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  • Medical Transportation Procedures > Public Transportation (Bus and Train)

    TABLE 2
    PUBLIC TRANSPORTATION (BUS AND TRAIN)
    Service Area Medicaid Medicaid Advantage HMO Dual Eligible (HMO SNP) MAP-MLTC & MLTC Dual Eligible HMO/ PPO SNP

    New York City

    Covered by Medicaid FFS

    Covered by the Plan

    Covered by the Plan

    Covered by Medicaid FFS if member has benefit

    Nassau

    Covered by Medicaid FFS

    Covered by Medicaid FFS

    Covered by the Plan

    Covered by Medicaid FFS if member has benefit

    Rockland

    N/A

    N/A

    N/A

    HMO SNP - N/A

    PPO SNP - Covered by Medicaid FFS if member has benefit

    Suffolk

    Covered by Medicaid FFS

    Covered by Medicaid FFS

    Covered by the Plan

    Covered by Medicaid FFS if member has benefit

    Westchester

    Covered by Medicaid FFS

    Covered by Medicaid FFS

    Covered by the Plan

    Covered by Medicaid FFS if member has benefit

    Prior Approval: Not required.

    Who Arranges Services: Members.

    Member and Provider Reimbursement:

     

    • When covered by the Plan, network physician group practices, dentists, individual practice PCPs and OB/GYNs reimburse members. Providers send the Public Mass Transportation Reimbursement Ledger to EmblemHealth for members assigned to the Managing Entity HIP or HCP or to Montefiore for MLTC members if CMO is the Managing Entity shown on the member's ID card. Providers submit logs to Coordinated Transportation Solutions (CTS) for reimbursement.
    • When covered by Medicaid FFS, members contact the LDSS' vendor to arrange transportation and seek reimbursement.

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    Glossary terms found on this page:

    An organization that provides comprehensive health care coverage to its members through a network of doctors, hospitals and other health care providers. Also called a Health Maintenance Organization.

    A card which allows the subscriber to identify himself or his covered dependents to a provider for health care services.

    A city or county social services district as constituted by Section 61 of the New York State Social Services Law (SSL). Also called a Local Department of Social Services.

    Acronym for Medicare Advantage. An alternative to the traditional Medicare program in which private plans run by health insurance companies provide health care benefits that eligible beneficiaries would otherwise receive directly from the Medicare program.

    A jointly funded federal and state program that provides hospital and medical coverage to the low-income population and certain aged and disabled individuals.

    An individual and each of his or her eligible dependents, including Medicare beneficiaries who are enrolled or participate in a benefit program and who are entitled to receive covered services from the practitioner pursuant to such benefit program and the terms of the practitioner's agreement.

    The group of physicians, hospital, and other medical care providers that a specific plan has contracted with to deliver medical services to its members.

    A family physician, family practitioner, general practitioner, internist or pediatrician who is responsible for delivering or coordinating care. Also called a primary care physician.

    A health plan that offers benefits in-network and out-of-network. In-network services are available to enrollees at lower out-of-pocket cost than the services of non-network providers. In addition, PPO enrollees may self-refer to any network provider at any time. Also called a Preferred Provider Organization.

    The process of obtaining advanced approval of coverage for a health care service or medication. The request for services is reviewed to assess medical necessity and appropriateness of elective hospital admissions and non-emergency outpatient services before the services are provided. Also called pre-authorization or pre-certification or pre-determination.

    A medical practitioner or covered facility recognized by EmblemHealth for reimbursement purposes. A provider may be any of the following, subject to the conditions listed in this paragraph:

    • Doctor of medicine
    • Doctor of osteopathy
    • Dentist
    • Chiropractor
    • Doctor of podiatric medicine
    • Physical therapist
    • Nurse midwife
    • Certified and registered psychologist
    • Certified and qualified social worker
    • Optometrist
    • Nurse anesthetist
    • Speech-language pathologist
    • Audiologist
    • Clinical laboratory
    • Screening center
    • General hospital
    • Any other type of practitioner or facility specifically listed in the member's Certificate of Insurance as a practitioner or facility recognized by EmblemHealth for reimbursement purposes

    A provider must be licensed or certified to render the covered service. The covered service must be within the scope of the Provider's license or certification.

    The geographic area in which a health plan is prepared to deliver health care through a contracted network of participating providers.

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