Non-Emergency Transportation (NEMT) services are recognized in Kentucky Medicaid as Provider Type (56) and may bill Kentucky Medicaid using this provider type number. To provide services to a Medicaid beneficiary, an NEMT provider must:
- be licensed
- be enrolled as a Kentucky Medicaid Provider
- be enrolled with the Managed Care Organization (MCO) of any beneficiary they wish to treat.
Medicaid covers only medically necessary transportation to and from a Medicaid-covered service, performed by a Medicaid enrolled provider.
What are Non-Emergency Ambulance Stretcher Transportation Services? Non-emergency stretcher ambulance services are covered if the eligible beneficiary is confined to a bed before and after the ambulance trip or the member must be moved only by stretcher to receive medically necessary Medicaid-covered medical services.
Non-Emergency Medical Transportation (NEMT) Non-emergency medical transportation is for Medicaid members who do not have access to free transportation that suits their medical needs and need to be transported to a Medicaid-covered service performed by a Medicaid enrolled provider.
For transportation outside a member's medical service area or for specialty care, a referral from the primary care physician is required.
Requesting Services: Non-emergency medical transportation services are available through the Human Service Transportation Delivery (HSTD) program a regional brokerage system. Depending on a member's medical needs, transportation is provided by taxi, van, bus or public transit. Wheelchair service also is provided if medically necessary. To find your regional broker, please see the HSTD Brokerage Listing. For program policies and complaints, contact the Office of Transportation Delivery at (888) 941-7433.
How do I verify eligibility? Once eligibility is determined, you may verify continued eligibility by one of the following methods:
- contact the automated voice response system at (800) 807-1301
- use the Web-based KYHealth-Net System
NEMT providers must meet the coverage provisions and requirements of 907 KAR 3:066. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Non-Covered Services: Services not considered medically necessary are not covered by Kentucky Medicaid.
Reimbursement: Reimbursement for transportation services is provided in Kentucky Medicaid Hearing Fee Schedule and defined in 907 KAR 3:066.
Duplication of Service: The department will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same time period.
FFS beneficiaries who require NEMT must call their broker to arrange transport. For MCO beneficiaries who require prior authorization for additional services that are medically necessary, contact the MCO for more information.
Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid fee for service claims. Each MCO processes its own claims.
Coding: Kentucky Medicaid utilizes the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15) Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied FFS claims must be submitted to Gainwell Technologies. The request must include the reason for the request and a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Claims Filing: Claims must be received within 12 months of the date of service or six months from the Medicare pay date whichever is longer, or within 12 of from the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Office of Transportation Delivery at (888) 941-7433
Prior Authorization - CareWise - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth.net assistance -Gainwell Technologies - (800) 205-4696
Provider MCO InformationAnthem - (800) 205-5870Aetna Better Health of KY - (855) 300-5528Humana - (855) 852-7005Molina - (800) 578-0775UnitedHealthcare Community Plan - (866) 293-1796
WellCare of KY - (877) 389-9457
KRS 281:870 Coordinated Transportation Advisory Committee
KRS 281:872 Program coordinators duties relating to eligibility for participation in human service transportation delivery program -- Resolution of complaints -- Penalties.
KRS 281:873 Definitions for this section and KRS 281.874- Determination of participants' eligibility for special carriers transport -- Escort or assistance for the person receiving transportation delivery services.
KRS 281:874 Freedom of choice for participants in human service delivery program -- Duties of a broker.
KRS 281:875 Administrative regulations governing human service transportation delivery program -- Requirement for documentation -- Preferential treatment by cabinet prohibited -- Handbook
KRS 281:876 Waiving of notice requirement with physician verification
KRS 281:877 Coordination of human service transportation delivery program with general public transportation
KRS 281:878 Prohibition against the imposition of requirements not provided by law
KRS 281:879 Penalties for violation of statutes relating to human service transportation delivery
907 KAR 1:060 Ambulance transportation
907 KAR 1:061 Payments for ambulance transportation
907 KAR 3:066 Nonemergency medical transportation waiver services and payments
907 KAR 3:130 Medical necessity and clinically appropriate determination basis
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