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Community Services – Medical Transportation Providers

FACILITIES PROCEDURE TO SCHEDULE NON-EMERGENCY MEDICAL ASSISTANCE TRANSPORTATION (NEMT)

The following procedure is to be used when a facility needs to schedule non-emergency transportation services for a Medical Assistance (MA) patient for doctor’s appointments, transferring clients to an advanced level of care and hospital-related services such as admissions, discharges and transfers, when no other transportation resource is available.  Butler Medical Transport (Butler) is contracted with the Carroll County Health Department (CCHD) to provide these transports.

 These procedures pertain only to non-emergency transports-NOT 911 emergencies.

 When the facility needs to schedule transportation services for an MA patient:

Weekdays 8:00am-4:00pm:

  1. Call the CCHD at 410-876-4813 and email or fax 410-876-4957 the required documentation to schedule a transport.

                        Required Documentation:

  • Complete Transport Certification, Out of Area, or Transfer/Discharge Forms as appropriate, for each transport request.
  •  Patient face sheet -Please note the EVS confirmation number on the face sheet or print and send eligibility confirmation page.
  1. The CCHD will validate the paperwork provided and schedule the transport with the vendor.
  2. The CCHD will contact the facility to confirm scheduled pick up time.

Weeknights 4:00pm-8:00am, Weekends and Holidays:

  1. Call 410-876-4813 and leave a message on voice mail indicating a transport was scheduled and email or fax 410-876-4957 the required documentation.
  2. Call Butler 410-602-4007 or 888-602-4007 to schedule the transportation.
  3. Email or fax 800-602-4006 the required documentation.

                       Required Documentation:

  • Complete Transport Certification, Out of Area, or Transfer/Discharge Forms as appropriate, for each transport request
  • Patient face sheet – Please note the EVS confirmation number on the face sheet or print and send eligibility confirmation page.
  • Physician’s Medical Necessity Certification
  1. Butler will provide scheduled pick up time.
  2. CCHD will validate the paperwork provided the next business day after transport.

The pickup window is 10 minutes before or after the scheduled pick-up time.  Please ensure the patient is ready.

The response time for Ambulance, Wheelchair and Ambulatory pick-up is typically 2 hours from receipt of completed paperwork.  However, Ambulance transports take priority and may delay wheelchair and ambulatory response times.

Bariatric Ambulance transports require a minimum 4 hours’ notice (more is always better).

The following information is needed to schedule non-emergency transportation services for Medical Assistance patients:

  • First and Last Name of patient/recipient
  • Home Address of patient/recipient
  • Home Phone Number of patient/recipient
  • Date of Birth of patient/recipient
  • MA # of patient/recipient
  • Social Security # of patient/recipient
  • Caller’s name
  • Caller’s contact #
  • Mode of transport- Ambulatory, Wheelchair, or Ambulance BLS, ALS ,SCT
  • Pertinent info about patient needs such as O2, Hoyer lift, Monitoring, Room #, Floor #, weight, etc.
  • Facility where patient is to be picked up
  • Address of pick up facility
  • Phone # of the contact at the pick-up facility
  • Destination for the patient/recipient
  • Why they will be going to that location (This information is needed to determine whether this is a covered transport through the MA Program).
  • Address of destination facility/residence
  • Phone # of the contact at the destination facility

Additional information may be required to determine transportation eligibility.

Payment for transportation remains the facilities or patient’s responsibility until MA eligibility is verified by the CCHD for the date of transport.

If the facility does not leave a message with the CCHD, prior to transport, authorization may not be provided. If authorization is not provided, the facility, recipient or transportation provider will be billed for the transport.

For your convenience, click on the appropriate form for a fillable, e-signature Transport Certification, Out of Area, or Transfer/Discharge Fillable Distant Transport Certification    Fillable PCF        Fillable PCF Transfer and Discharge Form e signature

For more information, please call the NEMT Transportation Program Manager at 410-876-4813.