Non-Emergency Medical Transportation (NEMT) and travel coverage
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Governance of Alaska Medicaid travel benefits, prior authorization requirements, and coverage criteria for arranging member travel including NEMT, escorts, and emergency transportation; affects Alaska Medicaid members, referring and receiving providers, and transportation coordinators.
No material clinical or coverage changes in this revision.
Travel Coverage Criteria
inv-01: Travel coverage authorization criteria
Coverage of travel services requires that each trip meet all five specified components and follow program rules; transportation benefits are only available when no personal or voluntary options exist and travel is for an Alaska Medicaid covered service.
ALL of the following must be met
- Medicaid Benefit Status: Member must be eligible for Alaska Medicaid on the date of the requested service and have a benefit plan that includes travel.
- Provider Enrollment: Both the referring and receiving providers must be enrolled with Alaska Medicaid (exceptions include military/VA and emergency situations where the member was transported to the closest acute care hospital that could meet their needs).
- Covered Service: Travel must be for an Alaska Medicaid covered service (examples: diagnostic, therapeutic, preventive, therapy, discharge, behavioral health/SUD/inpatient psychiatric/Title 47/court-ordered, or escort services as specified).
- Closest, Most Appropriate Provider: Transportation must be to the closest most appropriate provider able to meet the member's needs; Alaska Natives may be approved to travel to the nearest tribal facility; this requirement does not apply to travel within a member's home community.
- Medical Necessity: The healthcare service(s) must be reasonable, necessary, and appropriate based on evidence-based clinical standards; medical necessity standards established by the Department of Health or by standards of practice applicable to the ordering or referring provider apply.
inv-02: Core coverage criteria
Five required components must be met before authorizing travel:
Establish all five components
- Medicaid Benefit Status: Member eligible for Alaska Medicaid with travel benefit on the date of service.
- Provider Enrollment: Referring and receiving providers enrolled with Alaska Medicaid (military/VA and emergency exceptions apply).
- Covered Service: Service must be an Alaska Medicaid covered service.
- Closest, Most Appropriate Provider: Travel is to the closest appropriate provider able to meet the member's needs; Alaska Natives may go to nearest tribal facility; excludes travel within the member's home community.
- Medical Necessity: Service(s) must be reasonable, necessary, and appropriate per evidence-based clinical standards or applicable provider licensure standards.
inv-03: Therapy treatment plan guidance
Treatment-plan related criteria relevant to authorizing travel for therapy visits:
ALL of the following
- Treatment plan must include diagnosis, anticipated treatment goals, service type, and the amount, duration, and frequency of each service.
- Treatment plan maximum durations vary by therapy and age: typically up to <3 years in some instances (examples noted: 6 months, 1 year, 6 weeks depending on age/type); specific references: PT, OT, SLP rules (7 AAC citations) govern durations.
- Certain services are non‑covered (examples: maintenance therapy not related to developmental disability/delay, swimming therapy, therapy for physical fitness/weight loss, habilitation services, services provided by a therapy aide) and may not justify travel coverage.
- Prior authorization for travel related to therapy is conditional per the Therapy Billing Manual / Fee Schedule; verify PA requirements for each therapy type.
inv-04: Subsequent travel
Subsequent travel request criteria to streamline follow-up travel when prior documentation exists.
ALL of the following
- Applicability: Subsequent requests apply when Alaska Medicaid has previously paid for an initial travel event for the member and relevant documentation is already on file with the fiscal agent.
- Initial-trip requirement: If the member traveled initially on their own, the first Medicaid-requested trip must be submitted using an initial packet; subsequent requests can then use the streamlined second-request packet.
- Purpose: Subsequent requests are intended to simplify processing when the fiscal agent already holds documentation demonstrating the member's travel needs.
- Forms: Use the Out-of-Area Travel Service 2nd Request Fax Packet for subsequent requests (link provided in provider guidance).
inv-05: Travel authorization completion and documentation criteria
Provider must complete required fields on the Travel Authorization Fax Cover Sheet and supply supporting documentation; forms with incomplete provider, appointment, or out‑of‑area details are common reasons for return.
ALL of the following
- Complete required cover sheet fields: Include provider/facility names and NPIs in the correct sections (business/facility name and NPI in box 1; individual provider name and NPI in box 2), member contact and Medicaid ID, dates of travel, and appointment details.
- Submission timing and urgency: Submit requests at least 10 days prior to scheduled appointment when possible; mark URGENT only for travel needed within 3 days with treating provider attestation that delay would be detrimental.
- Documentation completeness: Fax requests with missing or insufficient documentation will be returned to the provider; common RTP reasons include incomplete provider information and missing appointment details in out‑of‑area sections.
- Fax failure alternative: If fax fails, email the packet only after obtaining and attaching at least two failed fax confirmations as attestation; include those confirmations with the emailed packet.
- Helpful practices: QA forms prior to submission, consolidate trips when possible, and include personalized medical necessity rationale; behavioral health providers should list their organization as requesting or receiving provider when applicable.
inv-06: Rate review project scope and deliverables
Guidehouse will conduct a rate and policy review for transportation services with defined deliverables and stakeholder meetings; final report submitted to Alaska DOH.
Codes and Treatment Plan Attributes
| No codes listed |
| ADT S00210 | Meals (example code listed on form) |
| AD1 B0HDVAD200HD | Lodging - Permaternal Home (form lists lodging codes) |
Submission, Documentation, and Authorization Actions for Providers
Authorization Criteria Overview
Authorization Criteria Overview: Prior authorization for transportation and escorts requires establishing five components before a travel event can be authorized: (1) Medicaid Benefit Status — the member must be eligible on the date of service and have travel included in their benefit plan; (2) Provider Enrollment — referring and receiving providers must be enrolled with Alaska Medicaid (exceptions: VA/military and certain emergency situations); (3) Covered Service — the travel must be for an Alaska Medicaid covered service; (4) Closest, Most Appropriate Provider — travel must be to the closest appropriate provider able to meet the member’s needs (special rules for Alaska Natives and exclusion of local intra-community ground travel); and (5) Medical Necessity — the service and related travel must be reasonable, necessary, and appropriate per applicable standards of care. The department must be able to document compliance with each component prior to authorization.
- Medicaid Benefit Status: member eligibility and travel benefit on date of request.
- Provider Enrollment: both referring and receiving providers enrolled (exceptions apply).
- Covered Service: service must be covered by Alaska Medicaid.
- Closest, Most Appropriate Provider: transport to closest appropriate provider; tribal exceptions; local intra-community ground travel excluded.
- Medical Necessity: evidence-based standards; applies to services and products used to treat or prevent conditions.
Subsequent Travel Requests
Subsequent Request Process: Use a Subsequent Travel Request when Alaska Medicaid has previously paid for the member’s initial travel and the fiscal agent already holds required documentation. If the member’s first Medicaid-paid trip was requested using an initial packet or if the member traveled initially on their own (first Medicaid trip requires an initial packet), submit a subsequent request to simplify and expedite processing. Refer to the Travel Service 2nd Request Fax Packet for the required form and guidance.
- Subsequent requests apply only when Medicaid previously paid for the member’s travel.
- If the first Medicaid-paid trip used an initial packet, follow initial submission for that event; later trips may use the subsequent packet.
- Link to packet (provider extranet) must be used for form and detailed instructions.
Fax Cover Sheet and Return-to-Provider (RTP) Handling
Travel Authorization Fax Cover Sheet and RTP Handling: Submit travel requests by fax or telephone using the Travel Authorization Fax Cover Sheet. Requests should be submitted at least 10 days prior to the appointment; urgent travel is defined as travel needed within the next 3 days where delaying more than 3 days would be detrimental to the member’s health. The cover sheet includes indicators for new requests, updates to authorized travel (requires PA number and Travel Authorization Update Form), supplemental documentation, behavioral health/long-term care flags, and linkage to other members traveling together. Providers must attach the required Travel Packet and supporting documentation when faxing. Fax submissions that are missing or have insufficient documentation will be returned to the provider (RTP).
- Submit via Travel Authorization Fax Cover Sheet by fax or telephone.
- Requests should be submitted at least 10 days prior to the appointment; urgent = within 3 days with treating provider attestation.
- Use Update form and provide PA # when updating an authorized travel.
- Missing or insufficient documentation will be returned to provider (RTP).
Documentation Completeness Requirement
Documentation Completeness Requirement: All required documentation identified in the Medicaid Travel Request Packets and Documentation Guidance must accompany the submission. Incomplete packets or absent required attachments (including proof of at least two failed fax attempts when applicable — see alternate email attestation) will result in the request being returned to the provider for completion. Providers should coordinate appointments to minimize repeat trips and ensure documentation demonstrates lack of other transportation means and reasonableness of travel.
- Refer to Medicaid Travel Request Packets and Documentation Guidance for full required document list.
- Incomplete or missing documentation will cause RTP (returned to provider) and delay authorization.
- Documentation must show lack of personal means of transport and that travel is for a covered, medically necessary service.
Alternate Email Attestation for Fax Failures
Alternate Email Attestation for Fax Failures: If a provider is unable to successfully fax the Travel Packet to HMS, email submission is allowed only after the provider has obtained at least two failed fax confirmations. The provider must attach those two failed fax confirmations to the Travel Packet and include the following attestation in the emailed submission: confirmation that two failed fax attempts occurred and acknowledgement that email use is limited to instances of fax failure. Email requests and attachments should be sent to skservicesauthorizations@gainwelltechnologies.com as noted on the Fax Cover Sheet. Note that email submission is solely a fallback for fax issues and does not waive the required documentation completeness standard; requests sent by email with missing or insufficient documentation will be returned to the provider.
- Email allowed only after at least two failed fax confirmations are attached.
- Include attestation that email is used only because of fax issues.
- Email address for fallback submission as specified on Fax Cover Sheet.
- Emailed requests with missing/insufficient documentation will be returned to provider.
Key Terms and Definitions
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