how to become a medicare transportation provider in california

Transportation providers who wish to newly enroll in Medi-Cal for NMT will need to submit a completed Medi-Cal Transportation Provider Application package, which includes a “Medi-Cal Medical Transportation Provider Application" form (DHCS 6206), a “Medi-Cal Provider Agreement" form (DHCS 6208) and a “Medi-Cal Disclosure Statement" form (DHCS 6207).

Full Answer

How do I become a Medicare provider in California?

Apply online through the Provider Enrollment, Chain, and Ownership System (PECOS). You must be a federally approved Medicare provider in order to receive approval to accept Medicare payment in the state of California.

What do I need to enroll as a medical transportation provider?

Copies of the Department of Motor Vehicles (DMV) commercial vehicle registration and proof of commercial vehicle insurance must be included. Effective January 1, 2013, applicants requesting enrollment as a Medical Transportation Provider are subject to payment of an application fee upon submission of their application.

How do I get approved by the California Medicare administrative contractors?

Prior to being approved by the state of California Medicare Administrative Contractors, you will need to have completed the process of registering with EDI. Ensure PECOS documentation is sent to the appropriate California Medicare Administrative Contractor (MAC).

How does Medi-Cal transportation work?

Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies. There are two types of transportation for appointments.

Does Medi-Cal pay for transportation to Medi-Cal appointments?

Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies.

Does Medi-Cal reimburse for mileage?

Will Medi-Cal reimburse me for gas/mileage? No. Medi-Cal does not reimburse beneficiaries who drive themselves to their appointments. MCPs may reimburse friends or family members of beneficiaries who drove the beneficiaries to their appointment.

Does Medi-Cal cover Nemt?

Program Coverage Medi-Cal covers ambulance and non-emergency medical transportation (NEMT) only when ordinary public or private conveyance is medically contra-indicated and transportation is required for obtaining needed medical care.

What does it mean to be a Medi-Cal provider?

Medi-Cal is the Medicaid program in California that allows low-income individuals and families who don't have the financial means to obtain health care coverage to gain access to necessary medical and health care providers and services.

How do I start a non emergency medical transportation business in California?

The Step-by-Step Process of Starting a NEMT BusinessRegister your NEMT business. ... Obtain a National Provider Identifier (NPI) ... Apply as a Medicaid provider. ... Get your fleet ready. ... Arrange for commercial insurance. ... Get livery plates for your fleet. ... Apply for a vehicle license (if required)More items...•

Can you charge a Medi-Cal patient cash?

Healthcare providers are prohibited by law from billing people with Medi-Cal for charges not covered by their insurance.

What is a litter van?

Litter Van means a vehicle which is modified, equipped and used for the purpose of providing non- emergency medical transportation for those medical passengers with stable medical conditions who require the use of a litter or gurney, and which is not routinely equipped with the medical equipment or personnel required ...

What is the CPT code for non emergency transportation?

HCPCS codesCodeDescriptionA0100Non-emergency transportation; taxiA0110Non-emergency transportation and bus, intra or inter state carrierA0120Non-emergency transportation: mini-bus, mountain area transports, or other transportation systemsA0130Non-emergency transportation: wheelchair van44 more rows

What is FFS Medi-Cal?

A significant proportion of total Medi-Cal expenditures is generated through the Fee-for-Service (FFS) health care delivery system. FFS providers render services and then submit claims for payment that are adjudicated, processed, and paid (or denied) by the Medi-Cal program's fiscal intermediary.

What are the two types of Medi-Cal?

This guidebook explains the two kinds of Medi-Cal: Regular Medi-Cal and Medi-Cal Health Plans.

Is CalOptima the same as Medi-Cal?

For the fifth year in a row, CalOptima is California's top-rated Medi-Cal plan, according to the NCQA's Medicaid Health Insurance Plan Ratings 2018–2019.

What's the difference between covered California and Medi-Cal?

Medi-Cal offers low-cost or free health coverage to eligible Californian residents with limited income. Covered California is the state's health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it.

How to become a Medicare provider?

Become a Medicare Provider or Supplier 1 You’re a DMEPOS supplier. DMEPOS suppliers should follow the instructions on the Enroll as a DMEPOS Supplier page. 2 You’re an institutional provider. If you’re enrolling a hospital, critical care facility, skilled nursing facility, home health agency, hospice, or other similar institution, you should use the Medicare Enrollment Guide for Institutional Providers.

How long does it take to change your Medicare billing?

To avoid having your Medicare billing privileges revoked, be sure to report the following changes within 30 days: a change in ownership. an adverse legal action. a change in practice location. You must report all other changes within 90 days. If you applied online, you can keep your information up to date in PECOS.

How to get an NPI?

If you already have an NPI, skip this step and proceed to Step 2. NPIs are issued through the National Plan & Provider Enumeration System (NPPES). You can apply for an NPI on the NPPES website.

Do you need to be accredited to participate in CMS surveys?

ii If your institution has obtained accreditation from a CMS-approved accreditation organization, you will not need to participate in State Survey Agency surveys. You must inform the State Survey Agency that your institution is accredited. Accreditation is voluntary; CMS doesn’t require it for Medicare enrollment.

Can you bill Medicare for your services?

You’re a health care provider who wants to bill Medicare for your services and also have the ability to order and certify. You don’t want to bill Medicare for your services, but you do want enroll in Medicare solely to order and certify.

How many one way trips per month for FFS?

If the beneficiary has FFS Medi-Cal, more than eight one-way trips per month requires documentation on the claim form or an attachment stating that the beneficiary required the transportation to obtain necessary Medi-Cal covered services. Some MCPs may require prior approval for NMT. Please check with the MCP.

Do you need a prescription for NMT?

No. NMT does not require a prescription from a licensed provider. However, beneficiaries will need to attest to the provider verbally or in writing that they have an unmet transportation need and all other currently available resources have been reasonably exhausted.

How to set up a ride?

To set up a ride, you can call your health care provider and ask about transportation providers in your area. When you contact the transportation provider, they will ask you for information about your appointment date and time.

What is a FFS and managed care?

In FFS and managed care, licensed, professional medical transportation companies are able to provide NMT and NEMT. In addition, Medi-Cal managed care plans also contract with other transportation providers for these services.

Does Medi-Cal cover transportation?

Medi-Cal offers transportation to and from appointments for services covered by Medi-Cal. This includes transportation to medical, dental, mental health, or substance use disorder appointments, and to pick up prescriptions and medical supplies.

Do you have to verbally let NMT know you have an appointment?

You will need to verbally let them know that you do not have any other way to get to your appointment. Please see the link below for a list of NMT providers in your county. You may contact the NMT provider directly to arrange transportation to your appointments.

How to become a Medicare provider in California?

To become a Medicare provider in the state of California, you must complete an application online at the website for the United States Department of Health and Human Services. The online application process is known as the Provider Enrollment, Chain, and Ownership System (PECOS) and is currently the only way to apply to become a Medicare provider ...

Who can apply for Medicare as a provider?

Learn the types of Medicare. Any physician or non-physician medical care or supply provider who offers services or goods necessary for the physical and mental health of those who receive Medicare coverage are eligible to apply as providers.

How long does it take for a MAC to approve a Medicare application?

Wait for your MAC to send your approval letter. Within 45 to 90 days, you will receive electronic verification from the appropriate MAC letting you know whether your application was accepted or rejected. If you have been approved as a Medicare provider, you will receive a Provider Transaction Access Number (PTAN).

Who approves Medicare Part A and Part B?

In California, Noridian and National Government Services are the MACs who will approve your application. Noridian provides approval for providers of Medicare Part A and Part B as well as DMEPOS suppliers in the state of California.

Does Medicare require licensing?

Medicare relies on state licensing regulations to practice medicine to determine eligibility. In order to be approved as a Medicare provider or supplier, you will need to meet licensure regulations and legal authorizations to practice within the state of California, your county, city, and other local.

Do hospice providers need to complete additional forms?

Home Health and Hospice providers will need to complete additional forms and documentation for vehicles and other items. These will be added to the PECOS application, when you identify as a Home Health or Hospice provider.

Does the ASCA pay Medicare claims electronically?

In addition to requiring documentation to be filed electronically, the ASCA also pays out Medicare claims electronically. Once you have been approved as a Medicare provider by your MAC, complete the EFT form included in their packet. If you did not receive the EFT form, contact your MAC right away.

When did the California Medi-Cal Act become effective?

Provisions of the Drug Medi-Cal Regulation – Informational bulletin summarizing the emergency changes made to the California Code of Regulations, Title 22 effective August 17, 2015, pertaining to the Drug Medi-Cal program.

Is the Medicare application fee changed for 2019?

The Centers for Medicare & Medicaid Services has announced a change in the provider Application Fee for Calendar Year 2019.