Commonwealth of Massachusetts
Executive Office of Health and Human Services
Office of Medicaid
600 Washington Street
Boston, MA  02111
www.mass.gov/masshealth
	MassHealth
	Transportation Bulletin 15
	April 2008




	TO:	Transportation Providers Participating in MassHealth

	FROM:	Tom Dehner, Medicaid Director 

	RE:	Specialty Care Transport (Service Code A0434)  


Background	MassHealth now pays for specialty-care transport (Service Code A0434). 
Specialty-care transport is an ambulance transport of a critically injured or 
ill member from one hospital to another. In order to qualify for specialty-
care transport, the member must require a level of care that is beyond the 
scope of a paramedic, as defined in the National EMS Education and 
Practice Blueprint. Specialty-care transport is necessary when a person’s 
condition requires ongoing care that must be furnished during transport 
by one or more health professionals in an appropriate specialty area (for 
example, nursing, emergency medicine, respiratory care, cardiovascular 
care, or care from a paramedic with additional training).
										

Documentation		When the transport does not include additional staff from the originating 
Requirements 		facility, the ambulance provider must include documentation in the trip logs
and notes, that the credentials of the paramedic on duty are appropriate as 
identified in the Department of Public Health’s Office of Emergency Medical 
Services regulations. When the transport includes additional staff from the 
originating facility, the ambulance provider must include in the trip logs and 
notes, the names, titles, and signatures of the additional staff.
	

New Billing 	Effective March 1, 2008, for dates of service beginning September 1, 2005, 
Requirements 	ambulance providers can bill for specialty-care transport by using Service 
Code A0434. MassHealth will reprocess all claims for services provided  
before March 1, 2008, that were billed and denied for Service Code A0434. 

For specialty-care transport services provided after September 1, 2005, 
that were billed and paid under a different ambulance service code, 
providers can submit adjustment paper claims or a void/replace     
transaction under HIPAA guidelines for those claims within 12 months  
from the date of service, or within 18 months from the date of service if   
there is an explanation of benefits (EOB) from a primary insurer attached 
to the claim.                                              
		
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New Billing 	For such claims that are beyond 12 months from the date of service, or
Requirements 	beyond 18 months from the date of service if there is an EOB from a 
(cont.)                                      primary insurer attached to the claim, the provider needs to file an 
                                               appeal to MassHealth’s Final Deadline Appeal Board. The Final Deadline 
                                               Appeal Board has exclusive jurisdiction to review appeals submitted by 
                                               providers of claims for payment that were, as a result of a MassHealth 
                                               error, denied or underpaid, and that cannot otherwise be timely 
                                               resubmitted.
                                                              
For additional information on the appeal submission process, please see 
the information about appeals of erroneously denied or underpaid claims 
in the MassHealth billing regulations (beginning at 130 CMR 450.323). 

For all reprocessed and adjusted claims, providers will need to include 
the documentation requirements as noted above.
	

Questions	If you have any questions about the information in this bulletin, please 
contact MassHealth Customer Service at 1-800-841-2900, e-mail your 
inquiry to providersupport@mahealth.net, or fax your inquiry to 
617-988-8974.
.  


			MassHealth
			Transportation Bulletin 15
			April 2008
			Page 2