Need A RIDE?

Presented by Melvin ThomasManager Transportation

IHCP Annual 2010

APP0045 (09/10)

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MDwise Transportation

Transportation Calls

Verifying Member Eligibility for Transportation

Scheduling

Authorization Process

Audit Process

Payment Process

How we Find Vendors

Changes Going forward

Question and Answer

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Transportation Calls

MDwise Customer Service receives incoming calls from MDwise members, who are in need of a ride to a medical appointment.

MDwise routinely conducts member education to communicate this benefit as well as its limitations.

MDwise encourages its members to use their trips wisely, and to always look to a family member or a friend before calling us. This helps them to save the trips that they have for when they really need them.

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Verifying Member Eligibility for Transportation

Before MDwise schedules transportation for a caller, representatives make sure that the person is an eligible MDwise member. We do this through our member eligibility database.

MDwise covers transportation for Package A, B, and P members. Package C members are only covered for emergency ambulance transportation, and a co-pay of $10.00 will apply.

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Scheduling

Transportation services are provided in the most appropriate, cost effective manner that meets the medical needs of the member. The member’s physical, mental or medical condition will often dictate the appropriate mode of transportation.

Members must call MDwise Customer Service to schedule appointments by 4:00 p.m. on the business day before their appointment. For urgent care, the member’s PMP or PMP office staff must call the MDwise Customer Service Department for same day transportation (Urgent Care).

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Scheduling

Although members may schedule transportation visits up to one business day in advance of a scheduled appointment, members are encouraged to contact MDwise when their appointment is scheduled, so that if appropriate, bus passes may be mailed to the member.

When a MDwise member is able to phone us in advance, MDwise offers bus passes that will cover their transportation to and from the doctor, plus give them extra trips to go to additional doctor appointments, to the pharmacy or other important places of the member’s choice.

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Scheduling

A MDwise Customer Service representative gathers pertinent information from the member to include correct address for pick-up, current phone number, doctor name, doctor location, etc.

This information is entered into the MDwise Transportation database.

For urgent care, after MDwise customer service receives a call from the member’s PMP or PMP office staff, we will fax the transportation vendor a trip sheet with all the pertinent information to transport the member that same day.

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Scheduling

MDwise Transportation is a department within MDwise Customer Service. A Transportation Specialist checks each entry, assigns the trip to an available vendor and then generates a schedule for the next day. These schedules are distributed daily to each of the vendors as well as our Customer Service representatives and the MDwise after hours phone service.

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Authorization ProcessMDwise covers 20 one-way rides for a rolling 12-month period.

MDwise Medical Management must authorize all trips that are fifty miles or more one way, airline, air ambulance, and transportation services to a medical provider located out-of-state.

MDwise Medical Management also authorizes rides for member who have exceeded their 20 trip limit.

MDwise Medical Management has 48 hours to make a determination and approve or deny the request.

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Audit Process

Each month, MDwise reconciles all trip invoices submitted by vendor.

MDwise makes random calls to provider offices to confirm that appointments are in fact scheduled prior to scheduling the trip.

MDwise compares the mileage on vendor invoices to the mileage on mapping software, for the same location.

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Audit Process

MDwise documents all transportation complaints that are received from members and providers. These are tracked and trended by vendor. Vendors are contacted to determine corrective action when necessary.

MDwise also conducts on-site audits and reviews with contracted transportation vendors. During these on-site visits, the vendor will make all records, meeting minutes, forms, statements and other information reasonably pertaining to its performance, on a selected or sample basis as requested, available to MDwise and the State.

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Payment Process

Scheduled trips for MDwise members are faxed or put on the vendors personal FTP site to transportation providers daily (in the evening) for the next day’s scheduled trips.

On the day following the provided transportation services, the transportation provider will fax that same schedule information back to MDwise with the mileage and cost of the trip.

MDwise expects invoices from the transportation providers for trips from the 1st to the 15th by the 22nd of that same month and for trips from the 16th to the 30th or 31st of the month, by the 10th of the next month.

Once MDwise receives invoices, they are reconciled and paid.

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How We Find Vendors

When MDwise expands into a new area, local transportation vendors are contacted and meetings are set up to inform them about MDwise, and what transportation providers MDwise is looking for.

The provider must have a Medicaid IHCP number to provide transportation services for MDwise members.

If a provider calls MDwise directly, a contact name, address, phone, fax, and information about the company is requested. As transportation providers are needed, MDwise will contact vendors to set up a meeting to discuss potential provision of transportation services.

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Question and Answer

Q & A

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MDwise Transportation