Transportation Provider Manual
Contents
1. rarer Note This file may be imported into your routing software Unfortunately because there are so many different software packages available MTM is unable to provide specific instructions on how to import the file into your software Liquidated Damages Process Pre Assessment Review This process allows Transportation Providers the opportunity to review their potential liquidated damages prior to the amounts being deducted from their check Any liquidated damage found in your pre assessment review that you do not believe should be assessed need to be emailed to PAR mtm inc net Your requests will be reviewed by Quality Management and a determination will be made regarding the assessments prior to your pay date Damages not reviewed by the Transportation Provider within the allotted time frame will be assessed as normal Appeals Be advised this process will not affect your right to appeal any liquidated damages actually assessed to your company All appeals should be emailed to LDappeals mtm inc net eae Complaints and Grievances A complaint is an expression of dissatisfaction about any matter other than an action Possible subjects for complaints include but are not limited to aspects of interpersonal relationships such as rudeness of a provider or employee or failure to respect the Member s rights A serious complaint involves complaints such as those of sexual harassment discrimination threatening2. OMTM Transportation Provider Manual re Table of Contents TASH OR CONV eE E E telat yesesnedesgisitectaeeeseens scan osesenn lesa tsadessacbodeseseseneeversenven 1 OSS iV esate aici ne ae a atten gin nate atesncten in op esti E A E Seb seceumiocanentes 2 OW IDG ICOM aCe IVI e E E E E E A 4 MPAA teres tee A E E E E E E E E E 4 COn eE AP OAN E eaa E E E E 6 A cident Incident Reporting scasssnasasevenersanrvnnrnracwensaadsnnoraborvnenaadsvontabanenesacissnnrebeienesanisacemabanenniacassoncebedens 8 murance ReduiremeN S osier aer E RA 8 Transportation Provider Website sesdsccssssieiciceussedsanceeacteesdeeduravaniuc rar A r AET 9 onlie Che eG eR E eaa a E E E AE ETE E E R 9 CIME POCE S oN N E E NE E E E NE E EEN 9 Level LAPPE eaor a E E E A A E EE O E E 12 ESUE E oc E N E E eee eee E A nee ee eae eee ere 12 Provider Trip Management Process oc ic scsavsscivawticnssnac aininouadesandieasgwaussdussaoeciucenen sdvaeaGenacnwaeksawanaunas 14 ETO TUCO VS eee eres ena se races E AE E E castes seen canescens eee ene hoeene awe caaneceee 14 Liquidated Damages PIO eS cccccssesccesccenceceneceeneceeececenseteneceeueeseeceeeuceteuceteueeseueseeeuceneueeteneetens 15 Pre Assessment RE VICW sicesecdien erences nee rii acs suces cadeee eanawsnae EEEE EEE UNE 15 PO NG orcas sate pes gerne eecesete es ance eaieoaa te E sane etanadamaedseeteranae 15 Bey gaye reyianscurs alele G a l 2219 E te een oon nest ee ae ne nnn renee nee een enn ne
3. button Otherwise skip this step e Select the Submit button when you are satisfied with the results displayed in the list Selecting the Submit button will add your claims automatically to the packet and will be displayed in the list on the Submit Packet page Claims from the spreadsheet should be in the same order as the signatures appear within the document Note Claims added to the packet that are not represented with a signature in the image will be denied The format of the spreadsheet and further instruction can be found in the Claims Website User Manual which can be accessed by selecting the Help tab 4 Step Submit the Packet Review the trip costs listed for each claim to ensure accuracy Trips costs will not be adjusted after a claim has been made If the Trip Cost of a claim is incorrect remove it from the packet by pressing the Delete button next to the claim and contact MTM Transportation Provider Helpdesk The claim may be added to a new packet at a later time The image of the signature will need to be uploaded again with the new packet Press the Submit button when you are satisfied that the trip costs are accurate 5 Step Submit the Packet Pressing the Submit button will prompt a certification window to appear requiring you to agree to the following reer I certify that all claim data entered for this packet is accurate and complete and that un
4. conversation behavior safe driving issues etc All complaints are directed to the MTM Quality Management Department QM A toll free number is provided 866 436 0457 and calls are received Monday through Friday 7 00 AM to 5 00 PM CST Complaints can be received via phone fax mail or email Calls received after normal business hours are directed to leave a message regarding the complaint information The voice message will be returned within 24 hours of receipt The goal of Quality Management is to identify complaint trends against your company Quality Management wants to work with your company to lower the number of complaints received This will help maintain a positive reflection of your company and MTM QM will document investigate and attempt to resolve the complaint within three 3 business days Transportation Providers are contacted via fax or email regarding any complaints received for their company each day The complaint will be accompanied with a request for resolution to the complaint issue see Sample Document below Information which constitutes a complete response from a transportation provider e The name of the driver staff involved in the complaint e A detailed response as to what happened e Any documentation to support the transportation provider s claim for example submit a copy of the signed trip log to verify timeliness issues e Corrective Action identify any changes made to ensure this type of
5. for member needing to lay in a prone position but not in need of medical assistance e Member may use transportation services for approved services only e Members should attempt to use the closest appropriate facility unless a health care provider has referred the Member outside of the immediate community e Return trips are only provided from the authorized point of drop off e The transportation provider must pick up the Member within one hour from the time the Member calls for the return ride or will call trip rarer e Members must await pick up in an area where that is a pre arranged look out position This is not necessarily outside but an area that allows easy and speedy access to the pick up vehicle The vehicle will not be required to wait more than 10 minutes e For verification purposes Members must sign a driver s log for each trip taken In lieu of Member signature MTM will accept the signature of one of the following e Parent or guardian e Medical provider e Care giver
6. spreadsheet containing multiple claims To add claims one at a time e Select whether you want to enter your Pick up and Drop off times using 12 hour or 24 hour format by selecting the appropriate button e Identify the first trip in the signature image e Enter the driver and vehicle used to provide service by using the drop down boxes provided e Enter the trip number identified with either an A or B for example KSMA1234567A e Enter the pick up and drop off times e Enter the signature type by making a selection from the drop down e Press the Add button to add the claim to the packet if you have any inaccuracies see step 4 below e Identify the next trip in the signature image e Repeat the steps above until you have added all claims from the signature image Note Claims added to the packet that are not represented with a signature in the image will be denied ln To add claims using a spreadsheet e Select Upload Claims this will take you to the Upload Spreadsheet page e Upload the spreadsheet of your claims using the instructions provided on the page e All claims from the spreadsheet will be displayed in a list at the bottom of the page e Correct any errors identified by the system during the upload process Errors will be highlighted and details will be provided about what caused the error e If you have corrected the errors revalidate the list by selecting the Re evaluate
7. can be found using the website s Help tab Preparation 1 A fax is sent to you selecting your company to transport passenger s for appointment s on specified date s and time s 2 Your company transports passenger s and collects one signature for each leg of the trip to verify the trip was completed A round trip requires two signatures a three leg trip will require three signatures etc 3 After transport log in to the MTM Claims Website to begin claiming your trips 1 Step Create a Packet An electronic packet must be created so you can attach your signature image and claims to it and submit it to MTM e Navigate to the Packets tab e Enter a packet name e Select the Create Packet button lt rarer Selecting the Create Packet button will take you to the Submit Packet page 2 Step Upload Signatures The Submit Packet page allows you to upload an image of all the signatures you would like to claim on the packet e Navigate to the Submit Packet page e Select the Upload Image button this will navigate you to the Upload Image page e Upload the image of your signatures using the instructions provided on the page e Save the image Saving the image will navigate you automatically back to the Submit Packet page 3 Step Add Claims to the Packet There are two ways to add claims You may choose to add claims one at a time or by importing a
8. to comply with the insurance requirements will be deactivated prior to the expiration of their insurance certificate You will not receive any new trip assignments from MTM and already scheduled trips will be canceled until the new and updated policy has been received and approved by MTM en Transportation Provider Website Online Credentialing MTM has developed a credentialing application that is an online tool which helps Transportation Providers and MTM manage credentialing information electronically It was created to be efficient to assist in organization and to ease compliance It allows MTM to monitor the usage of authorized non authorized drivers and or vehicles It is also helpful in organizing the Transportation Provider s files making sure all credentialing requirements for each driver vehicle and their company are current Using this website all credentialing interaction between providers and MTM occurs online and via e mail Each user is given login information to access the website If a Transportation Provider has multiple provider codes MTM will link them together so they all become associated with a single login MTM s Transportation Provider website instruction manual details step by step instructions for on line credentialing can be found on the Help tab Claims Process Detailed instructions on how to use the MTM Claims website can be found in the Claims User Manual A copy of the manual
9. will follow the timelines prescribed by the Office of Administrative Hearings within 90 days of when the provider files the appeal with MTM for standard resolution The appellant will be notified of the decision by mail reer Member s Responsibilities When Members call to schedule transportation to medical appointments they must provide e Medicaid ID number e Pick up address e Telephone number e Date of birth e Date time place and type of appointment s e Doctor s name e Facility name address and telephone number to verify appointments if required Any additional passenger and car seat information if needed Members should schedule transportation services for routine medical appointments following their health plan guidelines for days notice This could be anywhere from two to five days notice Some plans require a certain number of business days where others require calendar days Kansas requires five 5 business days notice with the exception of urgent care trips or discharges and trips to the ER If the Member calls for urgent same day trips MTM is responsible for calling the medical provider to confirm urgency and set the trip up according to MTM urgency guidelines e Members will be assigned to the type of transportation that is most appropriate to their needs in the following order e Ambulatory sedan van minibus etc Includes wheelchair transfer e Wheelchair lift equipped vehicle e Stretcher
10. complaint does not occur in the future The information referenced above will ensure accurate information regarding complaint issues against your company are reported to our clients in a precise manner Your Transportation Provider Guidelines stipulate all complaints must be responded to within 24 hours of receipt le Grievance Resolution Request Sample Document 1 1 2001 Dear XYZ Transportation Provider This grievance is being forwarded for investigative purposes If the grievance is accurate please include what steps will be taken to avoid such a grievance in the future If the grievance is in regard to any part of a trip s pick up time and you feel the grievance should be unsubstantiated the grievance can be made invalid by receipt of a faxed copy of the signed driver s log Responses must be returned no later than 24 hours from the receipt of the grievance Failure to respond may result in a temporary suspension from future trips until the response is received You may respond by fax email or phone Please remember to include the name of the driver dispatcher in regards to each grievance issue Thank you MTM Quality Management Coordinator Office 636 463 0457 qm mtm inc net FAX 866 343 0998 eee Transportation Provider Greivances against MTM As a Transportation Provider you have the right to file a grievance whether it is regarding denial of claims a decision made by MTM or oth
11. e eee ee ee 16 Grievance Resolution Request Sample DOCUMENLE ccccceseccceesecceeeececeeceeeeseeeeeueceseuesseeeneeees 17 Transportation Provider Greivances against MTM cccccsscccsseccesecceseceeeesetenseseeceeeeceeenceteneeeens 18 Member s Responsibilitie Siessd ccrescancaueatesesansetecausessatoeersaueestoncuseaesassestaesnatonaeseusaanensueeaeseaneeaesnetencemurs eas 19 ln Glossary Americans with Disability Act ADA Federal law that provides protection from discrimination for individuals who are regarded as having a physical or mental impairment that does not substantially limit major life activities Appropriate Mode of Transportation The most cost efficient type of transportation that best meets the physical medical or behavioral needs of a client requiring transportation to a medical care provider or service This includes ambulatory vehicles wheelchair vehicles stretcher vehicles private providers such as taxis and Public Transportation Attendant A person in addition to the Driver paid by the transportation service provider to accompany the client in the vehicle who assists in transporting a passenger to ensure his or her safety Escort A person permitted to accompany an eligible client or groups of clients during transport at no cost to the Broker or the transportation service provider Exceptional Transportation Services Non emergency transportation services necessary und
12. easons have been disputed MTM will review your appeal and make a decision to approve or deny the claim Level 2 Appeals Transportation Providers may escalate any denied appeals to a supervisor at MTM Denied appeals can be found by navigating to the Claims tab and filtering the results by All Denied or Denied e Locate the denied claim using the claims list from the Claims tab before the claim s new Appeal Deadline located in the claims list nn e Select the trip number of the claim from the list Selecting the trip number will navigate the user to the Trip Detail page The Trip Detail page displays the results of the initial appeal e Select the Escalate button to escalate the appeal to a supervisor Enter the required information into the pop up window and press Save A supervisor at MTM will review your appeal and make a decision to approve or deny the claim The escalated appeal will not be reviewed by the staff member who reviewed your initial appeal Level 2 appeals are final eee Provider Trip Management Process To access the Provider Trip Management Website navigate to the Main Menu by logging in or by selecting the Main Menu link from the login box in the upper right corner of your screen The Provider Trip Management Website allows Transportation Providers to report cancellations no shows and turn backs to MTM W
13. er extraordinary medical circumstances that requires travel out of area such as air and other ground travel for health care treatment not normally provided through health care providers Fair Hearing A formal meeting where an impartial Hearings Officer assigned through the Office of Administrative Hearings listens to all of the facts and then makes a decision based on the law Grievance A complaint not resolved to the client s satisfaction or an issue presented by the client to MTM in writing for formal consideration Medicaid A joint federal state entitlement program also known as Medical Assistance which pays for medical care on behalf of certain groups of low income persons The program was enacted in 1965 under Title XIX of the Social Security Act The Medicaid program pays for transportation to non emergency medical appointments if the client has no other means to travel to the appointment errr Medicaid Eligible This term is used in reference to persons who have completed the certification process and are now eligible to receive services and other assistance under the guidelines of the Medicaid program The term does not include persons who could be eligible for Medicaid e g meet all income and asset criteria tied to eligibility that are not enrolled in the program Non Covered Transportation Services NET services not covered under this contract include transportation to any service not covered
14. er items that affect your business relations with MTM Grievances can be reported to your Network Representative Claims Specialist or the MTM Grievance Hotline at 1 866 436 0457 These grievances are addressed and then reported ona monthly basis to the client If you are not satisfied with the resolution of your grievance you have the right to appeal MTM s decision within 30 days of the date of the notice You may call our corporate grievance line at 1 866 436 0457 or send your request by mail If you wish to mail a letter please be sure to include your name and the name of your company as well as a contact telephone number Please send your appeal to Medical Transportation Management Inc 16 Hawk Ridge Drive Lake St Louis MO 63367 Attn Quality Management Department MTM has 30 days to determine an appeal Once an appeal decision has been made MTM will notify you in writing of the decision You may request a Fair Hearing from the State of Kansas at any point during the determination process Request for Fair Hearings must be written and signed by the requester The request for fair hearing must be mailed to Office of Administrative Hearings 1020 S Kansas Topeka KS 66612 The request for a Fair Hearing can be faxed to Office of Administrative Hearings 785 296 4848 A request for a Fair Hearing must be received within 30 days of the date of the notice of the appeal resolution All hearing dates resolutions and notifications
15. he name of the driver transported passenger s and specific details of the accident incident and related injuries A copy of the police report must be provided to MTM as soon as it is available Insurance Requirements Prior to contracting with MTM you are required to submit a current certificate of insurance Network Management staff monitors insurance certificates on a daily basis to ensure all insurance policies are current The limits of vehicular liability coverage shall not be less than 300 000 combined single limit or the state minimum whichever is greater coverage carried on each vehicle used to transport a recipient The Transportation Provider shall further obtain Commercial General Liability insurance in the amount of 300 000 Combined Single Limit Transportation Provider shall also obtain Workers Compensation coverage in the statutory amount for the state in which services are rendered At the transportation provider s expense MTM must be named as Additional Insured and Certificate Holder on both Auto and General Liability policies When your insurance policy is within forty two 42 days of expiring you will receive emails and prompts on the MTM Transportation Provider website reminding you of the expiration date and the need to submit a copy of the renewal insurance certificate prior to the expiration date The notification process continues until you forward a copy of the renewal Transportation Providers who fail
16. hen you report a trip on the Provider Trip Management Website it will automatically update MTM s system This method should be used instead of calling MTM or sending changes in by fax or by email ETD Instructions You will need e Computer with Excel e Internet Access You should have already received your username and password from the Network Recruiter If you have misplaced this please contact your Network Representative or Area Liaison Open Internet Explorer and go to onlineaccess mtm inc net 1 Enter your username and password and click the Log on button 2 Select Electronic Trip Download from your menu options 3 Click on Create New 4 Once Create New is selected put in the dates that you want your ETD downloaded for and hit Save P The file will begin downloading and become available for you to access your ETD file 6 In order to keep any changes made to the file you must save it to your computer Also note the ETD website will only save reports pulled within the last two weeks In order for you to keep these files they must be saved to your computer 8 Ifyou are unable to accommodate a trip and wish to turn it back please use the Provider Trip Management option in the MTM web portal onlineaccess mtm inc net main menu or email the following information to MTMturnbacks mtm inc net a Trip Number b Members First Name c Member s Last Name d Trip Date e Trip Time
17. is reviewed for accuracy and presented to the Credentialing Committee for approval Once the Transportation Provider has been approved by MTM s Credentialing Committee the contracts are reviewed and countersigned by MTM In the event a driver is denied by MTM s Credentialing Committee the Transportation Provider will receive written notification of the denial The Transportation Provider has 30 days to appeal MTM s decision Following contracting and credentialing the MTM delegate will inform the Transportation Provider that they must have all aspects of the contracting and credentialing process in place for review during for the on site visit During the on site visit the MTM delegate will inspect the Transportation Provider to ensure compliance with the MTM Transportation Provider Guidelines The MTM delegate will discuss deficient areas with the Transportation Provider at the time of the visit If non compliant the Transportation Provider may be removed from the MTM network assessed Liquidated Damages or issued written notification of non compliant items through a Performance Improvement Plan PIP If compliance to the PIP is not met the MTM delegate may pursue disciplinary measures including suspension or termination from the MTM network or assessment of Liquidated Damages Transportation Providers may receive a Performance Improvement Plan PIP for Non Safety and Safety Issues Non Safety Issue Defined as any issue that does n
18. less have entered No Signature have verified that a signature is visible on the image file that uploaded with this packet understand that submitting data with errors may constitute Medicaid fraud agree to accept the Trip Cost listed for all claims as payment in full for all claims am submitting on this packet If you agree select the I Agree button otherwise select cancel Selecting I Agree will submit the claims to MTM for review 6 STEP Appeals Price changes will not be considered after a trip has been claimed and may not be appealed Level 1 Appeals Transportation Providers may appeal denied claims using the online system Denied claims can be found by navigating to the Claims tab and filtering the results by All Denied or Denied e Locate the denied claim using the claims list from the Claims tab before the claim s appeal deadline located in the Claims List e Select the trip number of the claim from the list Selecting the trip number will navigate the user to the Trip Detail page The Trip Detail page displays any and all reasons a claim was denied All reasons must be disputed to appeal the denial e Select the Dispute button next to the denial reason you would like to dispute Enter the required information into the pop up window and press Save e Repeat for all denial reasons e Select the Appeal button after all denial r
19. ot directly endanger the immediate health and welfare of the Recipient For minor non safety issues such as provider s no show or cancellation of a trip less than 24 hours notice rate of more than 1 99 provider discipline shall be as follows 1 At the first occurrence of 1 99 or more of their monthly total trip volume MTM will send an education letter of warning to the provider ln 2 Atthe second occurrence consisting of 1 99 or more of their monthly total trip volume MTM will send a PIP suspending the Transportation Provider to new trips for two 2 consecutive calendar days 3 Atthe third occurrence consisting of 1 99 or more of their monthly total trip volume MTM will send a PIP suspending the provider to new trips for five 5 consecutive calendar days 4 Atthe fourth occurrence consisting of 1 99 or more of their monthly total trip volume MTM will send a PIP suspending the provider to new trips for thirty 30 consecutive calendar days 5 If the Transportation Provider is still out of compliance after the PIP MTM reserves the right to terminate the Transportation Provider Safety Issue is defined as any complaint that directly endangers the immediate health and welfare of the Recipient For minor safety incident complaints provider discipline shall be as follows 1 Upon a first occurrence of a substantiated Transportation Provider safety complaint MTM will send a PIP suspending the Transportation Pr
20. ovider to new trips for two 2 consecutive calendar days 2 Upon a second occurrence of a substantiated Transportation Provider safety complaint MTM will send a PIP suspending the Transportation Provider to new trips for five 5 consecutive calendar days 3 Upon a third occurrence of a substantiated Transportation Provider safety complaint MTM will send a PIP suspending the Transportation Provider to new trips for thirty 30 calendar days 4 Apart from an extenuating circumstance any additional occurrences of substantiated Transportation Provider safety complaints would result in the Transportation Provider being terminated from the MTM Transportation Provider Network All aspects of Transportation Provider services to MTM are monitored for compliance with the MTM Services Agreement and the MTM Transportation Provider Guidelines a Accident Incident Reporting Transportation Provider must report all incidents accidents and injuries occurring while the Transportation Provider or a sub contracted Transportation Provider is transporting any MTM passenger s Transportation Provider accident incident reports must be made in writing by the end of the next business day following an accident incident while transporting an MTM passenger If there are injuries involved Transportation Provider must also report verbally to MTM within three 3 hours of the accident incident At a minimum the accident incident report must include t
21. rovision of such services we receive or obtain from our clients or the Covered Persons or review or create for the Covered Persons or the clients PHI regarding the Covered Persons Covered Person PHI As a result we are a Business Associate of each client with whom we contract MTM requires its subcontracted transportation providers and other subcontracted entities to comply with the requirements of HIPAA applicable to Business Associates MTM requires its employees agents and independent contractors Workforce to adhere to the restrictions and conditions regarding Covered Person PHI MTM will not disclose Covered Person s PHI to any member of our Workforce unless the individual is advised of his her obligations under HIPAA and the consequences of a violation of these obligations including disciplinary action against any member of our workforce that uses or discloses Covered Person PHI in violation of this Section a Contracting amp Performance Once MTM receives a Transportation Provider s completed questionnaire Network Management verifies the Transportation Provider s profile information i e vehicle types hours of operations special services fees and billing information initializing the contracting credentialing process When the provider has completed the credentialing requirements driver vehicle and insurance and MTM has received a signed contract back from the Transportation Provider it
22. through the healthcare program or emergency ambulance transportation Prior Authorization A required pre approval the client needs from MTM prior to the delivery of Non emergency Transportation Services Urgent Care An unscheduled situation requiring Non emergency Transportation Services where the client must be seen on the day of the request and treatment cannot be delayed but there is no immediate threat to life or limb Urgent Care also includes a client s discharge from a hospital eee How Do I Contact MTM Transportation Provider Helpdesk 1 888 513 0713 HIPAA As you are contracted with MTM to provide non emergency medical transportation you may have from time to time reason to learn of and handle Protected Health Information PHI that is protected under the Health Insurance Portability and Accountability Act of 1996 As part of our contract with you there is a section that explains and commits you to following the rules and laws governing the treatment of PHI and other confidential information This section of the contract is copied below to remind you of the serious nature of handling such material The U S Department of Health and Human Services HHS enacted new regulations the Regulations under the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 the Act the Act and the Regulations sometimes referred to collectivel
23. y as HIPAA These Regulations require health care providers health plans and health care clearinghouses individually Covered Entity and collectively Covered Entities to maintain the privacy confidentiality of Protected Health Information PHI which they receive or obtain from their patients or covered persons or which they review or create for their patients or covered persons These same Regulations require Covered Entities to obtain written assurance from the businesses to whom they disclose PHI Business Associates that such Business Associates will maintain the privacy confidentiality of any PHI provided to them by the Covered Entities and otherwise comply with the requirements of HIPAA applicable to Business Associates In addition these Regulations require Business Associates to obtain from those businesses to whom they disclose PHI written assurance that they will maintain the privacy confidentiality of any PHI provided to them by the Business Associate and otherwise comply with the requirements of HIPAA MTM contracts with State County health plans and other health care providers as defined by HIPAA to provide non emergency non emergent ambulance medical transportation services central intake and dispatch services and utilization review reports and services for e a Page 4 reer these clients and the individuals patients covered by such client Covered Persons In connection with our p
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