CurrentFidelis CarePolicy N/A
Non-emergent Transportation Policy
Governs coverage, vendor arrangements, provider expectations, scheduling, and billing processes for non-emergent medical transportation for Fidelis Care members in New York; affects providers, transportation vendors, and members (with county-specific rules).
Policy Summary
PayerFidelis Care
PolicyNon-emergent Transportation Policy
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionProviders must not service members without prior authorization where required; obtain prior authorization from Fidelis Care for applicable transportation services.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
RocklandCounties with direct coverage
90 daysTimely filing period
Jan 1, 2025SADC change (MLTC)
200+/moElectronic claims threshold
60 daysCorrected claim window
Coverage Criteria
Plan-specific coverage criteria
Coverage varies by product and county; key rules by product are listed below.
New York Medicaid: Fidelis Care transitioned non-emergent transportation to fee-for-service Medicaid in all counties except Rockland; prior authorization requests and claims for members outside Rockland should be directed to LogistiCare Solutions or Medical Answering Service (MAS).
Rockland County Medicaid: Fidelis Care uses AIM Byisroel, Inc. to arrange livery and ambulette services; ambulance trips for Rockland members must be authorized and scheduled by Fidelis Care's Transportation Department.
Managed Long Term Care / Fidelis Care at Home / Wellcare Fidelis Dual Plus (MLTC/ILTC/IMAP): Non-emergency transportation is arranged by the statewide broker Medical Answering Services (MAS) and covered by Medicaid Fee‑For‑Service; arrange at least three days in advance when possible and provide appointment details and the member's Medicaid ID to MAS.
Wellcare by Fidelis Care No Premium: Non‑emergent transportation by livery or ambulette is not covered.
Essential Plan 1, 2 and 200–250: Non‑emergent transportation is not covered. Non‑emergent facility transfers by ambulance are covered only with prior authorization when medically necessary (other means would endanger the member's health).
Essential Plan 3 and 4: Non‑emergent transportation (personal vehicle, bus, taxi, ambulette, or public transportation) is covered; members or providers must call MAS at the county-specific numbers to arrange service (e.g., 1‑844‑666‑6270 for Richmond/Suffolk/Westchester; 1‑866‑932‑7740 for other counties).
Qualified Health Plans (Ambetter from Fidelis Care): Fidelis Care covers non‑emergent ambulance transportation between facilities when one of the specified conditions is met (from non‑participating to participating hospital; to a more cost‑effective acute‑care facility; to a hospital providing a higher level of care not available at the original hospital; or from acute‑care to a subacute setting).
Claims submission and processing criteria
Provider must follow these submission and documentation requirements for claims to be accepted and processed:
Timely filing: Submit standard claims within 90 days of service; acceptable reasons for late submission include litigation, primary insurance processing delays, retroactive eligibility determination, or rejection for reasons other than timely filing; late claims must include proof of prior billing or a letter specifying the acceptable reason.
Claim forms: Providers must submit claims within ninety (90) days. Most providers should use the CMS‑1500 claim form; hospital‑based ambulance companies and some day care centers may use UB‑04. Ensure required member, provider, and claim information is included (member ID, name, DOB, provider ID, transportation company details, pickup/drop‑off ZIPs, procedure code, units, total charges, etc.).
Electronic submission and EDI: Fidelis recommends using EDI (837P) and accepts clearinghouse‑originated claims. Providers submitting more than 200 claims per month should contact Fidelis for electronic options. The Fidelis EDI receiver ID is provided for electronic submissions; contact clearinghouse for setup and ERA (835) delivery options.>200 claims/month
Remittance advice (ERA/835): Providers can receive 835 electronic remittance advice via their clearinghouse or directly from Fidelis Care by completing the eCommerce request form or working with their clearinghouse vendor.
Corrected claims: Submit corrected claims within 60 days of the remittance advice. Corrected claims are any changes to a previously submitted claim (e.g., date of service, procedure codes/modifiers, place of service, diagnosis, dollar amounts, units, provider identifiers). When submitting corrected claims electronically, include the original claim number and use claim frequency type code '7' (replacement).60 days
Multiple trips same member same day: For multiple trips scheduled for the same member on the same date, aggregate trips and mileage and submit a single service line with the total miles and appropriate units.
Coding and Timely Filing
Billing codesmixed
| Claims must be billed using accepted NYS Medicaid procedure codes and will be reimbursed at NYS Medicaid rates. |
Diagnosis codingICD-10
| ICD-10 | Generic ICD-10 diagnosis code accepted if exact diagnosis unknown |
Timely filing window
Timely filing windowClaims must be submitted within 90 days of service; late claims require an acceptable reason (e.g., litigation, primary insurance delays, retroactive eligibility, or rejection for reasons other than timely filing) and must include proof of prior billing or a letter explaining the delay.
Contractual timeframeAll claims must be submitted within the time frames specified by the provider's Fidelis Care contract.
Documentation for late claimsLate claims must be accompanied by proof of prior billing to another carrier or a letter specifying the acceptable reason for delay.
Corrected claim frequency type code
Frequency type code for corrected claimsUse claim frequency type code '7' to indicate a replacement of a prior claim when submitting corrected claims electronically.
Include original claim numberWhen submitting a corrected claim electronically, include the original claim number with the replacement submission.
Submission deadline related to remittance adviceCorrected claims must be submitted within 60 days of the remittance advice for that claim.
Provider Responsibilities and Actions
Prior Authorization
Manifest and Trip Management
Providers are expected to retain assigned trips unless cancelling for reasonable circumstances. If a provider must re-route or cancel an assigned trip, the provider must notify the Transportation Department no later than 6:00 PM the day prior to the scheduled trip. Providers must not service members without prior authorization where required by the member's plan.
- Manifest is sent daily via email or fax at 4:00 PM.
- Manifest trip types: New — newly scheduled trips (can be scheduled as early as one month in advance); Cancelled — trips cancelled for future dates.
- If re-routing trips, call the Transportation Department by 6:00 PM the day prior to the trip.
- Providers must comply with Article 19-A of the Vehicle and Traffic Law and NYS DMV Part 6 regulations and provide same-day service for urgent, non-life-threatening appointments when requested.
Billing Rule
EFT Enrollment and Lost Payment Procedures
Participating providers may enroll to receive payments via Electronic Funds Transfer (EFT). To be eligible, providers must be participating, receive remittances/rosters electronically, submit electronic claims for at least two months, and agree to receive all payments and communications electronically.
- Complete the EFT Enrollment form available at Fidelis Care's EFT Enrollment web page.
- For lost or missing EFT payments, follow the instructions in the "Missing EFT Payment: Stop Payment and Reissue of Checks" PDF.
- To request stop payment and reissue of a check, submit a written request to: Attn: Finance Department, Fidelis Care, 25-01 Jackson Ave, Long Island City, NY 11101.
- Written requests must include: a completed and notarized affidavit (see Section 12A of the provider manual: Affidavit of Lost/Stolen/Destroyed Check), verification of the correct remittance address, a contact person and phone number, and who the check was made payable to (if known).
Key Definitions
Non-emergent transportation
DefinitionNon-emergent transportation refers to scheduled, non-urgent trips for medical appointments, including livery, ambulette, and facility-to-facility transfers as specified by plan and county.
Examples of modesIncludes livery, ambulette, and ambulance (facility transfers) depending on plan and county arrangements.
Plan/county variationCoverage and vendor arrangements vary by product and county; e.g., Fidelis Care administers services in Rockland County, while other counties may be served via Medicaid Fee-For-Service or statewide brokers.
SADC transportation
DefinitionTransportation to/from Social Adult Day Care (SADC) facilities provided by the SADC remains a covered benefit under Fidelis Care when the transportation is provided by the SADC.
MLTC change effective Jan 1, 2025As of January 1, 2025, under MLTC plans SADC-managed transportation remains a covered benefit and all SADCs will be responsible for managing their own transportation (they may use their own vehicles or contract with vendors).
Other transportation arrangementsAll other forms of SADC member transportation not provided by the SADC must be arranged using the statewide broker information and are covered by Medicaid Fee-For-Service.
Electronic Data Interchange (EDI)
DefinitionElectronic Data Interchange (EDI) refers to electronic submission of claims (e.g., 837P) to Fidelis Care to reduce errors and expedite processing.
Clearinghouse acceptanceFidelis Care accepts claims originating from clearinghouses; providers should confirm with their clearinghouse that claims will be forwarded to Fidelis Care or contact the Fidelis Care EDI team.
High-volume contact thresholdProviders submitting more than 200 claims per month should contact Fidelis Care to learn about electronic claim-submission options.
Electronic Remittance Advice (835)
DefinitionElectronic Remittance Advice (835) is the HIPAA-mandated electronic remittance advice file used to deliver payment and remittance information.
Delivery optionsProviders can receive the 835 via their claims clearinghouse or directly from Fidelis Care by completing the Fidelis Care eCommerce Request form.
Clearinghouse coordinationFor clearinghouse delivery, providers should contact their clearinghouse to confirm availability and setup.
Corrected claim
DefinitionA corrected claim is any claim with changes made to an original claim previously submitted (examples include date of service, procedure codes/modifiers, place of service, diagnosis, dollar amounts, units, or provider identifiers).
Submission timeframeCorrected claims must be submitted within 60 days of the remittance advice for that claim.
Electronic submission requirementsWhen submitting a corrected claim electronically, include the original claim number and use frequency type code '7' to indicate a replacement claim.
Policy Summary
PayerFidelis Care
PolicyNon-emergent Transportation Policy
Policy CodePolicy N/A
Change TypeNo material changes
Effective DateN/A
Next Review DateN/A
Key ActionProviders must not service members without prior authorization where required; obtain prior authorization from Fidelis Care for applicable transportation services.
SourceLink
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