Mercy Care and Mercy Care RBHA will be implementing requirements noted in Chapter 14 of the AHCCCS Fee For Service Provider Manual related to split-billing.
Mercy Care and Mercy Care RBHA have been seeing split billing for transportation services where the loading charge (base rate) is on a separate claim from the mileage.
Chapter 14 of the AHCCCS FFS Provider Manual notes the following:
- All services occurring on the same date of service for a member’s transport must be billed on a single claim. If multiple transports occurred on the same date of service, then the provider must bill the total number of trips (base rate) on the first line and the total loaded mileage on the second line of the claim.
- All trips taking place on the same day, for the same member, must be billed on one claim. The base rate must be billed on the first line, the loaded mileage on the second line, and the wait time (in the event that wait time is billed for) on the third line. Any additional lines will deny.
- A claim submitted with only the base code and a second claim submitted with only the mileage will be denied, as split-billing transport services is not permitted. Multiple claims submitted for the same date of service will be denied as duplicates.
For non-emergency transportation services there are two different billing scenarios:
- Loaded transportation (the member is with the staff)
- Provider travel (the provider is traveling to where the member is to provide a service)
AHCCCS FFS Manual Chapter 14 states the following regarding loaded mileage:
Non-emergency transportation providers must bill the number of trips and the number of loaded miles as units of service on the CMS 1500 claim form. Loaded mileage is defined as the distance traveled,
measured in statute
miles, with a recipient on board the vehicle and being transported to receive medically necessary AHCCCS covered services.
Please note that
services should be billed with both the appropriate base rate (A0100, A0120) and the associated mileage (S0215). Mileage and base rate billing does not begin until the member is in the vehicle with the driver.
The trip to pick up the member is not billable in terms of mileage or time.
, the member is not in the vehicle with the staff. The staff is traveling to where the member is
to provide a service
. This is billed utilizing code A0160 only. Please note as per the AHCCCS Covered Behavioral Health Services Guide that this code is not billable for the first 25 miles. The first 25 miles are not encountered. The only mileage that can be billed is mileage over the 25 mile threshold. This is true for each segment of the trip.
This code is not billable to for travel time/mileage when going to pick up the member for loaded transportation
- Please note that A0160 is a mileage code and S0215 should not be billed with it. There is no loading charge with this service as the member is not in the vehicle with the provider.
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!