April 15, 2018
Non-emergency transportation - trips over 100 miles and multi-leg trips

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care, and Division of Developmental Disabilities

Since February 1, 2018 Mercy Care has required the inclusion of pick-up and drop-off locations for trips billed greater than 100 miles per total trip. As you know, AHCCCS requires prior authorization for trips greater than 100 miles. Mercy Care had chosen to conduct pre-payment review on these services rather than require prior authorization. 

Now that the process has been in effect for a year, some changes are required for this process. Mercy Care will be implementing the following changes effective immediately:

For mileage over 100 where the corresponding base code (A0100, A0120, A0130) is 1 or 2, the claims will still be reviewed on a pre-payment basis. The corresponding pick-up and drop-off locations will be required to be included prior to payment of the claim. Instructions are noted below:

Instructions for submitting claims electronically : Claims submitted electronically will need to have the correct information loaded into the appropriate loops on the 837P files that are sent to us. According to CMS guidelines, pick-up information should be included in Loops 2310E if it is at the claim level or 2420G if it is as the line level. Drop-off information should be included in Loops 2310F for claim level information and 2420H for line level. The requirements for both of these are under the 5010 standards and are as follows:
“Required when billing for ambulance or non-emergency transportation services. If the location is an area where there are no street addresses, enter a description of where the service was rendered (for example, ‘crossroad of State Road 34 and 45).”

Instructions for submitting claims via paper : Trip ticket should be included with the claim. 

For mileage over 100 where the corresponding base code (A0100, A0120, A0130) is for 3 to 5 units (AHCCCS code maximum per day), the trip ticket will need to be included with the claim for review. If the trip ticket is not appended to the claim at the time of submission, the claim will be denied for records and will be reviewed at the time the trip ticket is received (within claim submission timelines).
As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website .

Thanks for all you do!