Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA  02111
www.mass.gov/dma	

				MASSHEALTH
			TRANSMITTAL LETTER TRN-26
			April 2002 
	
     TO:      Transportation Providers Participating in MassHealth

	FROM:	Wendy E. Warring, Commissioner

	RE:	Transportation Manual  (Revised Service Codes)

This transmittal letter issues a new Subchapter 6 for the Transportation Manual, and reminds providers that the Division of Health Care Finance and Policy (DHCFP) has adopted new rates for Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance services, and chair-car services.  Only those services appearing in the revised Subchapter 6 of the Transportation Manual are covered services. 

Providers can obtain the new DHCFP ambulance and chair-car regulations (114.3 CMR 27.00) from DHCFP’s Web site, at http://www.mass.gov/dhcfp/pages/pdf/114.3_27.pdf.  The DHCFP regulations include the new fee schedule, service codes, and definitions.  

Effective April 15, 2002, claims for ALS and BLS services for dates of service on or after May 15, 2001, must be billed with the new codes or they will be denied.  Effective April 15, 2002, claims for chair-car services for dates of service on or after July 1, 2001, must be billed with the new codes or they will be denied.

Adjustments to Previously Paid Claims

Claims for ALS and BLS services with dates of service between May 15, 2001, and March 31, 2002, will be systematically adjusted by the Division if those claims were submitted with the old service codes and processed and paid by March 31, 2002.  Claims for chair-car services with dates of service between July 1, 2001, and April 14, 2002, will be systematically adjusted by the Division if those claims were submitted with the old service codes and processed and paid by April 14, 2002.  Providers will be responsible for ensuring that all other claims are submitted, resubmitted, or adjusted appropriately to ensure the correct payment rate.

			MASSHEALTH
			TRANSMITTAL LETTER TRN-26
			April 2002		
			Page 2

The retroactive systematic adjustments will be made as follows:

Old Code	Description	New Code	Description	
A0362	Ambulance service, BLS, emergency transport, one way	A0429	Ambulance service, basic life support, emergency transport (BLS–emergency)	
A0380	Ambulance service, BLS, per mile	A0425	Ground mileage, per statute mile	
A0360	Nonemergency transportation, BLS, one way	A0428	Ambulance service, basic life support, nonemergency transport (BLS)	
X0146	Nonemergency ambulance service, BLS, per mile	A0425	Ground mileage, per statute mile	
A0370 (I.C.)	Advanced life support service ($96.37 payment)*	A0426 or

A0427 	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) 
Ambulance service, advanced life support, emergency transport, level 1 (ALS 1–emergency) 
*For all ALS claims processed under Service Code A0370 that were paid at $96.37 and were indicated as a nonemergency transport, the claim will be adjusted to A0426. If the claim was indicated as an emergency transport, it will be adjusted to A0427.	
A0370 (I.C.)	Advanced life support service ($143.37 payment)	A0427	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1–emergency) 	
A0370 (I.C.)	Advanced life support service ($227 payment)	A0433	Advanced life support, level 2 (ALS 2)	
A0390	Advanced life support mileage	A0425	Ground mileage, per statute mile	
A0130	Chair car, one way (plus mileage)	A0130	Nonemergency transportation:  wheelchair van (chair car)	
X0174	Chair car, mileage per loaded mile, one way	X0174	Mileage for chair car, each way	
X0147	Chair car, each additional person, one way (no additional mileage allowed)	X0147	Chair car, each additional person, each way (no mileage fee allowed)	
X0153	Chair car, additional attendant (one way)	X0153	Second attendant, each way	

				MASSHEALTH
				TRANSMITTAL LETTER TRN-26
				April 2002
				Page 3

The systematic adjustments for ambulance services will be created as detailed above before the end of October 2002.  The adjustments will appear on a single remittance advice, along with any other claims that may be scheduled for payment in the weekly pay cycle.  In addition, the systematic adjustments for chair-car services will be implemented as detailed above.  The adjustments will appear on a separate remittance advice, along with any other claims that may be scheduled for payment in the pay cycle, before the end of October 2002.  Providers will receive the resulting payment as they would normally receive their MassHealth payment (by check or electronic funds transfer). 

Upon receiving the remittance advices containing the adjustment claims, providers will have 30 days from the date of the remittance advices to review the remittance advices for accuracy and notify the Division of any discrepancies.  If providers believe that an adjustment has resulted in a claim being underpaid, they must submit a letter detailing the underpayment and providing all supporting documentation (for example, a copy of the remittance advice with claim highlighted) to the following address:

Division of Medical Assistance
Andrea Costello
Attn: Ambulance and Chair Car Retroactive Adjustments 
600 Washington Street
Boston, MA 02111

If an adjustment has resulted in a claim being overpaid, providers must return the overpayment to the Division as required under the Division’s regulations (130 CMR 450.235).  Overpayments must be returned by preparing and submitting negative adjustment claims to Unisys.

New Service Codes and Billing Instructions

Claims for ALS services must now be billed with the applicable service code.  ALS claims will no longer suspend for pricing and, consequently, can be billed electronically or on paper without attachments.

Providers should note that the definition of Service Code X0165 has changed.  X0165, which was previously defined as “Each additional person, one way (no additional mileage fee allowed),” should now be used for transportation of an additional person, one way, in an emergency situation.  Claims for an additional person in emergency situations must be billed with Service Code X0165, and will suspend to the Division for the appropriate pricing at one-half the applicable base rate.  Transportation by ambulance of an additional person in a nonemergency situation is no longer a covered service.  

				MASSHEALTH
				TRANSMITTAL LETTER TRN-26
				April 2002
				Page 4

The following codes will be changed or eliminated as of April 15, 2002:	
		
X0165		Each additional person, one way (no additional mileage fee allowed)
X0163		Round‑trip nonemergency ambulance, same day (base rate)
X0173		Mileage for round-trip nonemergency ambulance, same day (after one mile)
X0166		Each additional person, round-trip (no additional mileage fee allowed)
X0150 		Round-trip, chair car (base rate)
X0175		Mileage for chair-car round-trip (after 10 miles)
X0151		Each additional person, round-trip (no mileage fee allowed)
X0154		Second attendant, round-trip

Round trips should now be billed as two units of the applicable service.

If you have any questions about the information in this transmittal letter, please contact MassHealth Provider Services at 617‑628‑4141 or 1-800-325-5231.

NEW MATERIAL
(The pages listed here contain new or revised language.)

Transportation Manual

Pages 6-1 and 6-2

OBSOLETE MATERIAL
(The pages listed here are no longer in effect.)

Transportation Manual

Pages 6-1 and 6-2 — transmitted by Transmittal Letter TRN-22

Commonwealth of Massachusetts
Division of Medical Assistance 
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-1	

TRANSPORTATION MANUAL
	
TRANSMITTAL LETTER

TRN-26	
DATE

04/15/02	

601  Service Codes and Descriptions:  Dial‑A‑Ride Services

Service
Code   	Service Description

X0137	One‑way dial‑a‑ride services (I.C.)
X0138	Round‑trip dial‑a‑ride services (I.C.)

602  Service Codes and Descriptions:  Taxi Services

Service	
Code   	Service Description

A0100	Nonemergency transportation:  taxi–intracity (one passenger)
X0141	Waiting time, after 40 miles round trip (per hour, maximum two hours)
X0143	Two or more passengers

603  Service Codes and Descriptions:  Chair‑Car Services

Service
Code   	Service Description

One-Way Trip

A0130	Nonemergency transportation:  wheelchair van (chair car)
X0174	Mileage for chair car, each way 
X0147	Chair car, each additional person, each way (no mileage fee allowed)
X0153	Second attendant, each way 

Commonwealth of Massachusetts
Division of Medical Assistance 
Provider Manual Series	
SUBCHAPTER NUMBER AND TITLE

6  SERVICE CODES AND DESCRIPTIONS	
PAGE

6-2	

TRANSPORTATION MANUAL
	
TRANSMITTAL LETTER

TRN-26	
DATE

04/15/02	

604  Service Codes and Descriptions:  Ambulance Services

Service 	
Code   	Service Description

		Ground Mileage

A0425	Ground mileage, per statute mile

Ambulance Service, Advanced Life Support

A0426	Ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1) 
A0427	Ambulance service, advanced life support, emergency transport, level 1 (ALS 1–emergency) 
A0433	Advanced life support, level 2 (ALS 2)
X0165	Additional person in emergency situation, advanced life support, level 1 (ALS 1) (I.C.)
X0165	Additional person in emergency situation, advanced life support, level 2 (ALS 2) (I.C.)

Ambulance Service, Basic Life Support

A0428	Ambulance service, basic life support, nonemergency transport (BLS)
A0429	Ambulance service, basic life support, emergency transport (BLS–emergency)
X0165	Additional person in emergency situation, basic life support (BLS) (I.C.)

605  Service Codes and Descriptions:  Other Licensed Carriers

Service
Code   	Service Description

A0110	Nonemergency transportation and bus, intra- or interstate carrier
A0140	Nonemergency transportation and air travel (private or commercial), intra- or interstate