As of January 1st, Kentucky has a new Medicaid HMO, this is UHC Community Plan of KY. UHC Community Plan of KY requires prior authorization through ModivCare (formerly Logisticare). In addition to this, ModivCare is the broker for Caresource Medicare HMO. Without prior authorization for any non-emergency transport with UHC Community Plan of KY or Caresource Medicare HMO, there is no means for reimbursement. To be eligible for reimbursement you MUST be a contracted transportation provider with ModivCare.
It is our understanding that KAPA is fighting this but that does not mean they will get this requirement changed. At this time, it is our opinion that you should become a contracted transportation provider with ModivCare to avoid interruption in reimbursement. We have contacted ModivCare and asked multiple questions to give you a feeling of what to expect.
The greatest downfall to their process that we see, is that it relies on the sending facility to arrange the transport through ModivCare directly. They will not be able to request the service directly from the provider. If they do, it will be the responsibility of the provider to decline transport without the prior authorization before transport.
The greatest advantage that we see, is the reimbursement structure that we have seen will result in payment much higher than the current Medicaid Non-Emergency transport fee schedule.
According to Laura Watkins at ModivCare, they have been reaching out to providers to provide education and to attempt to contract.
Attached is documentation that we have secured, which can be used for review of what their contract details. It is imperative however that you contact ModivCare directly to begin the contracting process and avoid lost reimbursement if you provide non-emergency transports to anyone with these Medicare and Medicaid components.
Q&A with MCA and Laura Watkins at ModivCare (formerly Logisticare)
Q: The insurance plans that require authorization through Logisticare
A: UHC Medicaid and Caresource Medicare
Q: The population of Kentucky that this effects geographically
A: This is not a large plan. We do not have exact counts but the trip volume is expected to be low.
Q: The plan for education to the facilities
A: Outreach was done through UHC
Q: Standard contract conditions
A: I have attached a contract for you to review
Q: Are you accepting the companies State License in placement of inspections for credentialing
Q: Rate structure (is there one for Medicare components and one for Medicaid, a blend, and is the rate negotiable)
A: Rates are based on Medicaid and Medicare allowable rates
Q: Documentation requirements
A: Full contract, certificate of insurance to meet LogistiCare requirements, Workers’ compensation
Q: Billing requirements
A: Providers cannot bill without an executed contract
Q: Process for billing when insurance discovery takes place after transport happens
A: See above
Q: Notification of trips, how does this take place, some of the providers have contracts with facilities, will they remain the preferred provider
A1: Trip Notification
- Members/Facilities must call ModivCare to schedule a reservation with proper notice
- ModivCare’s customer advocate team will reach out to the providers to schedule the trip
- Hospital discharges/urgent appointments are handled same day
A2: Facility contracts – There is a questionnaire included with the contract documents where the providers can list the facilities they are contracted with – these will be first calls
Q: We also have clients in bordering states, how will this affect them? Will they need to contract as well?
A: If they provide transport to covered NEMT services to members with UHC Medicaid or Caresource Medicare in Kentucky then they will need to be contracted to receive payment
Q: Will an authorization be required on hospital to hospital transfers?
A: Hospital to hospital transfers are generally a non-covered service
Q: We also have some clients that provide wheelchair van services in addition to ambulance transportation. Will it be the same requirements for the wheelchair van services?
A: Providers with wheelchair van service would go through the same process – we would need to add wheelchair rates to their contract
Q: Anytime there is change there is concern. The largest concern that providers should have, even once contracted, is that they will need to rely on the facility owning the process. By this I mean, in a perfect scenario, when a patient has “x” plan, the facility would contact Logisticare, who then would arrange transportation with a contracted provider. When currently what they know is that they need to free up the bed in the ER ASAP, or someone forgot to arrange transportation and the patient has been discharged so they need someone right now, or the person trying to clear the bed has no clue who the insurance provider is, in each of these scenarios they call who they know and as the ems provider they show up and do the transport. The difference now will be that they will not be reimbursed for their services. Right now providers are taking such a hit financially and have been since the whole pandemic began. They can not afford to absorb an additional loss on top of it. What is the recourse when this happens? Who is responsible for the facility outreach? Is there any backing in place in the form of legislation to hold facilities responsible? I understand that this may be something that you are unable to answer yourself but maybe you could let me know who we may be able to talk to regarding those concerns.
A: Facility outreach was done by UHC. We are working to adopt policies used in other networks if there is pushback with facilities about scheduling for discharges and we will have more info to come soon.
Contacts at ModivCare:
Manager, Provider Relations