Why NEMT operators need to let IT solutions perform their billing functions




Millions of people rely on Medicaid to provide and meet their medical and healthcare needs and requirements. For many of those covered by Medicaid, who number slightly above 76.3 million as of June 2021 according to official figures, getting to a health facility requires them to call on the various Non-Emergency Medical Transportation (NEMT) operators to ferry them to their destination.

The NEMT services are particularly crucial for Medicaid beneficiaries who cannot comfortably use public or private transportation means to their healthcare provider and instead need either an ambulance, wheelchair van, or litter van to get to their preferred medical facilities. For this group of Medicaid beneficiaries, their journey to the healthcare facility and from the provider’s premises back to their residences is handled by an NEMT operator, all in an effort to ensure comfort and safety for the beneficiary.

Once the Medicaid beneficiary (or patient) has been safely delivered to and brought back from the healthcare provider, the NEMT operator then bills Medicaid to reimburse them for the transportation service(s) offered to the eligible beneficiary(ies) within a given period.

Proper billing is important. It not only ensures efficiency and that the reimbursement by Medicaid is done promptly but also protects the NEMT operator from penalties, fines, and (or even) possible backlisting by Medicaid that may come as a result of irregular billing.

And to help NEMT operators prepare and submit clean, proper and correct bills to Medicaid, iSi Technology developed NYBillPro, a cost-efficient and easy-to-learn software platform which eliminates errors and ensures that NEMT operators are satisfactorily reimbursed for their services.

With NYBillPro, NEMT operators are to save on time and related costs related the billing process while at the same time enhancing their overall productivity as the platform handles the various hurdles related to Medicaid billing.

Being a Web-based solution, NYBillPro requires no downloads or installations on the part of the NEMT operator and is also a cross-platform solution, enabling the user to access their account from any device of their choice. It also comes in handy when issues of Claims correction arise and also imports data automatically, thereby ensuring the data is accurately downloaded and imported. And the operator is also saved from the hassle of tracking and following up on pending payments as it the platform has an   auto remittance resolution feature to handle such cases.

To ensure that the two parties in the exercise – that is the Medicaid beneficiary and NEMP operator – are all satisfied by the service (beneficiary) and adequately compensated (NEMT operator), each US State has rules and regulations which operators have to follow and abide by as well as the various categories of Medicaid beneficiaries or enrollees who are eligible for NEMT services.

In New York, the beneficiaries covered by fee-for-service transportation (or NEMT services) include: Medicaid enrollees; Medicaid/Medicare dually eligible enrollees; most Medicaid managed care enrollees; Health and Recovery Program (HARP) enrollees; HCBS Waiver participants; and enrollees of the State offices of Mental Health and for Persons with Developmental Disabilities among other groups.

The specific, most cost effective and medically appropriate mode of transport appropriate for a beneficiary has to be assessed and approved by medical professional, who also has to provide the mobility–related reason why the enrollee requires the preferred mode of transportation while visiting a healthcare provider of facility.

Because regulations and limitations differ in every jurisdiction, the iSi Technology team has consistently strived to ensure that it develops the preferred Medicaid Billing Software for NEMT companies in New York as state-based Medicaid programs have to be aligned to each state’s own Medicaid policies and also meet specific standards instituted by the federal authorities.

Working with the needs of NEMT operators in mind, the iSi Technology team therefore designed a New York Medicaid transportation software by focusing on all the unique and specific aspects of the New York City Medicaid policy. The process was meant to ensure that billers and transportation companies try out and settle on the NYBillPro software to perform their crucial business operations without any challenges.

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