Transportation Provider Manual

TRANSPORTATION PROVIDER MANUAL

Overview

Part of Fidelis Care’s Mission is to remove the obstacles members face in accessing medical care.

Many of our members struggle with transportation to their medical appointments. Fidelis Care covers

non-emergent transportation in applicable counties for members active in the following health insurance

products:

 New York Medicaid - Rockland County only

 Wellcare by Fidelis Care Dual Access

 Wellcare by Fidelis Care Medicare Assist

 Wellcare by Fidelis Care No Premium

 Essential Plan 1, 2, 3, 4, and 200-250

 Qualified Health Plans (Ambetter from Fidelis Care)

The non-emergent transportation benefit covers round-trip transportation from the member’s home to

medical appointments with in-network providers located. This may include public

transportation or scheduled trips by livery, ambulette, or ambulance.

Members may not use their benefit to schedule transportation services for another person. If a member

requires an attendant, or if a child is a member of the plan, transportation is covered for the escort.

Discharges from hospitals or transfers to non-emergent facilities, skilled nursing homes, or

rehabilitation centers are also included in this benefit.

The Fidelis Care Transportation Department can schedule trips for members as early as one month in

advance, and no later than 4 PM the business day prior to the requested date of service.

 Fidelis Care at Home/ Wellcare Fidelis Dual Plus members must schedule non-emergent medical

transportation through Medical Answering Servics (MAS), and transportation is covered by

Medicaid Fee for Service.

Please note: Transportation to and from Social Adult Day Care (SADC) facilities will continue to be

covered by Fidelis Care if the transportation is provided by the SADC. All other forms of transportation

would need to be arranged using the information below and is covered by Medicaid Fee-For-Service.

Provider Expectations

 Providers are expected to retain assigned trips unless they must cancel for

reasonable circumstances.

 Providers are not to service members without a prior authorization.

 Provider cancelations/re-routes must be made before 6 PM the business day prior to the date of

service.

 Fidelis Care will make every effort to prevent same-day cancellations. However, when same-

day cancellations occur, the member and provider affected will be notified as soon as possible.

 Fidelis Care will schedule pickup times 60 to 90 minutes prior to the member’s appointment,

depending on the destination. This allows a 30 to 60 minute window for members to arrive to their

appointments on time.

 If drivers arrive early for the pickup, they must wait until the scheduled pickup time, plus an

additional 10 minutes. If a member cannot be located and is considered a “No Show,” the

provider should report this by calling the Transportation Department at 1-888-FIDELIS (1-

888343-3547).

 Members must be taken to their appointments on time, regardless of the number of passengers

combined into a single vehicle.

 Members must be picked up within 45 to 60 minutes of the requested return ride home.

 Providers shall provide same-day service for urgent, non-life-threatening appointments as

requested by Fidelis Care or Fidelis Care’s after-hours service.

 Providers shall provide pharmacy stops for members when a prescription pickup is needed. The

pharmacy stop is not considered an additional leg and can be added to a trip without additional

paperwork. Members are advised to have prescriptions called in ahead of time or to just drop a

prescription script off, as a transportation provider will only wait 15 minutes at the pharmacy

location. Please note that the pharmacy stop should be on the way to the member’s home

or next scheduled destination.

 Providers must comply with all applicable requirements of Article 19-A of the Vehicle and Traffic

Law and Part 6 of the Commissioner’s Regulations issued by the New York State Department of

Motor Vehicles.

Manifest

The Manifest will be sent via email or fax every day at 4 PM. If a provider must re-route trips, they must

call the Transportation Department no later than 6 PM the day prior to the scheduled trip. There are two

types of trips on the Manifest:

1. New: These are new scheduled trips. Trips can be scheduled as early as 1 month in advance.

2. Cancelled: Any cancelled trip for future dates.

Personal Assistance, Escorts, and Carry-Downs (From the NYS Medicaid Program Transportation

Manual Policy Guidelines)

The Medicaid Program requires the transportation company staff to provide physical assistance to the

ambulatory and non-ambulatory (wheelchair-bound) Medicaid enrollees in:

 Walking, climbing, or descending stairs, ramps, curbs, or other obstacles.

 Opening and closing doors.

 Accessing an ambulette vehicle.

 Removing obstacles to ensure Medicaid enrollees move safely.

There is no separate reimbursement for the escort of a Medicaid enrollee. Transport for necessary

escorts is provided by the ambulette service at no additional or enhanced charge.

The Medicaid Program DOES NOT limit the number of stairs or floors that a provider must climb in

order to assist a Medicaid enrollee. The staff must transport the enrollee from his/her front door

(including apartment door, nursing home room, etc.), no matter where it is located, to the door of the

medical practitioner from whom the enrollee is to receive Medicaid-covered medical services.

 
 
Non-Emergent Transportation Benefit for Each Health Insurance Product 
New York Medicaid (NYM) 
Non-emergent transportation for Fidelis Care members has transitioned from Fidelis Care to fee-for-
service Medicaid in all counties, except for Rockland County. Prior authorization requests and claims 
for non-emergent transportation for members outside of Rockland County should be directed to 
LogistiCare Solutions or Medical Answering Service. Providers and members can contact the agency 
corresponding to their county listed at 
https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_PA_Guidelines_Contact_List.p
df  
Rockland County: 
Fidelis Care uses AIM Byisroel, Inc., as the vendor to arrange transportation for Medicaid members 
living in Rockland County. This includes livery and ambulette service. Members or providers can reach 
AIM Byisroel at 845-354-5900. Please note, if a member needs to be transported by ambulance, Fidelis 
Care’s Transportation Department must authorize and schedule the trip. 
HealthierLife Health and Recovery Plan (HARP) 
Non-emergent transportation is covered by Fidelis Care in Rockland County (please see NYM benefit for 
Rockland County transportation information). Prior authorization requests and claims for non-emergent 
transportation for members residing in all other counties should be directed to LogistiCare Solutions or Medical 
Answering Service. Providers and members can contact the agency corresponding to their county listed at  
https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_PA_Guidelines_Contact_List.p
df  
Managed Long Term Care / Fidelis Care at Home / Wellcare Fidelis Dual Plus (MLTC/LTC/MAP) 
 
Non-emergency medical transportation services for members enrolled in Fidelis Care at Home/ Wellcare 
Fidelis Dual Plus plan will be arranged by the Statewide Transportation Broker - Medical Answering Services 
(MAS) and covered by Medicaid Fee-For-Service. 
 
Please note: Transportation to and from Social Adult Day Care (SADC) facilities will continue to be covered by 
Fidelis Care if the transportation is provided by the SADC.  All other forms of transportation would need to be 
arranged using the information below and would be covered by Medicaid Fee-For-Service. 
 
To arrange non-emergency medical transportation on or after March 1, 2024, the provider or the member must 
contact MAS at https://www.medanswering.com/ or call 844-666-6270 (Downstate) or 866-932-7740 (Upstate). 
If possible, transportation arrangements should be made at least three days before the medical appointment.  
MAS will require the provider or member to provide the appointment information (date, time, address, and 
name of provider) and the member’s Medicaid identification number. 
 
Contact Information for Questions 
 
  please contact https://www.medanswering.com/ or  
call 844-666-6270 (Downstate) or 866-932-7740 (Upstate).  
 
Additional information is  available on the Department of Health Transportation Webpage.  
 
 
 

Wellcare by Fidelis Care Medicare Assist

Fidelis Care will cover routine transportation services by livery to medical providers when a member

needs to receive medical services, and to pharmacies when members need to pick up prescriptions.

Wellcare by Fidelis Care Dual Access

The Fidelis Dual Access plan provides ten (10) one-way trips by livery per calendar year to medical

appointments. Once the benefit has been exhausted, members should contact Medicaid fee-for-

service transportation services. Medical justification is required with any request for routine

transportation by ambulance. Prior authorization is required except if a member is being transported

by livery.

Wellcare by Fidelis Care No Premium

Non-emergent transportation by livery or ambulette is not covered. Non-emergent ambulance services are

covered with prior authorization if a member has a documented medical condition that requires

transportation by ambulance and other means of transportation are contraindicated (could endanger the

person’s health). Prior authorization is required for network and out-of-network non-emergent ambulance

services to ensure the services meet Medicare coverage guidelines.

Essential Plan 1,2 and 200-250

Non-emergent transportation is not covered. Non-emergent facility transfers by ambulance are covered with

prior authorization only if the member’s medical condition requires transportation by ambulance and other

means of transportation could endanger the person’s health.

Essential Plan 3 and 4

Non-emergent transportation for Essential Plan 3 and 4 includes personal vehicle, bus, taxi, ambulette, or

public transportation to medical appointments. Providers or members must call the vendor listed below to

arrange transportation:

 New York City (Bronx, Brooklyn, Manhattan, Queens, Staten Island): Medical Answering Service, 1-

844-666-6270

 Long Island (Nassau and Suffolk): LogistiCare, 1-844-678-1103

 All other counties: Medical Answering Service, 1-800-850-5340

You can access this information online at:

https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_PA_Guidelines_Contact_List.

pdf

Qualified Health Plans (Ambetter from Fidelis Care)

Fidelis Care covers non-emergent ambulance transportation by a licensed ambulance service (either ground

or air ambulance, as appropriate) between facilities when transportation is any of the following:

 From a non-participating hospital to a participating hospital

 To a hospital that provides a higher level of care that was not available at the original hospital

 To a more cost-effective acute-care facility

 From an acute-care facility to a subacute setting

Claims and Billing Guidelines

Fidelis Care will only pay claims that are billed using the accepted NYS Medicaid procedure codes. These

codes will be reimbursed at the rate set forth by NYS Medicaid. Please call Fidelis Care if you are unsure

of the codes you are permitted to bill, or reference the New York Medicaid Programs Provider Manual

under Transportation at:

https://www.emedny.org/ProviderManuals/Transportation/index.aspx.

Prior authorization from Fidelis Care is required for transportation services under specific plans.

Provider Access Online

Fidelis Care wants you to have the tools and resources you need to provide your customers and our

members the transportation services they deserve. Our new enhanced provider portal, Provider Access

Online, is a critical part of Fidelis Care's efforts to increase efficiency and expand services to our

providers.

Provider Access Online benefits include:

 Download capabilities for your Remittance Advice statements

 Ability to perform claim-status inquiries

 Electronic submission of claim appeals

 Member eligibility search capabilities

 Ability to check authorization status

Provider Access Online is available at providers.fideliscare.org. If you have trouble logging into your

account, please call 1-888-FIDELIS (1-888-343-3547).

Remittance Advice

A Remittance Advice can be obtained by logging onto Provider Access Online. Providers who need

assistance obtaining their ID and password can contact their local Provider Relations Specialist for

assistance.

The Remittance Advice identifies which members and services are covered by a particular check. Claims

are listed in alphabetical order according to the member’s last name. Each item in the list includes the

following:

 Fidelis Care claim number as assigned by Fidelis Care

 Member's name

 Member's Fidelis Care ID number

 Provider's name

 Date of service

 Procedure code

 Patient account number

 Denied amount

 Allowed amount

The Remittance Advice should be examined to reconcile payments from Fidelis Care with accounts

receivable records.

Fidelis Care Claim Inquiry

To check the status of claims processed more than 3 months ago, please go to Provider Access Online.

You can also call us at 1-888-FIDELIS (1-888-343-3547) Monday through Friday, from 8:30 AM to 5:00 PM.

Electronic Fund Transfer (EFT)

Providers can request to receive payments electronically if they meet the following criteria:

 Participating provider

 Submitting claims electronically for at least two months

 Receiving remittances and/or rosters electronically

 Agrees to receive all payments in an EFT format: claims, capitation, and QCMI (if applicable)

 Agrees to receive other communication electronically

If you would like to receive Electronic Funds Transfers, please complete the EFT Enrollment form located at

Electronic Funds Transfer.

For lost or missing transactions, please view the following PDF for instructions: Missing EFT Payment. Stop

Payment and Reissue of Checks

To request a stop payment and the reissue of a check, the request must be sent in writing to the following

address:

Attn: Finance Department Fidelis Care

25-01 Jackson Ave.

Long Island City, NY 11101

The written request must have the following information:

 A completed and notarized affidavit; the affidavit form is found in Section 12A of the provider

manual Affidavit of Lost/Stolen/Destroyed Check.

 The contact person and phone number

 Verification of the correct remittance address for the check

 Who the check was made payable to, if known

Submitting Claims

Timely Filing

All claims must be submitted to Fidelis Care within the time frames specified by your Fidelis Care provider

contract. Claims for services provided to Fidelis Care enrollees must be submitted within ninety (90) days.

Acceptable reasons for a claim to be submitted late are: litigation, primary insurance processing delays,

retroactive eligibility determination, and rejection of the original claim for reason(s) other than timely filing.

Late claims must be accompanied by proof of prior billing to another insurance carrier or a letter that

specifies an acceptable reason for the delay.

Electronic Claim Submissions (837P – Health Care Claims)

Fidelis Care recommends using the Electronic Data Interchange (EDI) system for submitting claims.

Electronic claims submissions can help reduce administrative and operating costs, expedite the claim

process, and reduce errors.

Fidelis Care accepts claims originating from clearinghouses. Please contact your preferred clearinghouse to

confirm that they will forward your submitted claims to Fidelis Care or email the Fidelis Care EDI team at

hipaa-edi_team@fideliscare.org.

If you are currently submitting more than 200 claims per month to Fidelis Care, please contact us at 1-

888-FIDELIS to learn more about your electronic claim-submission options.

If you have more questions about beginning to submit claims electronically to Fidelis Care, please email

the Fidelis Care EDI team at hipaa-edi_team@fideliscare.org.

General Information for Claims Submission

Receiver Name: Fidelis Care

Fidelis Care Receiver ID: 113153422

Fidelis Payer ID: 11315

Electronic Remittance Advices (835 – Health Care Claim Payment/Advice)

Fidelis Care offers secure electronic delivery of Remittance Advices. You may receive these either

through your claims clearinghouse or directly from Fidelis Care.

For clearinghouse delivery, please contact your clearinghouse for availability.

If you would like to receive the HIPAA-mandated 835 Electronic Remittance Advice directly from Fidelis

Care, please complete the Fidelis Care eCommerce Request form located at Electronic Data Trading

Form.

Paper Claim Submission

Mailing addresses for paper claim submission can be found below:

Claim Forms

Providers must submit claims within ninety (90) days. Most providers should use the CMS 1500 claim

form. Hospital-based ambulance companies and some day care centers may submit form UB-04.

Form CMS1500 can be found at:

https://www.fideliscare.org/Portals/0/Providers/FormsApplications/CMS-1500.pdf

Form UB-04 can be found at:https://www.fideliscare.org/Portals/0/Providers/FormsApplications/2018-

FidelisCare-Form-UB04-English.pdf?ver=2018-08-02-141549-243

Claim Requirements

Prior to submitting a claim to Fidelis Care, you must have the following information:

1) Member information requirements

 Member ID number

 Member last name

 Member first name

 Member date of birth

 Member address: street, city, state, zip

2) Provider information requirements

 Transportation company name

 Appropriate transportation provider ID number for county served

 Company address: street, city, state, zip

 Zip code: pickup zip code and drop-off zip code (Required for paper claims in box 32, A and B.

For electronic claims please work with claims submission vendor)

3) Claim information requirements:

 Patient account number - (invoice number, if there is one)

 Diagnosis code - Fidelis Care will accept a generic ICD-10 diagnosis code as long as it is a

valid code if the exact diagnosis is unknown

 Units: 1=one-way trip, 2=round trip, 3=second stop at provider’s office, 4=two round trips on the

same date of service and number of miles (enter total miles traveled)

4) Total charges

5) Procedure code

Corrected Claim

If a provider disagrees with the payment determination, the provider can submit documentation

supporting additional payment for the claim. Corrected claims must be submitted within sixty (60) days of

the remittance advice for that claim. If Fidelis Care does not receive a request for a corrected claim within

sixty (60) days of the remittance advice for that claim, the provider shall be deemed to have waived all

rights to assert that the claim is incorrect.

A corrected claim is a claim that has any changes made to an original claim previously submitted. It can

include, but is not limited to, changes to the following:

 Date of service

 Place of service

 Procedure codes - including adding or removing modifiers

 Diagnosis billed

 Units per service

 Dollar amounts

 Provider status changed

 Provider specialty change

 Provider tax ID number change

Corrected Claims Address:

Attn: Corrected Claims

Fidelis Care

480 CrossPoint Pkwy.

Getzville, NY 14068

Electronic Submission of Corrected Claims

When submitting a corrected claim electronically, the original claim number must be submitted and the

claim frequency type code must be a “7” (replacement of prior claim). Please go to Fidelis Care’s website

at fideliscare.org for additional information. Please note that corrected claims must be submitted within

sixty (60) days of receiving the remittance advice.

How to Submit Claims for Same Member, Multiple Trips, Same Day

When multiple trips are scheduled for the same member for the same day, please add up the trips and

mileage, and submit one service line for total trips, and a second service line for total miles. If tolls are

included, add up the tolls for a third service line.