19-770 Extra Payment for Ground Emergency Medical Transport
Date: 10/21/19
Extra Payment for Ground Emergency Medical Transport
You may receive a supplemental payment
You may receive a payment of up to $339* per service for non-contracted fee-for-service ground emergency medical transport (GEMT), for the following HCPCS codes during state fiscal years (SFYs) 2018–2019 from July 1, 2018, to
June 30, 2019:
· A0429 – Basic life support (BLS) emergency,
· A0427 – Advanced life support (ALS) emergency, or
· A0433 – Advanced life support, level 2 (ALS2) emergency
Supplemental payments may be extended into future fiscal years, and may include extra GEMT transport codes. A W-9 form is required for payment.
*If you have already been paid for past claims, your extra payment will be sent to you minus the amount you’ve already been paid for the claim. This will bring your payment total to the amount above.
Submit your W-9 form to get paid
A W-9 form is required for payment. After receiving the completed W-9 form, payments take about five weeks to process and send out. The W-9 form must include your:
· National Provider Identifier (NPI) – If two NPI numbers are used (individual and group), include both NPI numbers where space is available.
· Individual taxpayer identification number (TIN).
Example:
This communication includes a W-9 form. You can also download it from the Internal Revenue Service (IRS) website at www.irs.gov/pub/irs-pdf/fw9.pdf with complete instructions.
Send a current or updated W-9 by email or fax:
HNCA_W9_Submissions@CENTENE.COM (Clearly add the words “W9” in the subject line.) | |
FAX | 1-833-794-0423 (Include a cover sheet and clearly add the words “W9” and “PROTECTED HEALTH INFORMATION.”) |
Dual eligible
For dual eligible beneficiaries with Medicare Part B coverage, A0429 is the only HCPCS code in certain geographic areas where Medi-Cal reimbursement level may result in a crossover payment obligation.
GEMT definition
Ground emergency medical transport is defined as the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped, in accordance with applicable state or local statutes, ordinances, or regulations, excluding transportation by an air ambulance provider, that are billed with HCPCS codes A0429, A0427 and A0433.
Additional information
For additional information regarding the GEMT supplemental reimbursement program, refer to the Department of Health Care Services (DHCS) website at www.dhcs.ca.gov/provgovpart/Pages/GEMT.aspx.
For all other questions, contact California Health & Wellness Plan at 1-877-658-0305.