CSH Presentation on Travel Services - Conduent · CSH Presentation on Travel Services . Revised...
Transcript of CSH Presentation on Travel Services - Conduent · CSH Presentation on Travel Services . Revised...
Conduent – Wyoming Medicaid
CSH Presentation on Travel Services Revised June 2018
2 June 18, 2018
Topics • Requirements for eligibility
• Per diem policy
• Timeline
• Emergency Travel
• How it all works
3 June 18, 2018
Topics • Reasons for processing delays
• Scenarios/examples
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• Client must be eligible for date of service (DOS)
• Client must be eligible under covered plan
• Provider/facility enrolled/active for DOS
Requirements for Eligibility
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• CSH Authorization Form
– Only required if travel is outside Medicaid policy – Public Health Nurse (PHN) will contact CSH for approval
• CSH can make exceptions to Medicaid policy in special circumstances – PHN contacts CSH, CSH contacts Transportation Call Center
Requirements for Eligibility - CSH
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Requirements for Eligibility – Covered Plans
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• Client under 21 years of age
• Mileage over 400 miles round-trip
• Exceptions: – Mileage over 150 miles with multiple appointments on consecutive days – Client is inpatient
Requirements for Eligibility – Per Diem
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• Number of nights & reimbursement determined by:
– Consecutive appointment dates – Inpatient vs. outpatient – Enrolled lodging provider vs. hotel/family/friend – Round trip distance
Requirements for Eligibility – Per Diem
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• Enrolled Lodging Providers:
– Ronald McDonald House (Denver/Aurora) – Brent’s Place (Billings, MT)
• Non-Enrolled Lodging:
– Any hotel not enrolled as Medicaid provider – Family or friend with whom client is staying for travel/appointment dates
Lodging – Enrolled vs. Non-Enrolled
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• Must be reported prior to or within 30 days after appointment
• Once reported, client has 1 year to return for processing
• Travel Authorization Confirmation (TAC) will be returned if not complete
– Appointment verification with authentic signature, or indicate electronically signed – Verification for overnight stay – Vendor Management Form/W9
Timeline for Travel Requests
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• Transportation provider must be enrolled
• Minimum of 24-hour notice for taxis
• Travel may be in-town or out-of-area
Taxi/Shuttle Requests
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• TI Shuttle (Cheyenne)
• Sheridan Mini-Bus
• Ark Regional Services (Laramie)
• Best Home Health (Evanston)
• Wind River Family & Community Health Care (Arapahoe)
• Northern Arapaho Tribal Health
Taxi/Shuttle Requests – Enrolled Providers
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• Airfare must be purchased by the State
• Rental car not eligible for assistance/reimbursement
Air Travel/Rental Car
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• Clients may be eligible regardless of CSH enrollment
• Limit of one request per 30 days per client
• Criteria must be met:
– Provider must be enrolled and active – Reimbursement total must exceed $100.00 – Appointment must be verified
Emergency Travel
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• If Transportation Call Center/CSH approves emergency travel:
– Check will be sent to PHN by CSH via FedEx – PHN distributes check to client/guardian
Emergency Travel
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• Please note:
– If the requested travel does not meet Medicaid guidelines and the client is eligible for a CSH program, the Travel Center will suggest they contact their PHN to request approval from CSH.
Emergency Travel
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• Client calls in request
• Team member enters request in transportation database
How It All Works
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• Paperwork sent every Thursday
– TAC Confirmation – Instruction Sheet – VMF/W9 if applicable
• Client returns with all documentation
• Processed within two business days
• QA’d and sent for payment within 30 days
How It All Works
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• From the Web Portal, clients are able to:
– Request transportation reimbursement for private car use – Check status of requests initiated online – Access transportation assistance manual (also available in Spanish) – Other self-service options
How It All Works - Web Portal
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• TAC not signed/dated
• Missing appointment verification/lodging receipts
• Verification does not state electronically signed
• Vendor Management Form/W9 incomplete
Reasons For Processing Delays
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Example #1:
• Client is 45 years old
• Driving to appointment from Douglas to Casper
• Full coverage plan eligible for travel
• Provider is active
Examples & Scenarios
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Example #1 process:
• Submit travel request
• Process once proper documentation is received after appointment
Examples & Scenarios
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Example #2:
• Client 15 years old, eligible under current plan
• Appointment took place March 3
• Called to request reimbursement May 26
Examples & Scenarios
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Example #2 process:
• 30 day limit for request passed
• Unable to process request
Examples & Scenarios
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Example #3:
• Client is 15 years old, under eligible plan
• Client lives in Basin, requires medically necessary surgery
• Referred to Children’s Hospital Aurora
• Parent does not have vehicle, requesting airfare
Examples & Scenarios
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Example #3 process:
• Letter of medical necessity must be received to proceed
• Transportation Call Center gathers travel information, submits to State for approval
• Once approved, State purchases ticket(s)
• Lodging reimbursement approved on per case basis
Examples & Scenarios
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Example #4:
• Adult client residing in Sheridan
• Client has dialysis appointments three days per week locally
• Does not have reliable transportation
Examples & Scenarios
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Example #4 process:
• Client calls Transportation Call Center to report travel through Sheridan Mini-Bus
• Client must have provider name and address available
• Call Center Agent provides TAC number
• Client calls transportation provider, gives TAC for scheduling & billing
Examples & Scenarios
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Example #5:
• Client in Cheyenne has appointment downtown
• Needs a ride to and from appointment
• No reliable transportation
Examples & Scenarios
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Example #5 process:
• Client calls Transportation Call Center to request taxi through TI Shuttle
• Client must have provider name and address available
• Taxi requests are reported twice daily by Transportation Call Center
• 24 hour notice minimum required
Examples & Scenarios
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Client Relations: (800) 251-1269
Transportation Services: (800) 595-0011
CSC (Eligibility): (855) 294-2127, options 1, 3, 2
Provider Relations: (800) 251-1268
http://wymedicaid.portal.conduent.com
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