QUEST Integration – Transportation -–Ground (Non-Emergent)

Original Effective Date:

08/01/1994

Current Effective Date:

10/01/2021

HMSA has partnered with Modivcare to administer the NEMT benefit starting with July 1, 2025, service dates moving forward.

To request travel with Modivcare:

• Tripcare – Modivcare’s self-service tool https://www.modivcare.com/facilities/hmsa
• By phone by calling HMSA – QUEST Integration Provider Service.
  • Oahu – 808-948-6486, select option for “travel”.
  • Neighbor Islands – 1-800-440-0640 toll-free, select option for “travel.”

The availability of free transportation available through the patient’s own vehicle, as well as transportation provided by relatives, friends, volunteer services, and mass transit should be explored first. When no other transportation options are available, transportation may be authorized for patients requiring medical care but with no safe, appropriate means of obtaining that care. The most economical mode of transportation that best meets the individual circumstances of the patient when medically necessary as indicated by the patient’s PCP as documented through the medical necessity form.

Transportation benefits may include purchase of a bus pass, use of Handi-Van transportation, or rideshare (i.e., Uber or Lyft). Higher level mode of transportation or exclusion of a certain mode of transportation requires the completion and submission of a medical necessity form. Escorts are allowed only when determined to be medically necessary by the patient’s PCP or Health Coordinator.

The requesting provider must submit request for non-emergency transportation at least two business days before any scheduled travel to your appointment so we may make the patient’s transportation arrangements.

Ground Transport Discharges

Use the Request Trip tab in TripCare to request ground transportation on the member’s island.

For inter-island travel, use the Air, Meal, Lodging tab to request a trip.

Only if TripCare is unavailable, call in all ground discharges using the facility line at 1-833-283-6566.

Use the facility fax 866-475-5745 only when fax is needed/required.

Flight and Lodging Discharges

Use the Request Trip tab in TripCare to request ground transportation on the member’s island.

For inter-island travel, use the Air, Meal, Lodging tab to request the trip.

Only if TripCare is unavailable complete the Travel Request Form. Send the completed form to both AirOps@modivcare.com and DisPHXAfterhours@modivcare.com.

The facility is responsible for any updates to the member regarding changes in times or cancellations.

AMR for ALS/BLS Level of Service

Modivcare is not contracted to book ALS/BLS Services which include any services needing an EMT. For ALS/BLS Non-Urgent Request, please complete the following steps:

1. Confirm if pre-certification is needed based on the situations below:
   • If ground ambulance (any code for ground) is requested to go from lower level of care to higher level of care = NO PA
   • If ground ambulance (any code for ground) is requested to go from higher level care to lower level care = Requires PA
   • If ground ambulance (any code for ground) is requested for Facility to Facility Transfer for Routine Outpatient Services = Requires PA
   • If ground ambulance (any code for ground) is request for Discharge from facility to Home on Resident Island (including outer island) = Both Ground and Commercial Air (if outer island) require PA
   • For all other scenarios, please call 1-800-440-0640, option 3 provider, and then 4 for precertification to confirm if pre-certification needed.

For all ground ambulance scenarios that don’t require authorization, go to step 3.

2. If needed, please submit pre-certification using instructions located here. If prior authorization is approved move to step 3. If not approved, then you can coordinate with Modivcare for lower level of service.

   Do not coordinate with AMR if precertification not complete or not approved as the facility will be liable for those charges.

3. If no precertification needed or authorization obtained and approved, please coordinate with AMR directly by calling 808-531-0477, providing the member’s QUEST information, and letting them know to submit claim directly to HMSA.

Authorization of Services

Transportation to receive services that are not QUEST Integration benefits or that are not medically necessary will not be covered. Transportation will not be covered as a separate service for members living in Community Care Foster Family Homes (CCFFH), Adult Residential Care Home (ARCH), Expanded ARCH (E-ARCH), or domiciliary homes.

Multiple pick-ups are permitted in a single day; a request for each pickup must be submitted.

Pick-Up Definition: The act of taking aboard passengers from a location

EXAMPLE: A pickup is whenever a member is loaded into vehicle at location A to be dropped off at location B. If the member is picked up at location B and taken to location C or back to location A, this is a new pick-up.

Requests for transportation must include the following information:

• Reason for transportation
• If the medical service required prior auth, confirm the prior authorization was approved.
• Special equipment requirements
• Ambulation and mobility, including member’s ability to maneuver a wheelchair, and the degree of assistance needed.

Non-covered Taxi Charges

In keeping with city taxi ordinances, charges and payments for the following are excluded from QUEST Integration:

• No-show or cancellation charges
• Assistance of persons entering or leaving the vehicle
• Assistance of persons who use wheelchair or portable medical equipment such as oxygen concentrators or tanks.
• Cleaning the interior of the vehicle
• Waiting time
• Side trips, to include:
  • Pharmacy
  • Shopping
  • Visiting
  • Pick up or drop off for durable medical equipment or supplies.
  • Appointments for Supplemental Security Income (SSI) or Medicaid eligibility
  • Trips to classes, support groups, community events, etc., unless included as part of a patient’s plan of care by the Service Coordinator
• Mileage and/or time when the patient is not in the vehicle.
• General excise tax

Billing Information

The following will apply to service dates prior to July 1, 2025:

Mileage: When the mileage of a Non-Emergency Medical Transportation trip does not equate to a whole mile, providers are to round the mileage down if it is .49 miles and below; and are permitted to round up when mileage is .5 miles and above.

EXAMPLE: 1.4 miles = 1 mile ; 1.7 miles = 2 miles

Effective 10/1/21 Claims Billing Requirements have changed. We require that each leg of a trip be billed on a separate claim.

EXAMPLE: Pick-up at residence drop off at physicians’ office = 1 claim. Pick up from physician’s office drop-off at residence is another claim. In addition to the CPT Codes, pick-up and drop off address as well as the appropriate 2-digit modifiers need to be appended to the claim. This applies to both hard copy and electronic claim submissions. See pick-up and drop of modifier table and screenshots of claims for each leg below. NOTE: Claim examples DDE Application Electronic Submissions.

Starting with service dates July 1, 2025 forward, NEMT providers will coordinate reimbursement directly through Modivcare.

NEMT Provider Application

If you are interested in contracting as a Non-Emergency Ground Transportation (NEMT) Provider with HMSA, please contact Chad.Itagaki@Modivcare.com.