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Family Member/Associate Transportation Providers

The Indiana Health Coverage Programs (IHCP) allows a family member or close associate of a Medicaid member to officially enroll as a driver, so the driver's mileage can be reimbursed. This option is appropriate for members who must make frequent trips for medical services and who have a person willing and able to transport them, but doing so presents a financial burden.

Note: This enrollment process is for individual family members or associates. It is not appropriate for entities that operate a transportation business or that are already enrolled with the IHCP as another type of transportation provider. However, an IHCP-enrolled nonemergency transportation (NEMT) common carrier transportation provider can enroll as a family member or associate driver using their individual name.


Enrollment Process for Family Member or Associate Drivers

The following processes and guidelines apply to family member or associate drivers enrolling with the IHCP:

  1. The Medicaid member you are transporting must request your enrollment by completing the Medicaid Family Member or Associate Transportation Services Form (link is provided in step 3). Reimbursement is restricted to transportation for the specific member completing the form. If you drive more than one family member, you need to enroll only once, but your enrollment must include a separate request form from each Medicaid member you will be driving.
     
  2. You, the individual driver, must apply for enrollment with the IHCP as provider type 26 – Transportation; provider specialty 266 – Family Member.

Reminder: This provider specialty is for individuals only. If you have a transportation business or are already enrolled with the IHCP as another type of transportation provider, you would have to enroll under this specialty with your individual name.

You can enroll online or by mail as follows (see the Provider Enrollment module for more information):

Online: If enrolling online, follow these steps:

A. Go to the Provider Healthcare Portal.

B. On the Portal home page, click the Provider Enrollment link.

C. On the Provider Enrollment page, click the Provider Enrollment Application link.

D. On the Welcome page, click Continue to continue with the new enrollment.

E. In the Initial Enrollment Information section on the Provider Enrollment: Request Information panel:

i. Select Billing from the Provider Classification drop-down box.

ii. Select 26: Transportation Provider from the Provider Type drop-down box.

iii. Select New Enrollment from the Enrollment Request Type drop-down box.

F. Enter all remaining required information on the Provider Enrollment: Request Information panel.

G. Click Continue and follow the steps to complete the Addresses panel. On the Specialties panel, select specialty 266.

H. Click Continue to go to the Provider Identification panel and continue completing the sections as indicated.

I. Finish completing the application following online instructions and submit.

J. At the end of the application process, the provider will be prompted to upload supporting documentation. (See step 3).

By mail: If enrolling by mail, complete an IHCP Family Member or Associate Transportation Provider Enrollment and Profile Maintenance Packet. The form can be completed electronically and then printed for mailing. All required documentation must be mailed with the application, as described in the remaining steps.

  1. You must submit the following documents with your IHCP enrollment application (either online or by mail):
    • A copy of the Medicaid Family Member or Associate Transportation Services Form – completed and signed by the requesting Medicaid member
    • A copy of your current driver's license
    • A copy of your current auto insurance for the vehicle being used
    • A copy of your current auto registration for the vehicle being used
    • A W-9 tax form

Note: The Medicaid Family Member or Associate Transportation Services Form can be completed electronically by clicking the link provided and filling in the information. The completed form can then be printed for mailing with the printed application and other required documents, or saved as a PDF to be attached to the online Portal enrollment.

Be sure to keep a copy of all submitted documents for your records.

  1. Submit the application and supporting documentation according to the online Portal instructions or, if enrolling by mail, send the packet and other required documentation to the following address:

IHCP Provider Enrollment Unit
P.O. Box 7263
Indianapolis, IN 46207-7263

  1. The enrollment application will be reviewed for completeness and accuracy. If any information is missing or needs correcting, the IHCP Provider Enrollment Unit will contact you by telephone, email, fax, or mail.
     
  2. Please allow at least 15 business days for processing. An email will be sent notifying you when your enrollment is completed. The Provider Enrollment Unit will notify you by mail of your enrollment status.

Keeping Your IHCP Enrollment Up to Date

The information that identifies and describes you as an IHCP provider is called a provider profile. The provider profile includes the information you gave in your original enrollment application. You are responsible for keeping all the information in your provider profile up to date. These updates can be submitted by mail using the same packet that is used for enrollment, or providers can create a registered account on the Portal and submit the updates online. The following must be reported:

  • Changes to your name, address, telephone number, or other contact information
  • Changes or updates to your driver's license, vehicle registration, or vehicle insurance coverage, including providing copies of these documents when those on file with the IHCP expire

Every 5 years, you will be asked to revalidate your IHCP enrollment. You may voluntarily disenroll from the IHCP at any time online (if you have a Portal account) or by mail (submitting an IHCP Provider Disenrollment Form).


Trip Scheduling and Reimbursement Process

All transportation provided by family member or associate drivers must be managed through the Medicaid member's transportation broker. After you are successfully enrolled with the IHCP as a family member or associate driver, the Medicaid member's transportation broker will contact you to finalize any paperwork needed so that you can begin scheduling trips and submitting claims for reimbursement.

Before transporting a Medicaid member, authorization for the trip must be obtained from the member's transportation broker. This authorization will include information that is required for payment. The documentation and reimbursement processes will be defined by the member's transportation broker. Information required for payment may include but is not limited to:

  • Name of the Medicaid member being transported
  • Member's Medicaid ID
  • Name of the enrolled driver
  • Mailing address of the enrolled driver
  • Relationship of the driver to the member
  • Driver's Social Security number
  • Driver's telephone number
  • Trip date
  • Trip authorization number
  • Number of miles authorized
  • Name, telephone number, and signature of the medical provider
  • Signature of the Medicaid member

The transportation brokers for Healthy Indiana Plan (HIP), Hoosier Care Connect, and Hoosier Healthwise members vary depending on the member's health plan (Anthem, CareSource, MDwise, MHS, or UnitedHealthcare). Each transportation broker has its own process for scheduling trips and reimbursing mileage. Check the managed care entity (MCE) websites for transportation broker contact information.

The transportation broker for Traditional Medicaid members is Southeastrans. The general process for scheduling rides and submitting reimbursement requests with this broker is as follows:

  1. Before the appointment, the member must contact Southeastrans at 855-325-7586 to get approval for both legs of the trip (transportation to the appointment and transportation back home).
     
  2. Southeastrans will provide the member with a pre-populated Indiana Gas Reimbursement Form, along with instructions. The member must take the form to the appointment and have the medical provider fill out and sign the section to document the first leg of the trip. The member must fill out and sign the section to document the return leg of the trip. The driver completes the remaining information on the form. Both the driver and the member must sign the bottom of the form.
     
  3. The completed form can be faxed to Southeastrans at 678-510-1352 or mailed to the following address for payment:

Southeastrans
Attn: Claims
4750 Best Rd. Suite 300
Atlanta, GA 30337

 

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