Prepaid Health Plans (PHPs) began providing non-emergency medical transportation (NEMT) and non-emergency ambulance transportation (NEAT) services for PHP members on July 1, 2021. For NC Medicaid Direct and Eastern Band of Cherokee Indian (EBCI) Tribal Option members, local Department of Social Services (DSS) offices will continue to provide NEMT and NEAT services.
PHPs have contracted with transportation brokers that work with public and private transportation providers to arrange and provide transportation for these members. The brokers are:
- ModivCare: AmeriHealth Caritas of North Carolina, Carolina Complete Health, Healthy Blue and UnitedHealthcare of North Carolina
- One Call: WellCare of North Carolina
If you are assisting a member with arranging transportation, the member will need to contact the PHP Member Services line on their Medicaid ID Card or the member scheduling line for the transportation broker directly.
If a transportation provider has questions about scheduling trips, they will need to contact the transportation broker directly.
Transition of Care Protections
To help ensure continuity and access to care during this transition, if a provider fails to schedule NEMT or NEAT transportation through the broker for the first 60 days after NC Medicaid Managed Care launch (through Aug. 30, 2021), the PHPs and their transportation brokers will honor those trips and pay NEMT and NEAT providers equal to that of in-network providers.
- ModivCare: Transportation provider shall submit a W-9, Account Setup Agreement, and the trip information (run sheet, driver log, etc.) to ModivCare securely at firstname.lastname@example.org or may request authorization by calling 855-397-3604. Providers may request the Account Setup Agreement using the same email address or phone number. If an Account Setup Agreement has already been established by transportation provider, only the trip information (run sheet, driver log, etc.) is needed to authorize.
- One Call: Transportation provider shall complete a 30-Day Referral Agreement and provide their Atypical ID/NPI/Medicaid ID (NCTracks approval for private transits), W9 and Certificate of Insurance. Providers can request the 30-Day Referral Agreement by emailing or calling Nick LoPiccolo at the contact information below. If the Referral Agreement needs to be extended beyond 30 days, only a signature is required. Private transits will also need to provide driver and vehicle rosters. If a provider has received a direct request for transportation (not through One Call), the provider should contact One Call immediately to verify approval of NEMT to ensure scheduling and processing of claims. To help providers better understand the scheduling process after the transition period, One Call recommends that transportation providers contact One Call to ensure scheduling and processing of claims.
Contracting with Transportation Brokers
NEMT and NEAT contracting is an ongoing process. All NEMT and NEAT providers are strongly encouraged to contract with both transportation brokers to ensure PHP members have adequate access to care. Transportation providers not yet contracted with one of our transportation brokers still have the opportunity to contract with each broker. Contact information is below.
Emergent Care Reminder
For emergent ambulance transport, ambulance providers do not need to schedule transportation through the transportation broker and will submit claims for payment directly to the member’s PHP.