Payments

• Key Points:

  • Coverage Requirements: MCPs are required to cover NEMT and NMT services for members to obtain medically necessary Medi-Cal services.

  • Provider Enrollment: Transportation providers must be enrolled as Medi-Cal providers to receive reimbursement.

  • Reimbursement Rates: MCPs must ensure that reimbursement rates for NEMT and NMT services are consistent with Medi-Cal FFS rates, unless otherwise negotiated.

  • Documentation and Billing: Providers must maintain appropriate documentation to support claims for reimbursement and comply with billing requirements as outlined in the Medi-Cal Provider Manual.

• Reference: APL 22-008

• Key Points:

  • Reimbursement Methods: MCPs may use various methods, such as gas cards or prepaid cards, to reimburse members for gas mileage when private conveyance is used for NMT.

  • Provider Responsibilities: Clarifies the responsibilities of MCPs and providers in coordinating and reimbursing transportation services.

• Reference: APL 22-008 FAQ