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Welcome  » October 1, 2022 1:09 AM
Program Name: BadgerCare Plus and Medicaid Handbook Area: Ambulance
10/01/2022  

Covered and Noncovered Services : Covered Services and Requirements

Topic #1049

Non-Emergency Medical Transportation by Ambulance

Transportation from a hospital to a nursing home, from one nursing home to another nursing home, or from a member's residence to a doctor's or dentist's office is NEMT. Hospital to hospital transfers are also considered NEMT since the member should be in stable condition.

NEMT by ambulance falls into two categories based on whether life support services are required during transport:

  1. NEMT requiring life support services (either ALS or BLS)
  2. NEMT without life support services (for a member who requires transportation in a supine position)

Non-Emergency Medical Transportation Requiring Life Support Services

The following policy applies for NEMT requiring life support services for members who are required to receive their NEMT through the NEMT manager contracted with the Wisconsin DHS:

  • The ambulance provider must be contracted with the NEMT manager and must submit claims directly to the NEMT manager in order to receive reimbursement.
  • The transportation must be prescribed by a physician, physician assistant, nurse midwife, nurse practitioner, or registered nurse. The prescription must meet the following conditions:
    • Be in written form.
    • Be maintained and stored in the member's record at the hospital, clinic, or other originating facility.
    • State what medical care is necessitated by the member's condition that requires transport with life support services.
  • The hospital, clinic, or other originating facility has the following two options for coordinating the transportation:
    • Coordinating directly with the ambulance provider. With this option, the ambulance provider must contact the NEMT manager within 60 calendar days of dispatching the trip to obtain a trip identification number (trip ID). (The ambulance provider must obtain a copy of the prescription and submit it to the NEMT manager.)
    • Coordinating through the NEMT manager. With this option, the hospital, clinic, or other originating facility contacts the NEMT manager to arrange the trip. (The hospital, clinic, or facility must fax a copy of the prescription to the NEMT manager.)

Non-Emergency Medical Transportation Without Life Support Services

The following policy applies for NEMT without life support services for members who require transportation in a supine position and who are required to receive their NEMT through the NEMT manager:

  • The ambulance provider must be contracted with the NEMT manager and must submit claims directly to the NEMT manager in order to receive reimbursement.
  • The transportation does not require a prescription.
  • The referring hospital, clinic, or other originating facility must coordinate the transportation through the NEMT manager.
 
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