits of non-emergency ground transportation providers to verify that the mileage, medical condition, and specific location are correct and justifiable. AHCCCS recommends documentation of the member’s current medical concern and specific medical service to which member is being transported.

Where can you go for answers to further questions regarding Non-Emergency Transportation?

Online Claims Submission

FFS Billing Manual, Chapter 14

IHS Billing Manual, Chapter 11