What goes with a transportation TAR
The Medi-Cal provider manual asks for a legible prescription (or a signed order sheet for people in an institution) that states the purpose of the trip, how often or on which dates the rides are needed, and the medical or physical condition that rules out ordinary transport. For ongoing rides it must show the condition is chronic and include a treatment plan; a diagnosis alone, such as “stroke,” is not enough.
Modifiers belong on the TAR as well as the claim, up to four of them, and they must match for the claim to be paid. TARs for non-emergency transport go to the TAR Processing Center.
The one exception
Transport from an acute care hospital to a long-term care facility needs no TAR, prescription or signature. Every other non-emergency transport billed to fee-for-service Medi-Cal does.
TAR vs PCS
Managed care plans use the PCS form and their own authorizations; the TAR is for trips billed straight to Medi-Cal. Providers with questions about TARs can call the Medi-Cal Telephone Service Center at (800) 541-5555.
Related terms
- Prior authorizationPrior authorization is the payer’s approval of a ride before it happens.
- Physician Certification Statement (PCS form)A Physician Certification Statement (PCS) is the form a member’s provider signs to prescribe NEMT.
- Medi-Cal NEMT billing codes (HCPCS)HCPCS codes are the billing codes for each service on a claim.
- 837P claim (CMS-1500)An 837P is the standard electronic file for a professional health care claim, and the CMS-1500 is the paper form with the same content.
Sources
Checked on . Rules change: check the current version with the payer before you bill.