Welcome to Southeastrans!

1. Welcome to Southeastrans!

2. Overview Southeastrans Confidential Material Southeastrans Mission and Vision SET Portals (Facility, Provider, Member) Call Center Overview Provider Expectations, Provider Credentialing, and Provider Agreement PA Eligibility FSSA Updates

3. Who is Southeastrans? Southeastrans is a minority-owned, non-emergency medical transportation (NEMT) management company based in Atlanta, Georgia. We provide comprehensive NEMT administrative and related services to our state Medicaid and HMO clients, including verification of eligibility utilizing proven gatekeeping processes, claims management, provider credentialing, utilization review, and quality management. Mission Vision

4. Who is Southeastrans? Southeastrans is a minority-owned, non-emergency medical transportation (NEMT) management company based in Atlanta, Georgia. We provide comprehensive NEMT administrative and related services to our state Medicaid and HMO clients, including verification of eligibility utilizing proven gatekeeping processes, claims management, provider credentialing, utilization review, and quality management. Mission Vision To provide transportation management solutions that deliver the highest levels of quality and satisfaction to our consumers and partners, while offering exceptional value, performance, and responsiveness to our contracting agencies.

5. Who is Southeastrans? Southeastrans is a minority-owned, non-emergency medical transportation (NEMT) management company based in Atlanta, Georgia. We provide comprehensive NEMT administrative and related services to our state Medicaid and HMO clients, including verification of eligibility utilizing proven gatekeeping processes, claims management, provider credentialing, utilization review, and quality management. Mission Vision To be the leader in transportation management through the integration of specialized information technologies, innovative business practices, and a consistent emphasis on quality and consumer satisfaction.

6. Broker, Client and Provider Relationship The Broker, Client and Provider work together to provide NEMT services to Indiana Medicaid Members. • Southeastrans contracts with private companies (providers). Our responsibility is to administer and oversee the NEMT process which includes all gate-keeping for eligible individuals. • FSSA is responsible for assuring that Indiana Medicaid members have the opportunity to request and receive Medicaid services, including non-emergency transportation (NEMT), and that providers of these services are reimbursed. • The provider is responsible for transporting members safely to their medical appointments in a timely manner.

7. PROVIDER PortalAccess Request Access via email to: isupport@Southeastrans.com Facility Portal Provider Portal Member Portal Southeastrans Confidential Material

8. PROVIDER PORTAL https://provider.southeastrans.com/iportal

9. FACILITY PortalAccess Request an Account: www.southeastrans.com/facilities Facility Portal Provider Portal Member Portal Southeastrans Confidential Material

10. FACILITYPORTAL Southeastrans Confidential Material

11. MEMBER PortalAccess Request an Account: https://member.southeastrans.com/Account/Login Facility Portal Provider Portal Member Portal Southeastrans Confidential Material

12. MEMBER PORTAL Southeastrans Confidential Material

13. Scheduling A Trip Southeastrans Confidential Material

14. ELIGIBILITY Southeastrans Confidential Material Southeastrans will determine coverage eligibility for a member each time a trip is scheduled. The appointment reason and provider will be verified as an IHCP approved healthcare provider and service. Non-IHCP approved services or providers will be denied, and a letter will be sent to the member stating the reason for the denial.

15. PRIOR AUTHORIZATION PROCESS Southeastrans Confidential Material Southeastrans will complete and submit all required Prior Authorizations on behalf of the member. Prior Authorizations for trips in excess of 50 miles one-way, outside the State of Indiana, or modes of travel by commercial air, bus, or train must be submitted prior to the trip’s date of service!

16. How to Schedule a Trip - Member Southeastrans Confidential Material Non-urgent trips can be scheduled by calling the Reservation Line at 1-855-325-7586 Monday – Friday 7am – 6pm EST. Scheduling for urgent trips occurring in less than 48 hours can be completed by calling the Reservation Line 24 hours/7 days a week, Fax (facility only), Member Portal, Facility Portal and the Provider Portal.

17. How to Schedule a Trip - Facility Southeastrans Confidential Material • Non-urgent trips can be scheduled by calling the Facility Line at 1-855-325-7588 Monday – Friday 7am – 6pm EST. • Scheduling for urgent trips occurring in less than 48 hours can be completed by calling the Facility Line 24 hours/7 days a week. • Non-urgent trips can be faxed utilizing the Nursing Home Form to 317-642-0913. • If the facility has identified the provider in advance and gained the provider’s acceptance, the trip can be scheduled by calling the Facility Dispatch Line at 1-888-822-6124 Monday – Friday 7am-6pm EST . • www.southeastrans.com/facilities

18. PROVIDER EXPECTATIONS Southeastrans has high performance standards and requires each provider to meet and/or exceed those standards. Southeastrans monitors all providers to ensure compliance with the required standards.

19. PROVIDER SCORE CARD The Provider Scorecard assesses each provider’s performance on a monthly basis in the following key areas: Southeastrans Confidential Material

20. PROVIDER AGREEMENT Southeastrans Confidential Material Signed by all provider types with the exception of EMS at the time of credentialing Roadmap to performance and service standards Trip acceptance and send back guidelines

21. PROVIDER SEND BACKS • If providers are unable to provide transportation for a Member, the provider must decline the trip using the Provider Portal. • Send backs are due two (2) business days prior to date of service. Example: A Member’s scheduled day of service is Monday, July 16th. Send backs are due Thursday, February 12th at 12:30 pm.

22. PROVIDER CREDENTIALING for Non-EMS Providers Southeastrans Confidential Material Nationally Accredited Driver Training for all non-EMS providers Background checks, Motor Vehicle Report (MVR), and drug screens Vehicle Inspections Review of Insurance coverage Office of Inspector General (OIG)/System for Award Management (SAM) Exclusion List Verification of IHCP active status Business Documents – EIN, W9, etc.

23. PROVIDER CREDENTIALING for EMS Providers (ambulances only) Southeastrans Confidential Material Review of Insurance coverage OIG/SAM Exclusion List Verification of IHCP active status EMS License Business Documents – EIN, W9, etc. NO driver training or vehicle inspections

24. CLAIMS Southeastrans’ goal in processing provider payments is to provide accurate and timely payment to NEMT providers for services rendered while minimizing or eliminating the potential for billing fraud. All claims should be submitted via the iPortal.

25. PROVIDER IPAD USAGE Southeastrans Confidential Material • Trip assignment via provider web portal • Electronic signature capture (driver and member) • Real time trip status • Pick-up and drop-off verification • Geo coordinates • Time stamps • Auto generated electronic claim • Vehicle locator feature – NET Notes • Mapping functions • Messaging options

26. PROVIDER IPAD USAGE Southeastrans Confidential Material Minimum trips required for iPad use Effective December 1, 2018, all current providers must be credentialed with Southeastrans Effective January 1, 2019, all providers must use iPads or other electronic tablet. New providers MUST be credentialed within 60 days of signing a provider agreement Contact Kristy Swoveland at 765-602-6004 or Kswoveland@Southeastrans.com with any questions.

27. IMPORTANT CLAIMS REMINDER Eligibility for payment for trips is dependent upon the provider’s active status with IHCP. Should a Provider become inactive with IHCP, they will be ineligible to receive payment from Southeastrans.

28. SUBMITTING A PAPER REIMBURSMENT FORM The paper Trip Reimbursement Form (TRF) is only to be used by a provider in the event that the iPad is down. Completed original forms should be bundled by driver and vehicle date and submitted to Southeastrans on a weekly basis for processing provider payments. Payments for trips with illegible or incomplete information may be denied and returned to the NEMT Provider for correction and resubmission. All information recorded on the Trip Reimbursement Form is required or is essential for accurate payment of trips rendered. All information recorded must be true and accurate under penalty of violation of State or Federal Medicaid laws and regulations.

29. SUBMITTING CLEAN CLAIMS All Trip Reimbursement Forms (TRFs) must meets the following requirements: • The provider, driver, and vehicle information is complete and accurate • The driver and vehicle are authorized by Southeastrans • The form or e-form is signed by the driver • Each trip must include a valid Southeastrans pre-authorized trip leg ID number • The Member’s name must match Southeastrans trip confirmation information • The provider must be the assigned NEMT provider for the member as listed on the manifest • The member signed the form or e-form (or if the member is unable to sign, a healthcare provider representative’s signature is present). If the Member and/or the healthcare provider refuse to sign, the driver should record the name of the person refusing to sign and the reason given for refusal to sign. • Pick-up and drop-off times and mileages are present • If there is an escort, the escort’s name, signature, and relationship to the member is provided • NET provider is requesting reimbursement for the authorized mode of transport, unless a change in the mode of transportation was pre-approved by Southeastrans. • Any required special rate documentation is attached with prior authorization included in the trip notes

30. SUBMITTING CLEAN CLAIM CONT. Do not use white out/correction tape/correction fluid, etc. Usage will cause a final denial with no rights to an appeal. Illegible claims could lead to a potential claim denial.

31. RESUBMITTING A CORRECTED CLAIM AFTER DENIAL To resubmit a trip to the Reconciliation Department for review and payment: • Print the Virtual Trip Reimbursement Form (VTRF) from the iPortal or pull the paper Trip Reimbursement Form (TRF) for the trip. • Review the TRF, make the necessary corrections, and initial the changes before resubmitting. • Fill out the claims review Cover Sheet for Indiana (shown here). • Note: Be sure to include the driver input error and provide an explanation in the “Issue Comments” section. • Submit the VTRF or TRF and the Cover Sheet by fax or email as indicated on the Claims Review Cover Sheet. For detailed instructions, review the Indiana Reimbursement Guide.

32. 1500 FORM REQUIREMENTS In addition to the standard CMS-1500 requirements, providers are required to submit the following: • Actual Pick-up Time • Actual Pick-up Odometer Readings • Actual Drop-off Time • Actual Drop-Off Odometer Readings • Southeastrans Trip Leg ID- provided in Box 23 • Explanation of Benefit (EOB) - only if applicable* This information may be written/placed on the actual 1500 Form, or you can provide a Patient Care Report (PCR). The Patient Care Report is not required however some find it more easier to send. *Please note: If Box 11-D is checked yes or it is found that the member has another health insurance plan you must include the EOB (Explanation of Benefits). IF Box 11-D is checked no or it is found the member has no other insurance plan, the PCR (Patient Care Report) is not required.

33. FSSA UPDATES Southeastrans Confidential Material BT201835 - Dually Eligible Members BT201845 - Revised process for scheduling NEMT (Temporary Return to Non-Brokered Status) BT201844 - Hospital to Hospital Transport BT201842 - 9-1-1 Dispatch BT201848 - Credentialing Requirements BT201847 - Gas Reimbursement Program Update

34. Key Contacts

35. Questions