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

June 18, 2018 4

• 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

June 18, 2018 20

• 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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