Wyoming Medicaid Ambulance Services Presentation 8.17.15

30 Pages·2015·0.41 MB·English

by  D. Olson

Wyoming Trauma
Conference

Wyoming Medicaid
Ambulance Services

August 22, 2015

Presenters: K ilee Thom pson and Melissa Da vis, Field Represen tatives
CMS-1500 Provider Manual
 Located on the Wyoming Medicaid Website
o http://wymedicaid.acs-inc.com
o Select Provider
o Select Provider Manuals and Bulletins (Navigation Bar on Left)
o Select Ambulance Services within the CMS-1500 Provider Manual
and Bulletins section
o Select CMS-1500 Provider Manual
o Review for New/Updated Information
Important Policy Changes/Additions section

CMS-1500 Provider Bulletins section

o Additional Links section
Medicaid and State Healthcare Benefit Plans

NDC Crosswalk

Carrier Code List

2 August 18, 2015
CMS-1500 Provider Manual
General Information
Chapters 2 – 9
Contains general Wyoming Medicaid Policy that relates to all providers
that bill with the CMS-1500 Claim Form or submit an 837P claims
transaction
o Chapter 2 – Getting Help When You Need It
Contains phone numbers and websites

o Chapter 3 – Provider Responsibilities
Enrollment

When to bill a client

When NOT to bill a client

Record keeping requirements

3 August 18, 2015
CMS-1500 Provider Manual
General Information
Chapters 2 – 9
(continued)

o Chapter 4 – Utilization Review
Review of claims and state/fiscal agent access to records

Fraud and abuse, and how to report


o Chapter 5 – Client Eligibility
Types of eligibility

Importance of client identification

Eligibility verification

4 August 18, 2015
CMS-1500 Provider Manual
General Information
Chapters 2 – 9
(continued)
o Chapter 6 – Common Billing Information
Basic claim information

Completing the claim form & examples

Cap limits

Co-payments

Prior authorization

Electronic claims with attachments

Remittance Advices

Adjusting claims

Timely filing

Failure to notify providers of eligibility


5 August 18, 2015
CMS-1500 Provider Manual
General Information
Chapters 2 – 9
(continued)

o Chapter 7 – Third Party Liability
Dealing with other insurance


o Chapter 8 – Electronic Data Interchange (EDI)
Wyoming Medicaid electronic services

Registering for the Secured Provider Web Portal


o Chapter 9 – Wyoming Specific HIPAA 5010 Electronic
Specifications
Wyoming Medicaid specific electronic billing and transaction

requirements
6 August 18, 2015
CMS-1500 Provider Manual
Covered Services
Chapter 10 – Covered Services

Section 10.5 – Ambulance Services
o
Covered services and billing requirements specific to ambulance
services
Wyoming Medicaid covers services provided by independent

ambulances or hospital-based ambulances
Both ground and air transports, with medical intervention, to the nearest

appropriate facility are covered
All services provided must be medically necessary


7 August 18, 2015
Emergency Transportation
 Medicaid covers both Basic Life Support or
Advanced Life support if:
A medical emergency exists in that the use of any
o
other method of transportation could endanger the
health of the patient AND
The patient is transported to the nearest appropriate
o
facility AND
The destination is an acute care hospital were the
o
patient is admitted as an inpatient or outpatient

8 August 18, 2015
Emergency Transportation
Medical Emergencies are considered to exist

under any of the following circumstances:
An emergency situation, due to an accident, injury, or acute illness
o
Restraints are required to transport the patient
o
The patient is unconscious or in shock
o
Immobilization is required due to a fracture or the possibility of a
o
fracture
The patient is experiencing symptoms of myocardial infarction or
o
acute stroke
The patient is experiencing severe hemorrhaging
o
9 August 18, 2015
Non-Emergency Transportation
Covered when any other mode of transportation would

endanger the health or life of a client & at least one of the
following criteria is met:
Continuous dependence on oxygen
o
Continuous confinement to bed
o
Cardiac disease resulting in the inability to perform any physical activity
o
without discomfort
Receiving intravenous treatment
o
Heavily sedated
o
Comatose
o
Post pneumo/encephalogram, myelogram, spinal tap, or cardiac
o
catheterization
Hip spicas and other casts that prevent flexion at the hip
o
Requirement for isolette in perinatal period
o
State of unconsciousness or semi-consciousness
o

10 August 18, 2015