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  • Medical Transportation Procedures > Taxi and Van

    TABLE 3
    Taxi and Van

    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:

     

    • When covered by the Plan, providers must fax the Medical Necessity Taxi Transportation Request Form to the Managing Entity shown on the member's ID card. The prior approval period is based on the expected duration of the member's condition. Prior approval extensions require submission of a new form. Providers must give the member the prior approval information to enable the member to arrange for services.
    • For members with HIP or HealthCare Partners (HCP) as the Managing Entity: Call Customer Service at 1-800-447-8255  to request transportation and fax the Medical Necessity Taxi Transportation Request Form to 1-631-719-0911.
    • For MLTC members: If the Managing Entity is Montefiore (CMO), call 1-877-447-6668 to request taxi transport, or fax request to 1-914-377-4798.
    • When covered by Medicaid FFS, call the LDSS' vendor to arrange services.

    Who Arranges Services:

     

    • When covered by the Plan, the member must arrange services directly with the transportation provider at least 24 hours in advance of each trip for services to take place during the prior approval period. For MAP-MLTC, EmblemHealth case managers may assist members with transportation coordination.
    • When covered by FFS Medicaid, the member calls the LDSS' vendor to arrange services.

    Member and Provider Reimbursement:

     

    • When covered by the Plan, network transportation providers submit claims to the address on the back of the member's ID card. For non-network taxi service, the member is expected to pay the driver, and then contact the Managing Entity on their member ID card for reimbursement. For Medicaid Advantage HMO NYC taxi/van: Transportation providers submit claims to CTS.
    • When covered by Montefiore (CMO): Call Montefiore Provider Relations at 1-914-377-4477 for reimbursement.
    • When covered by Medicaid FFS, contact the LDSS' vendor for instructions.

      Criteria For Approving Taxi, Livery and Van Services

      Criteria for Approving Taxi, Livery and Van Services

      Transportation services are intended to ensure that members are able to access necessary medical care and services covered under their contract. Members who can get to medical care on their own should not have transportation services ordered for them. The transportation provided should be the least intensive mode required based on the member's current medical condition. Taxi, livery or van transportation should be ordered only when the below circumstances occur.

      County Criteria for Taxi, Livery and Van Transportation Services

      New York City

      Because of its extensive public transportation network, New York City members must use public transportation to travel to and from medical appointments unless a specific medical condition contraindicates such use.

      1. When members cannot use public transportation due to a debilitating physical or mental condition as determined by a physician.

      All Other Counties

      1. When members do not live within walking distance of the place of service and do not have access to a personal vehicle or public transportation.
      2. When members are traveling to and from locations that are inaccessible by public transportation and do not have access to a personal vehicle.
      3. When members cannot use public transportation or drive their personal vehicle due to a debilitating physical or mental condition as determined by a physician.

      Medical Necessity Taxi Transportation Request Form

      Medicaid Transportation Reimbursement Ledger: Taxi/Livery Transportation (TLT) General Instructions

      • All uses of taxi/livery transportation require prior approval from an EmblemHealth network Medical Center and/or authorized provider. The Medical Center shall reimburse round-trip (where appropriate) for authorized taxi/livery transportation when:
      1. There is documented medical justification, determined by an EmblemHealth network physician, on record with provider. Taxi/livery transportation is not to be utilized in lieu of public mass transportation.
      2. The patient has confirmed with the medical center/provider the use of such transportation and the medical center/provider has checked eligibility status and justification.
      • The patient is required to submit a receipt from the taxi/livery services. "Tips" are disallowed for purposes of reimbursement. The medical center/provider should retain receipt with the copy of this form.
      • In cases of round-trip (when authorized), the medical center/provider should reimburse twice the amount of the one-way receipt.
      • The medical center is responsible for reimbursement to specialists outside of the medical center. Such reimbursement shall be given to the patient at the next follow-up visit to the medical center after the specialist visit. Receipts (round trip) are required.
      • Submit forms monthly to EmblemHealth.
        Attention: Accounts Payable, 55 Water Street, New York, NY 10041-8190.

      Note: The transportation ledgers should not be used by the Managing Entities financially responsible for transportation services.

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      Glossary terms found on this page:

      Services that have been approved for payment based on a review of EmblemHealth's policies.

      An itemized statement of health care services and their costs provided by a hospital, physician's office or other health care facility. Claims are submitted to the insurer or managed care plan by either the plan member or the provider for payment of the costs incurred.

      A legal agreement between an individual member or an employer group and a health plan that describes the benefits and limitations of the coverage.

      A determination of whether or not a person meets the requirements to participate in the plan and receive coverage under the plan.

      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.

      Professional services rendered by a physician for the treatment or diagnosis of an illness or injury.

      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 type of health benefit plan that allows enrollees to go outside the health plan's provider network for care, but requires enrollees to pay higher out-of-pocket fees when they do. Also called Point of Service.

      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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