Medicaid Managed Care Non-Emergency Medical Transportation Provider Issue Resolution (IB 21-02 revised 11.13.24)

Date: 11/15/24

Revisions included:

Time Requirements: Provider has 365 days from the date of denial to correct and resubmit denied claims. A request for claim reconsideration review must be received from the provider within 180 calendar days of the Remittance Advice paid date or original denial date. A determination will made by the broker within 30 days of receipt.
How to Submit: Request may be submitted verbally, in writing or through the web portal (if applicable). The broker shall provide a reference number for all requests for claim reconsideration. This reference number can be used for claim appeals if necessar.
Except, per Act 204 of the 2021 Regular Legislative Session, mental health rehabilitation (MHR) service providers have the right to an independent review of an adverse determination by a managed care organization that results in a recoupment of the payment of a claim based on a finding of waste or abuse.

Providers are encouraged to review the entire bulletin for additional information.