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NETSPAP Training for Dialysis and NET Providers . Revised 11/17/08. 1. NETSPAP . N on- E mergency T ransportation S ervices P rior A pproval P rogram — NETSPAP

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netspap
NETSPAP

Non-Emergency Transportation Services Prior Approval Program— NETSPAP

  • As the single state Medicaid agency, HFS must ensure that reimbursement of non-emergency transportation meets federal guidelines.
  • NETSPAP allows HFS to maintain standards and controls necessary to comply with federal requirements.
  • Effective mechanism in preventing fraud and abuse.

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netspap3
NETSPAP
  • HFS contracts with First Transit to administer NETSPAP.
  • In performing this function, First Transit follows HFS’ policies for non-emergency transportation.
  • First Transit does not provide or arrange transportation services for HFS participants.
  • First Transit does not handle billing related questions or concerns.

3

training objectives
TRAINING OBJECTIVES
  • Provide overview of NETSPAP.
  • Review Post Approval Process.
  • Review Random Provider Selection Process.
  • Announce NETSPAP roll-out for long term care facilities.
  • Review changes to the Standing Prior Approval Process.
  • Review changes made to the NETSPAP Single Trip and Standing Prior Approval Form.
  • Provide overview of passPORT system.

4

netspap overview
NETSPAP OVERVIEW

In order for First Transit to approve a request for non-emergency transportatation, the following criteria must be met:

  • The participant has an appointment scheduled for a covered medical service, and
  • The participant is being transported to the closest appropriate medical provider, and
  • The Category of Service being requested is at the appropriate levelnecessary to meet the participant’s medical needsi.e. service car and medicar.

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netspap overview6
NETSPAP OVERVIEW
  • Examples for covered medical services include: doctor appointments, hospital admission or discharge, X-rays, lab work, chiropractic care, physical therapy, chemotherapy, radiation services, behavioral health services, outpatient surgery and dental appointments.
  • Examples of non-covered medical services include: acupuncture, prescription drop off or pick-up, SSI evaluations, wheelchair repair or pickup, methadone pickup or treatment, smoking cessation and day treatment programs.

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netspap overview7
NETSPAP OVERVIEW

Prior to contacting First Transit you should have the following information:

  • The participant’s Recipient Identification Number (RIN).
  • The participant’s date of birth.
  • Date and time of the medical appointment.
  • Information about the medical appointment (i.e. the type of services that the participant will receive).
  • Information about the medical provider. Must have correctly spelled doctor’s name or facility, the medical provider address, the most direct telephone number.
  • Information for the Transportation Screening. (i.e. Is the participant able to step into a regular car? Are they wheelchair bound?, etc.)
  • The participant’s appropriate Category of Service.(i.e. Service Car, Medicar, Non-emergency Ambulance)
  • The NET Provider information.

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netspap overview8
NETSPAP OVERVIEW

Once all information is gathered, three ways to request prior approval from First Transit:

  • First Transit’s Online System - passPORT
  • Fax or Mail
  • Telephone

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netspap overview9
NETSPAP OVERVIEW

Important to remember:

  • Whether requesting transportation through PassPORT, by phone, fax or mail, the requestor must give ALL INFORMATION requested on the NETSPAP Single Trip Form/Standing Prior Approval Form or by the Customer Service Representative.
  • All forms submitted to First Transit must be complete, accurate and legible. Incomplete forms will be returned.

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netspap overview10
NETSPAP OVERVIEW
  • Routine requests are usually processed within 2 business days.
  • Non-routine requests may take up to 5 business days to process. Some medical services must be validated by the Transportation Review Unit (TRU) in order for First Transit to determine whether the request for transportation is approvable or not.

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netspap overview11
NETSPAP OVERVIEW

Non-routine requests include:

  • Transport by non-emergency ambulance (prior and post approval)
  • Behavioral Health Services
  • Standing Prior Approval (SPA) Overrides
  • Long Distance Trips

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netspap overview12
NETSPAP OVERVIEW

If First Transit approves the request:

  • The NET Provider and the participant must coordinate the pick-up and drop-off times.
  • The NET Provider will need to obtain the Request Tracking Number (RTN) prior to transporting the participant.

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netspap overview13
NETSPAP OVERVIEW

If First Transit denies the request:

  • HFS will not pay for the transport.
  • The NET Provider should not transport the participant.
  • Alternate transportation must be arranged for the participant.

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netspap overview14
NETSPAP OVERVIEW

Common denial reasons, include:

  • Medical service is not covered by HFS.
  • Participant not eligible on date of service.
  • Post Approval was requested too late.
  • Unable to validate medical appointment.
  • Additional information requested was not received timely.
  • Closest appropriate medical provider is not being used.
  • Inappropriate Category of Service.

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post approval process
POST APPROVAL PROCESS
  • Post approval requests must be submitted to First Transit no later than 20 business days after the transportation service is rendered.
  • Post approval requests will only be approved if there are extenuating circumstances, such as:
    • Transport took place after First Transit’s operating hours.
    • Transport was of an urgent nature and prior approval would have unnecessarily delayed the medical service being rendered.
  • If prior approval could have been obtained before the transport occurred, the post approval will be denied.

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post approval process16
POST APPROVAL PROCESS

Two exceptions to the 20 business day requirement for requesting post approval:

  • Patient’s Medical Assistance or All Kids application has been submitted to Department of Human Services, but approval of the application has not been issued as of the date of service. Post approval must be requested no later than 90 calendar days following the date on the Agency’s Notice of Decision approving the application.
  • The participant did not inform the provider of eligibility for Medical Assistance or All Kids. Post approval must be requested no later than six (6) months following the date of service. Must provide documentation that provider has attempted to collect from the participant.

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random provider selection
RANDOM PROVIDER SELECTION
  • When a participant does not have a preferred NET Provider, First Transit offers information from a random selection of NET Providers that have agreed to transport participants in a particular area, at the NET Provider’s established rate.
  • To update your NET Provider service areas for the random selection process, take a few minutes to complete a form before you leave today.

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netspap long term care facilities
NETSPAP - Long Term Care Facilities
  • For dates of service on or after October 1, 2007, non-emergency services for residents of Long Term Care (LTC) Facilities require prior approval.
  • In August 2007, First Transit completed 3 weeks of training for LTC facilities, Dialysis Providers, and NET Providers throughout the state.
  • If prior approval is not obtained, the NET Provider will not be paid for their services rendered to LTC residents on or after October 1st.

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single trips
SINGLE TRIPS

Participants, Medical providers, LTC providers

and NET Providers can submit requests for

single trips.

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single trip form
SINGLE TRIP FORM

ADDITIONS TO THE SINGLE TRIP FORM INCLUDE:

  • Long Term Care Information
  • NET Provider Phone Number
  • Fixed Route (Bus/Train)

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single trip form22
SINGLE TRIP FORM

Addition of LTC Information

  • If applicable, select the type of Long Term Care Facility on the Form
    • Resident of Nursing Facility (NF)
    • Resident of Inter. Care Facility (ICF/DD – ICF/MR)
    • Resident of Supportive Living Facility (SLF)
  • If the participant resides in a nursing home, check ‘Resident of Nursing Facility (NF)

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single trip form addition of the net phone number
SINGLE TRIP FORMAddition of the NET Phone Number
  • Useful in selecting the correct NET Provider when there is more than one NET Provider with a similar name.

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single trip form addition of fixed route as a new type of category of service
SINGLE TRIP FORMAddition of Fixed Route as a New Type of Category of Service
  • Fixed Route (Bus/Train)

NOTE: The Category of Service must be the MOST ECONOMICALLY FEASIBLE TRANSPORTATION able to meet the participant’s medical needs.

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new policy for standing prior approvals
NEW POLICY FORSTANDING PRIOR APPROVALS

On October 5, 2007, a new standing prior approval

policy was implemented by HFS. In the new policy:

  • Standing Prior Approvals (SPAs) can be requested by anyone, not just the direct service provider.
  • All SPAs can be approved up to 6 months.
  • All initial SPAs must be validated to ensure that the transport is for the appropriate category of service, the correct number of trips per week, that the trips are for a covered service, and that attendants are medically necessary.

26

standing prior approval form has 6 main sections
STANDING PRIOR APPROVAL FORMHas 6 Main Sections
  • Requesting organization information
  • Participant information
  • Trip information
  • Non-Emergency Transportation (NET) Provider information
  • Category of Service
  • Explanation of primary & secondary diagnosis (reason for trip)

27

slide28
Two sections on the NETSPAP

Standing Prior Approval Form are

different from the NETSPAP Single

Prior Approval Form:

  • Trip information
  • Explanation of primary & secondary diagnosis (reason for trip)

28

standing prior approval form trip information
STANDING PRIOR APPROVAL FORMTrip Information

All Standing Prior Approval Medical Service that can be approved up to 6 months. The Beginning and End Dates, the Appointment Days, and the total trips per week must be written on the form.

29

standing prior approval form reason for trip
STANDING PRIOR APPROVAL FORMReason for Trip

The Reason for Trip, the Primary and Secondary Diagnosis, and all other pertinent information about the medical treatment must be detailed in this section.

30

standing prior approval form signature of the requesting person
STANDING PRIOR APPROVAL FORMSignature of the Requesting Person

The person requesting the Standing Prior Approval must certify under penalty of perjury that the Standing Prior Approval Form is correct.

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slide32

www.NETSPAP.COM

Single Trip Forms, Standing Prior

Approval Forms, and Certificates of Transportation Services can be downloaded from First Transit’s website www.NETSPAP.com.

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new procedure dialysis centers will receive renewal letters
NEW PROCEDUREDialysis Centers will Receive Renewal Letters

When the final month of the

Standing Prior Approvals

begins (that were

submitted on or after

October 1, 2007), First

Transit will send a letter

to the dialysis center.

34

slide35
NEW PROCEDUREThe Dialysis Center can return the letter to First Transit to continue the dialysis transportation.
  • Instead of completing a new standing prior approval for a time period of six months, the dialysis center only has to sign the letter to renew the Standing Prior Approval for a period equal to the previous Standing Prior Approval period.
  • This renewal process may be repeated as needed.
  • The SPA can be renewed through passPORT.

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slide36

SPA CHANGES

If there are any changes to a Standing Prior

Approval (SPA), a new SPA must be

submitted.

Examples of Changes that require a new SPA

  • Upgrades or downgrades to Category of Service (i.e. upgrade from a medicar to an ambulance).
  • Addition of a non-employee or employee attendant.
  • Changes to number of trips required per week.
  • Changes in the origin and destination addresses.

36

4 step process to obtain prior approval for net services remember these 4 steps
4 Step ProcessTo obtain prior approval for NET services remember these 4 Steps:

Step 1: Gather all information

Step 2: Contact First Transit –

On-line Fax Mail or Phone

Step 3: Wait for First Transit’s decision

Step 4: Coordinate the NET services with the Participant

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slide38
Q & A

Question and Answer Session

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slide39

passPORT

First Transit’s On-Line System

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first transit s online system s
FIRST TRANSIT’sOnline System’s

passPORT’s Features

  • NET Providers and Dialysis Providers may submit Single Trip requests.
  • NET Providers and Dialysis Providers may access trip information.
  • NET Providers and Dialysis Providers can receive authorization information.
  • Dialysis Providers may submit SPA requests.
  • Dialysis Providers may receive and submit SPA renewal letters.
  • NET Providers and Dialysis Providers do not have to wait to receive paper authorization through the mail.

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slide44

REQUESTING A USER NAMENET and Dialysis Providers will be required to enter a Medicaid Provider ID before submitting a request.

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slide49
RENEWAL AVAILABLE ONLINEDialysis Center will also be able to renew the Standing Prior Approval via First Transit’s Online System

49

first transit s online system s51
FIRST TRANSIT’sOnline System’s

passPORT Advantages

  • Available 24 hours a day – 7 days a week.
  • Unlimited inquiries and transactions.
  • Easy to organize and access participant information.
  • More efficient time management - no waiting to talk to a Customer Service Representative.

51

slide52
Q & A

Question and Answer Session

52