Covered and Noncovered Services : Covered Services and Requirements

Requesting Non-Emergency Medical Transportation Services

Members or providers should have the following information available when calling the NEMT manager contracted with the Wisconsin DHS to request NEMT services:

• Member's full name, home address, and telephone number
• ForwardHealth ID number
• The pick-up address with zip code and the telephone number at which the member may be reached
• Name, telephone number, address, and zip code of the Medicaid-enrolled provider
• Appointment time and date
• The end time of the appointment, if available
• Any special transportation needs (for example, if the member needs someone else to ride with them, if the member requires life support services, or if the member requires transport in a supine position)
• General reason for the appointment (doctor's visit, checkup, eye appointment, etc.)

A member or provider who calls to schedule a ride and does not have all of this information may not be able to schedule a ride and may have to call the NEMT manager back.

For NEMT requiring life support services, the medical provider arranging the transportation must fax a copy of the prescription from the physician, physician assistant, or nurse practitioner to the NEMT manager.

For members eligible to receive a ride through the NEMT manager to their covered appointments, the NEMT manager is required to schedule the least costly type of ride that meets the member's medical and transportation needs per 42 C.F.R. § 447.200.

At the end of the call, the NEMT manager will give the caller information about the ride. If the member is taking the bus, the NEMT manager will explain how they will mail the bus ticket or pass. For members getting picked up, the NEMT manager will notify the caller of the name of the transportation provider who will be picking the member up and when the member should be ready for their ride. The transportation provider will call the member the day before the appointment to confirm the ride, including the time the member is scheduled to be picked up for their appointment.

Health care facilities can also access a dedicated portal to quickly book and manage rides for members. This portal can be used for one or multiple facilities, is accessible via web browsers, and does not require any software installation. For more information and to sign up for a demonstration, go to mtm-inc.net/wisconsin.

Note: The NEMT manager may contact a member's health care provider to verify:

• The most appropriate mode of transportation for members who have special transportation needs. This verification process is referred to as LON certification. For members who request special transportation arrangements, the NEMT manager will fax a LON form to the member's health care provider to determine the most appropriate mode of transportation.
• The urgency of rides scheduled less than two business days before a covered appointment.
• Regularly scheduled appointments for members requesting standing order rides.
• The medical necessity of escorts requested to accompany members to their covered appointments.

Members and medical providers are encouraged to contact the NEMT manager with 24-hour notice, if possible, if the member's appointment has been changed or canceled. Members and medical providers may cancel a ride by calling the NEMT manager reservation line at 866-907-1493 (711 TTY) or by accessing the NEMT manager website. If rides are not canceled, the NEMT manager may require the member to call the reservation line to confirm all future rides the day before an appointment.