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Inter-facility Transport Provider Bulletin- Update

April 25, 2022

Beginning May 1, 2022, Wellcare of North Carolina will have a new non-emergency medical transportation (NEMT) vendor, Medical Transportation Management, Inc. (MTM). One Call, our current vendor, is leaving NEMT but will continue to provide transportation for our members through May 1, 2022.

The below information describes how inter-facility transport will work for Wellcare NC members.

Emergency inter-facility transport (A0427 and A0429):

  • Medical benefit managed by WellCare; do NOT need to call MTM to schedule; can schedule directly with ambulance provider
  • Claims filed to WellCare Health Plan
  • Prior authorization NOT needed

For questions related to Emergency inter-facility transport please contact your Provider Relations representative, email NCProviderRelations@wellcare.com or leave a voicemail for Provider Relations at 984-867-8637.

Non-emergent inter-facility transport (A0426 and A0428):

  • NEMT benefit managed by MTM, a contracted vendor of Wellcare.
  • Call MTM at 877-598-7602 to schedule; do NOT call ambulance provider directly to schedule.
  • If trip is >75 miles one way or out of state (40+miles from border), MTM will submit prior authorization request to Wellcare before scheduling trip.
  • Claims filed to MTM through their provider portal; if claim is filed to Wellcare it will deny and indicate that it needs to be submitted to MTM.
  • Transports that were dispatched as emergency but downgraded to non-emergency will be paid in accordance with the Medicaid Ambulance Fee Scheduled and/or Published Rates, if all other requirements are met, including appropriate documentation. Prior scheduling with MTM will not be required in these instances.

For questions related to non-emergency inter-facility transport please contact Tavis Keats at MTM at TKeats@mtm-inc.net.