Medicaid ensures eligible individuals have access to necessary medical services, which includes transportation to and from covered healthcare appointments. Generally, Medicaid enrollees are expected to utilize the same transportation methods they use for daily life. However, certain medical conditions may require specific transportation modes like taxis, ambulettes, or ambulances. In these cases, the Medicaid Transportation program aims to cover the most cost-effective and medically appropriate option, as verified by a healthcare provider.
A crucial update as of June 6, 2022, is the mandatory online submission of Form-2015 through the designated transportation manager’s online portal. It’s important to note that submissions via any other method will not be processed and will need to be resubmitted correctly through the online portal. This shift to “Fidelis Transportation Online” streamlines the process and ensures efficient handling of transportation requests.
Healthcare providers play a vital role in this process. They are required to complete the Verification of Medicaid Transportation Abilities form, known as Form-2015, to provide the necessary medical justification when a specific mode of transport is requested for a Medicaid enrollee.
For Form-2015 to be approved, several criteria must be met:
- Complete Submission: The form must be filled out in its entirety, leaving no sections blank.
- Clear Medical Justification: The diagnosis or medical condition necessitating the requested transportation type must be clearly and comprehensively described.
- Duration of Need: The anticipated timeframe for which the enrollee will require the specified mode of transport must be indicated.
Qualified licensed medical providers authorized to review and sign Form-2015 include:
- Physicians
- Physician Assistants
- Dentists
- Registered Nurses
- Nurse Practitioners
- Occupational Therapists
- Physical Therapists
- Licensed Master Social Workers (LMSW)
- Licensed Clinical Social Workers (LCSW)
- Mental Health Counselors
An approved Form-2015 can accommodate single trips, multiple trips, or even recurring appointments defined as standing orders. It’s essential for medical providers to update Form-2015 whenever there are changes to the enrollee’s medical status that might affect their transportation needs. It is important to understand that Form-2015 works in conjunction with, but does not replace, the requirement for obtaining prior authorization from the Department’s transportation manager. Form-2015 serves as supporting documentation for specific transportation mode requests during the prior authorization process.
Form-2015 submissions may face rejection under several circumstances:
- Incomplete Form: If the form is not fully filled out.
- Improper Signature: If the form is not signed and dated by an authorized medical provider using their unique NPI number.
- Unauthorized Provider Signature: If signed by a provider not listed among the authorized titles.
- Illegibility: If the form is unreadable.
- Inadequate Justification: If the medical justification fails to adequately support the necessity of the requested transportation mode.
- Diagnosis-Only Justification: If the justification only lists a diagnosis or code without detailing the individual’s ambulatory needs.
- Incorrect Submission Portal: If not submitted through the designated secure online portal.
For more detailed information, please consult the NYS Medicaid Program: Transportation Manual and the Medicaid Transportation – Verification of Medicaid Transportation Abilities (Form-2015) Policy and Procedure.
For any inquiries or concerns, individuals are encouraged to reach out to their Provider Relations Specialist. Contact details for designated representatives can be found at Contact Your Designated Provider Relations Specialist. This resource, often associated with “fidelis transportation online” queries, can provide further assistance.
