Apple Health - Mileage Limits Increase for Ambulance Providers

Washington State Health Care Authority sent this bulletin at 04/03/2019 01:44 PM PDT

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Apple Health (Medicaid) Provider Alert

What is changing?

Effective for claims with dates of service on and after May 3, 2019, the mileage limit for ambulance providers increases from 100 miles to 250 miles. This change means that the agency no longer requires a trip report/run sheet attached to the claim for some trips.

What does this mean for providers?

Effective for dates of service on and after May 3, 2019, provider documentation requirements will change as follows:

If a one-way trip is less than 250 miles, providers are not required to submit a trip report/run sheet with their claim.
If a one-way trip is greater than or equal to 250 miles, providers must submit a trip report/run sheet with their claim.

What happens if providers do not include a required trip report/run sheet with their claim?

If providers do not include the trip reports/run sheets when required, the agency will not pay for these trips.

The agency requires that the provider must take the patient to the closest and most appropriate facility, and a 250-mile trip or longer is not the closest. The agency requires a trip report/run sheet to document the medical necessity for the additional mileage.

Does this change effect all types of ambulance trips?

No. The documentation requirements for the following trips remain unchanged:

Round/multiple trips for the same client in the same day
Behavioral health (Involuntary Treatment Act)

Providers must continue to submit a trip report/run sheet for these claims.

Who do I contact if I have questions?

For more information, contact Shauna James, Ambulance & ITA Program Manager.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than two million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Apple Health - Mileage Limits Increase for Ambulance Providers

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination