the HHSC Transportation Provider Manual
Contents
1. 9 MTM Transportation Provider Manual Dm Table of Contents Ji QoR6o 0 nV Em 1 GI Ip 2 HOW GoM Contact MITIS idaxilidka ta teint DN erae dux Ep Ea T eae 4 Transportation Provider Website sas sancctisnaveneecaaunuadsacsie agree uia i ped tuc du deuil edita Re sna UR abra 5 Liguildated Damages PrOCBSS cies decsiasiicdcantvaceuesiceudvuvexentna Pa xeu Paca qudd de bep E Ee CH FLUR x adu ea Va Disi NEKET RU 10 C omplaintsand WAIN M 13 Complaint Grievance Response Request Sample Document 1 esses 14 Complaint Grievance Resolution Request Sample Document 2 sss 14 Recipient s Responsibilities sic decsecicade ipid ot bk Dre npe OR Pa AREE Enea SATEEN EV Fo pH nC p Dee ae ERTA HR n RUE 16 ll M nuances 17 Contracting PFOCeSS ederet eorr ever Edere eae epu y Fue e eU Y eeu evi ANE E EE EEES NA a decanters 20 Accident Incident RepoFtil g susecsxesetax tet teawentvxtaraenadsaatsaanceiurs Max b CUIRE AR a UIR eH taa EN DH RR ERR MIS Ra UE AUN 22 Insurance Requirements codo ecce eerte n en ae ete nager e rhe EREEREER 22 Training Requirements driver vehicl uico eci entere Ranae n Ro EU RR Re Ru R ER NES FREE E XR ERE RM es has 23 lolo ipo d T aena iieiaei 24 Appendix B suas nanaon pude2. 03 19 2013 03 26 2013 04 02 2013 04 09 2013 04 16 2013 04 23 2013 04 30 2013 05 07 2013 05 14 2013 05 21 2013 05 29 2013 06 04 2013 06 11 2013 06 18 2013 06 25 2013 07 03 2013 07 09 2013 07 16 2013 07 23 2013 07 30 2013 08 06 2013 08 13 2013 01 04 2013 01 10 2013 01 17 2013 01 25 2013 01 31 2013 02 07 2013 02 14 2013 02 22 2013 02 28 2013 03 07 2013 03 14 2013 03 21 2013 03 28 2013 04 04 2013 04 11 2013 04 18 2013 04 25 2013 05 02 2013 05 09 2013 05 16 2013 05 23 2013 05 31 2013 06 06 2013 06 13 2013 06 20 2013 06 27 2013 07 05 2013 07 11 2013 07 18 2013 07 25 2013 08 01 2013 08 08 2013 08 15 2013 New Years Day Martin Luther King Day Presidents Day Memorial Day Independence Day m ES 7 21 2013 07 27 2013 7 28 2013 08 03 2013 8 4 2013 08 10 2013 8 11 2013 08 17 2013 8 16 2013 08 24 2013 8 24 2013 08 31 2013 9 1 2013 09 07 2013 9 8 2013 09 14 2013 9 14 2013 09 21 2013 9 22 2013 09 28 2013 9 29 2013 10 05 2013 10 6 2013 10 12 2013 10 13 2013 10 19 2013 10 20 2013 10 26 2013 10 27 2013 11 02 2013 11 3 2013 11 09 2013 11 10 2013 11 16 2013 11 17 2013 11 23 2013 11 24 2013 11 30 2013 12 25 2013 12 07 2013 1 1 2014 12 14 2013 1 8 2014 12 21 2013 1 15 2014 12 28 2013 1 22 2014 01 04 2014 1 29 2014 01 11 2014 2 5 2014 01 18 2014 2 12 2014 01 25 2014 2 19 2014 02 01 2014 2 26 2014 02 08 2014 3 5 2014 02 15 2014 08 20 20
3. MFCU Antitrust and Civil Medicaid Fraud Section TMHP DFPS Department of Aging and Disability Services DADS Department of State Health Services DSHS Department of Assistive and Rehabilitative Services DARS U S Department of Health and Human Services HHS Any State or Federal agency authorized to conduct compliance regulatory or program integrity functions on the provider person or the services rendered by the provider or person or any agent contractor or consultant of any agency or division delineated above nuum Contracting Process 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 is reviewed for accuracy and presented to the Credentialing Committee for approval 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 has 30 days to appeal MTM s decision The Area Liaison
4. 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 9 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 m EN XA 7 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 If you 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 9 mtm inc net a Trip Number b Member s First Name Member s Last Name 2 p Trip Date m Trip Time 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
5. 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 um Accident Incident Reporting Transportation Provider must report all incidents accident 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 the 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 veh
6. in vehicles in addition to 6 7 requirements Hand Cleaner a waterless cleanser is suggested Umbrella Tire Gauge and Jumper Cables Rags and Wipes Wisk Broom Paper Towels Glass Cleaner Pouch with Maps Safety Manual Pre Trip Inspection Forms sam eo ao TD i Car Manual j Copy of MTM Driver Guidelines k Blanket l Water m Seat belt cutter Note It is recommended that aerosol cans not be carried in the trunks of vehicles in hot weather m E
7. 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 umm mE 2013 TEXAS PAYMENT SCHEDULE 12 2 2012 12 08 2012 12 9 2012 12 15 2012 12 16 2012 12 22 2012 12 23 2012 12 29 2012 12 30 2012 01 05 2013 1 6 2013 01 12 2013 1 13 2013 01 19 2013 1 20 2013 01 26 2013 1 27 2013 02 02 2013 2 3 2013 02 09 2013 2 10 2013 02 16 2013 2 17 2013 02 23 2013 2 23 2013 03 02 2013 3 3 2013 03 09 2013 3 10 2013 03 16 2013 3 17 2013 03 23 2013 3 24 2013 03 30 2013 3 31 2013 04 06 2013 4 7 2013 04 13 2013 4 14 2013 04 20 2013 4 21 2013 04 27 2013 4 28 2013 05 04 2013 5 5 2013 05 11 2013 5 12 2013 05 18 2013 5 18 2013 05 25 2013 5 26 2013 06 01 2013 6 2 2013 06 08 2013 6 9 2013 06 15 2013 6 16 2013 06 22 2013 6 23 2013 06 29 2013 6 30 2013 07 06 2013 7 7 2013 07 13 2013 7 14 2013 07 20 2013 Schedule 2013 01 02 2013 01 08 2013 01 15 2013 01 23 2013 01 29 2013 02 05 2013 02 12 2013 02 20 2013 02 26 2013 03 05 2013 03 12 2013
8. scheduled return trip such as dialysis rehabilitation etc after an appointment shall not exceed thirty 30 minutes Will Call the Transportation Provider must establish where applicable an internal schedule for the passenger s return trip pick up which does not impose unreasonable waiting time for the passenger not to exceed one 1 hour maximum from time of passenger s call Complaint means any written or verbal expression of dissatisfaction about services procedures or function of MTM which causes an intervention by MTM for the Recipient or caller Loaded Miles are from passenger s pick up location to drop off location How do I Contact MTM Network Management Representative Tasha Watson A I 713 680 4500 twatson mtm inc net Network Management Representative Rokitha Brown J Z 713 680 4500 twatson mtm inc net Area Liaison Reginald Valentine 713 680 4500 rvalentine mtm inc net Houston Office 5151 Mitcheldale Ste A 10 Houston TX 77092 Phone 713 680 4500 Fax 713 680 4501 MTM Transportation Provider Helpdesk Contact Number 1 877 892 3997 Hours 6 a m 7 p m CST Email address tphelpdesk mtm inc net Fax Number 1 866 652 3128 umm Claims Supervisor Christina Meyer 636 695 5544 cmeyer mtm inc net Field Monitor Dixie King 713 680 4500 dking mtm inc net Program Director Valorie Williams 713 680 4500 vwilliams mtm inc net umm s E Transportation P
9. total trip volume MTM will send a PIP suspending the Transportation Provider to new trips for two 2 consecutive calendar days m ES r Bd 3 Atthe third occurrence consisting of 1 9996 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 9996 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 Provider 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
10. 0 PM CST Complaints grievances can be received via the MTM website 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 the following business day OM will document investigate and attempt to resolve the complaints grievances within three 3 business days Transportation providers are contacted via fax or email regarding any complaints grievances received for their company each day see Sample Document 1 The complaint grievance will be accompanied with a request for resolution to the reported issue see Sample Document 2 Below you will find the information which constitutes a complete response from a transportation provider e The name of the driver staff involved in the complaint grievance e A detailed response as to what happened e Any documentation to support the transportation provider s claim Ex submit a copy of the signed trip log to verify timeliness issues etc e Corrective Action identify any changes made to ensure this type of complaint does not occur in the future The information referenced above will ensure accurate information regarding complaint grievance issues against your company are reported to our clients in a precise manner Your Transportation Provider Guidelines stipulate all complaints grievances must be responded to within 24 hours of receipt The goal of Quality Management is to iden
11. 13 08 27 2013 09 04 2013 09 10 2013 09 17 2013 09 24 2013 10 01 2013 10 08 2013 10 16 2013 10 22 2013 10 29 2013 11 05 2013 11 13 2013 11 19 2013 11 26 2013 12 03 2013 12 10 2013 12 17 2013 12 24 2013 12 31 2013 01 07 2014 01 14 2014 01 21 2014 01 28 2014 02 04 2014 02 11 2014 02 18 2014 02 25 2014 03 04 2014 03 11 2014 08 22 2013 08 29 2013 09 06 2013 09 12 2013 09 19 2013 09 26 2013 10 03 2013 10 10 2013 10 18 2013 10 24 2013 10 31 2013 11 07 2013 11 15 2013 11 21 2013 11 28 2013 12 05 2013 12 12 2013 12 19 2013 12 26 2013 01 02 2014 01 09 2014 01 16 2014 01 23 2014 01 30 2014 02 06 2014 02 13 2014 02 20 2014 02 27 2014 03 06 2014 03 13 2014 umm Labor Day Columbus Day Veterans Day Thanksgiving Day Christmas Day New Year s Day umm 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 Recipient s rights A serious complaint involves complaints such as those of sexual harassment discrimination threatening conversation behavior safe driving issues etc All complaints grievances are directed to the MTM Quality Management Department QM A toll free number is provided 866 436 0457 and calls are answered Monday through Friday 7 00 AM to 5 0
12. alth and Human Services HHS enacted 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 are sometimes referred to collectively as HIPAA or the Privacy Rule 45 CFR Parts 160 and 164 subparts A and E and the Security Rule 45 CFR Part 164 subparts A and C as amended by the Health Information Technology for Economic and Clinical Health Act HITECH Act These Regulations require States and Counties health care providers health plans and health care clearinghouses individually Covered Entity and collectively Covered Entities to maintain the privacy confidentiality of health information which they receive or obtain from their patients or covered persons or which they review or create for their patients or covered persons For purposes of HIPAA this health information is referred to as Protected Health Information or PHI 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
13. appeal Once an appeal decision has been made MTM will notify you in writing of the decision If you do not agree with the decision you have a right to ask for a fair hearing The request must be received within 30 days from the date on this letter The request must be in writing and postmarked no later than the 30th day Requests filed after 30 days must show good cause for the delay The request for a review is sent to the hearings administrator at Hearings Administrator Mail Code W 613 P O Box 149030 Austin TX 78714 m ES uum Recipient s Responsibilities When Recipients call to schedule transportation to their nonemergency medical transportation NEMT services they must provide Medicaid ID pick up address telephone number date of birth date time type of appointment s doctor s name facility name destination address and telephone number as well as any special needs medically necessary passengers or car seat information as necessary Recipients should schedule transportation services for routine medical appointments following HHSC requirement for scheduling transportation of 2 days notice for scheduling transportation If the Recipient calls for urgent same day transportation MTM is responsible for contacting the medical provider to confirm urgency MTM will approve or deny trip requests according to MTM urgency guidelines Recipients will be assigned to the mode of transportation that is most appropriate t
14. 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 herein contracts with the Transportation Provider to provide Non Emergency Medical Transportation Services Services In connection with your provision of such Services you receive or obtain Covered Person PHI As a result MTM requires written assurance that the Transportation Provider will i maintain the privacy confidentiality of all Covered Person PHI and ii comply with the requirements of HIPAA applicable to Business Associates all as more fully described below To comply with the requirements of HIPAA and related laws and regulations Transportation Provider agrees to maintain the privacy confidentiality of all Covered Person PHI as required by all applicable laws and regulations including without limitation the requirements of HIPAA to implement applicable electronic information security procedures to comply with the HIPAA Security Regulations not use or disclose Covered Person PHI other than to perform the Services as otherwise expressly permitted by the terms of this Agreement or as required by law provided however that Transportation Provider may use and disclose Covered Person PHI to manage and administer your business develop and implement appropriate safeguards to prevent the use or m ES um disclosure of Covered Person PHI for purposes oth
15. er than as set forth in this Agreement provide MTM with such information concerning such safeguards as MTM may from time to time request Except for disclosure of Covered Person PHI required in the administration of your business Transportation Provider shall not disclose any PHI requested by the Covered Person or a Third Party except as directed by HHSC Transportation Provider shall direct all requests for disclosure of PHI by the Covered Person or Third Party to MTM for forwarding to HHSC for its determination Transportation Provider agrees to notify MTM immediately upon your discovery of any unauthorized disclosure of Covered Person PHI establish procedures for mitigating any deleterious effects of any improper use and or disclosure of Covered Person PHI to require your employees agents and independent contractors Workforce to adhere to the restrictions and conditions regarding Covered Person PHI contained in this Section to include the HIPAA PHI protection provisions of this Agreement in all downstream subcontractor agreements not disclose Covered Person PHI to any member of your Workforce unless Transportation Provider has advised such person of the obligations under this Section and the consequences of a violation of these obligations take disciplinary action against any member of your Workforce that uses or discloses Covered Person PHI in violation of this Section not to disclose Covered Person PHI to any third party without first obta
16. g Responses must be returned no later than 24 hours from the receipt of the complaint grievance Failure to respond may result in the assessment of liquidated damages and or 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 9 MTM mum As a Transportation Provider you have the right to file a grievance MTM Inc would like to remind you that you have the right to file a grievance whether it is regarding denial of claims an MTM decision or other 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 on a monthly basis to HHSC 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
17. gnatures 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 m EN D 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 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 t
18. he trip number identified with either an A or B for example KSMA12345674 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 m EN 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 f you have corrected the errors revalidate the list by selecting the Re evaluate 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
19. icular liability coverage shall not be less than 500 000 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 1 000 000 Combined Single Limit or state minimum whichever is greater The 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 upload a copy of the renewal to the Transportation Provider Website for MTM approval Transportation providers who fail to comply with the insurance requirements will be deactivated prior to the expiration of their insurance certificate You will not receive any new trip awards from MTM and already scheduled trips will be canceled until the new and updated policy has been received and approved by MTM MTM recognizes there are many challenges and expenses related to insurance c
20. ing a Drivers every 2 years 4 Accurate Record Keeping a Claims Processing Transportation Provider Billing Department as needed b Trip Documentation Drivers annually c Medicaid Integrity and Fraud Reporting Transportation Provider Management Staff and Drivers annually 5 Wheelchair amp Scooter Securement a Drivers annually 6 Emergency Procedure Training a Drivers annually 7 HIPAA Training a Transportation Provider Management Staff and Drivers annually 8 Defensive Driving a Drivers every 2 years i Defensive Driver Training must include one of the following 1 National Safety Council DDC 8 Training Class 2 National Safety Council DDC PC Online Training 3 National Safety Council Video Self Instruction Kit 4 National Safety Council Self Instruction CD ROM Kit 5 American Association of Retired Persons AARP 55 Alive Driver Safety Program 6 Transportation Provider developed in house training must include a Pre Trip Inspections b Professional Avoid ability vs Legal Liability c Motorists Pedestrians d Backing e Intersections f Following Distance m ES mmm g Braking Skids h Drugs Alcohol Sleep Deprivation i Courtesy j Routines k Accident Procedures I On Job Driver Demonstration 9 False Claims Act 314563729 See MTM Fraud Waste and Abuse Training Program at http www mtm inc net tpfraudwasteandabuse html uum EE Appendix B Driver
21. ining the written approval of HHSC not disclose Covered Person PHI to any third party without first obtaining the written agreement of such third party to be bound by the requirements of this Section for the express benefit of Transportation Provider MTM and HHSC limit disclosure of Covered Person PHI by your workforce or third parties to the minimum amount of Covered Person PHI necessary to achieve the purpose for such use or disclosure to notify MTM immediately in the event Transportation Provider receive a request from a Covered Person identified in any Covered Person PHI Subject or such person s legal representative Legal Representative to review any records in your possession or control regarding the Subject Subject PHI to make available to MTM or at our request to HHSC any Subject PHI in your possession or control to notify us immediately in the event you receive a request from a Subject to amend or otherwise modify any Subject PHI in your possession or control to make any amendments to Subject PHI that HHSC has directed or authorized make your policies books and records relating to the use and disclosure of Covered Person PHI available to HHSC or to the Secretary of the U S Department of Health and Human Services or his or her designee for the purpose of determining compliance with HIPAA requirements return to MTM or otherwise destroy all Covered Person PHI in your possession or control upon termination of this Agreement to c
22. n the claims list m EN D 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 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 When 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 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
23. o their needs in the following order e Public Transportation e Ambulatory sedan van minibus etc includes wheelchair transfers e Wheelchair lift equipped vehicle e Stretcher for Recipients needing to lay in a prone position but not in need of medical assistance Recipient will be assigned to use transportation services for approved medical services only Recipients should attempt to use the closest healthcare facility unless a healthcare provider has referred the Recipient outside of their service area and the trip request has prior authorization Return trips are only provided from the authorized point of drop off The transportation provider must pick up the Recipient within one hour from the time the Recipient calls for their return ride for will call trips The transportation provider must pick up the Recipient within 30 minutes from the time listed in trip requests that have a scheduled return time Recipients must await pick up in an area 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 For verification purposes Recipients must sign the driver s log for each trip taken In lieu of Recipient signature MTM will accept the signature of one of the following e Parent or guardian e Medical provider e Care giver m ES Ium HIPAA The U S Department of He
24. ontinue to extend the protections of this Section to such Covered Person PHI and limit any further use of such Covered Person if such return or destruction of records is not feasible to indemnify defend and hold harmless MTM and HHSC and their respective parents subsidiaries and affiliates and their respective shareholders directors officers employees agents legal representatives heirs successors and assigns from and against any and all claims causes of action losses liabilities damages costs and expenses including without limitation court costs m ES Dm EE and attorneys fees arising out of resulting from or caused by a violation by Transportation Provider or any of your employees agents or subcontractors of any of the terms or conditions of this Agreement The parties agree that all Covered Person s records are to be treated as confidential so as to comply with all Federal and State laws regarding the confidentiality of such records However the following shall have the right upon request to immediately inspect any accounting administrative and other reports maintained by Transportation Provider pertaining to MTM Covered Services its Covered Persons and or activity hereunder but Transportation Provider shall not be required to disclose the records of any Covered Person to any party other than as required by law MTM HHSC Office of Inspector General OIG Texas Attorney General s Medicaid Fraud Control Unit
25. or MTM delegate will inform the Transportation Provider they must have all aspects of the contracting and credentialing process in place for review during the visit During the On Site Visit the Area Liaison or MTM delegate will complete the site visit to ensure compliance with the MTM Transportation Provider Guidelines The Area Liaison or MTM delegate will discuss deficient areas with the Transportation Provider at the time of the visit If compliance is not met 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 Area Liaison or MTM delegate may pursue disciplinary measures including suspension or termination from the MTM network or assess Liquidated Damages Transportation Providers may receive a Performance Improvement Plan PIP for Non Safety and Safety Issues Non Safety Issue is defined as any issue that does not directly endanger the immediate health and welfare of the Recipient Minor non safety issue 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 Atthe first occurrence of 1 9996 or more of their monthly total trip volume MTM will send an education letter of warning to the provider 2 Atthe second occurrence consisting of 1 9996 or more of their monthly
26. overage If you need assistance please contact your Network Representative m ES mms Training Requirements driver vehicle Transportation Provider must maintain a file on each driver including owners when they have driving responsibilities Owners Officers must submit the credentials noted below items i l The files shall include a Documentation of training b Copy of current driver s license c Driver evaluations d Results of a Computerized Criminal History CCH e Results of a State Sex Offender Registry search f Results of National Sex Offender Registry search g Results of a State specific Motor Vehicle Record search h Results of TX OIG search Results of Excluded Provider List check i Fraud Waste amp Abuse Training Owners Officers j Comptroller of Public Accounts Debarred Vendors List Owners Officers k Comptroller of Public Accounts Certificates of Accounts Status Owners Officers l Signed Drug Free Workplace policy nummum Appendix A 1 BasicFirst Aid Training must be given by a certified First Aid instructor a Drivers every 3 years 2 Passenger Assistance Training a Dealing with behavioral issues and violent behavior Drivers every 2 years b Client Rights amp Responsibilities Drivers annually c Customer Service Transportation Provider Management Staff and Drivers annually and as needed d Service Delivery Drivers annually 3 ADA amp Civil Rights Train
27. rovider 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 can be found using the website s Help tab Preparation 1 Afaxissent 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 si
28. rwise 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 reasons 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 i
29. s The program was enacted in 1965 under Title XIX of the Social Security Act The Medicaid program pays for transportation to and from non emergency covered medical services that are provided by an enrolled Medicaid provider if the Recipient has no other means to travel to the appointment The Texas Medical Assistance Program a joint federal and state provider provided for in Chapter 32 Texas Human Resources Code and subject to Title XIX of the Social Security Act 42 U S C 81396 et seq 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 Prior Authorization A required pre approval the Recipient needs from MTM prior to the delivery of NEMT services m EN m D Urgent Request means a request for non emergency medical transportation for illnesses or injuries of a less than serious nature than those constituting emergencies but for which treatment is required to prevent a serious deterioration in the client s health and for which treatment cannot be delayed without imposing undue risk on the qualified client s well being until client secure services form regular physician Wait Time means for a pre
30. t ase bacs idi E n UU aba MK RU Ma EEE ARAM eae tae 26 Pelei XC c T 27 Glossary Americans with Disability Act ADA Federal law that provides protection from discrimination to 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 healthcare or behavioral needs of a Recipient requiring transportation to a healthcare service This includes ambulatory vehicles wheelchair vehicles stretcher vehicles private providers such as taxis and public transportation Attendant An adult or service animal that accompanies a prior authorized Recipient to provide necessary mobility personal or language assistance to the Recipient during the time of transportation and healthcare services are provided to the Recipient Escort A person permitted to accompany an eligible Recipient or group of Recipients during transport at no cost to the Broker or the transportation service provider Grievance A complaint not resolved to the Recipient s satisfaction or an issue presented by the Recipient 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 person
31. 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 A 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 m EN X C J certify that all claim data entered for this packet is accurate and complete and that unless I 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 othe
32. tify complaint grievance trends reported against your company and to work with your company to lower the number of reported issues received This will help maintain a positive reflection of your company and MTM m ES MEE EE RENE Complaint Grievance Response Request Sample Document 1 DATE GRIEVANCE GRIEVANCE FILED TP NAME ALPHA LAST FIRST RECIPIENT APPT APPT CODE NAME NAME PHONE DATE TIME RCVD THE RECIPIENT CONTACTED MTM ON 02 02 11 AT 8 00 AM STATING 14811123456 VN SMITH JOHN HHHH 2 1 2011 12 00 2 2 2011 THE ABC TAXI TRANSPORTATION PROVIDER DID NOT ARRIVE FOR THE SCHEDULED PICK UP REQUEST THE RECIPIENT S SISTER CONTACTED MTM ON 02 02 11 AT 11 00 AM STATING THE DRIVER FOR THE PICK UP REQUEST 1411123459 VB JONES SALLY HHHH 2 1 2011 3 00 2 2 2011 WAS VERY RUDE ABC TAXI THE DRIVER REFUSED TO ASSIST THE RECIPIENT WHEN SHE WAS ATTEMPTING TO GET INTO THE VEHICLE Complaint Grievance Resolution Request Sample Document 2 This complaint grievance is being forwarded for investigative purposes If the information is accurate please include what steps will be taken to avoid such a complaint grievance in the future If the complaint grievance is in regard to any part of a trip s pick up or drop off times and you feel the information is unsubstantiated the complaint grievance can be made invalid by receipt of a faxed copy of the signed driver s lo
33. training both pre service and Annual suggested in addition to 4 3 requirements could include Sensitivity training Passenger relations On the road in vehicle practical training i e driving with supervision Pre post vehicle inspection responsibilities Transporting passengers with frailties and oxygen tanks Safety issues Radio contact Sw mono SF Pp Review of State Federal regulations p o New laws regulations j Transportation Provider internal procedures Suggested training resources a American Red Cross ARC for Basic First Aid and CPR Sate Department of Transportation DOT National Safety Council NSC Training given by local or regional transportation providers in your area Local fire departments often have certified people to teach first aid Transportation industry video tapes m mo ao State and local law enforcement agencies Appendix C Recommended equipment to carry in vehicles in addition to 6 7 requirements Hand Cleaner a waterless cleanser is suggested Umbrella Tire Gauge and Jumper Cables Rags and Wipes Wisk Broom Paper Towels Glass Cleaner Pouch with Maps Safety Manual 2m O A090 oD Pre Trip Inspection Forms i Car Manual j Copy of MTM Driver Guidelines k Blanket l Water m Seat belt cutter Note It is recommended that aerosol cans not be carried in the trunks of vehicles in hot weather Recommended equipment to carry
Download Pdf Manuals
Related Search