Non-emergency medical transportation — provider certification statements

Frequently asked questions

Introduction

To ensure that a Medi-Cal Managed Care (Medi-Cal) beneficiary is being transported in the most appropriate mode of transportation, a completed Physicians Certification Statement (PCS) is required for all non-emergency medical transportation (NEMT) requested through ModivCare for Anthem members. Upon receiving a PCS form, physicians must complete the form and submit it back to ModivCare within two business days. Anthem expects contracted providers to respond to ModivCare timely.

Content:

• Q: Who is ModivCare?
  • A: ModivCare manages and arranges non-emergency medical transportation for Medi-Cal beneficiaries who are Anthem members.
• Q: Where can a member or provider obtain a PCS form?
  • A: The PCS form can be found online: https://providers.anthem.com/california-provider/resources/forms
• Q: How can a member, Independent Physician Association/Primary Medical Group (IPA/PMG), or contracted provider request NEMT?
  • A: A completed PCS form is required for members to access NEMT. Members or providers can call 877-931-4755 to arrange for authorized transportation through ModivCare. The form can be found online: https://providers.anthem.com/california-provider/resources/forms
• Q: Who can complete a PCS form?
  • A: PCS forms can be completed and signed by the member’s physician or physician extender (including physician assistants [PAs], nurse practitioners [NPs], certified nurse midwives [CNMs], physical therapists, speech therapists, occupational therapists, and mental health or substance use disorder providers), or discharge planner who is employed or supervised by the hospital, facility, or physician’s office.
• Q: The IPA/PMG is not delegated for NEMT nor is financially responsible for providing NEMT. What are the expectations of delegated medical groups and physicians in respect to non-emergency medical transportation?
  • A: Anthem is responsible for providing non-emergency medical transportation through the vendor, ModivCare. IPA/PMGs and contracted providers are expected to sign and return requests for outstanding PCS forms to ModivCare within two business days.
• Q: If an IPA/PMG or primary care physician has not established care with the member in question, who should return the provider certification statement (PCS) form?
  • A: A member’s assigned primary care physician is not required to complete the provider certification statement form. PCS forms can be completed and signed by the member’s physician or physician extender (including physician assistants [PAs], nurse practitioners [NPs], certified nurse midwives [CNMs], physical therapists, speech therapists, occupational therapists, and mental health or substance use disorder providers), or discharge planner who is employed or supervised by the hospital, facility, or physician’s office.
• Q: The member resides in a skilled nursing facility and has not seen the assigned PCP. Does the assigned PCP need to complete the form, or can the skilled nursing facility provide the signature?
  • A: A member’s assigned primary care physician is not required to complete the provider certification statement form. PCS forms can be completed and signed by the member’s physician or physician extender (including physician assistants [PAs], nurse practitioners [NPs], certified nurse midwives [CNMs], physical therapists, speech therapists, occupational therapists, and mental health or substance use disorder providers) or discharge planner who is employed or supervised by the hospital, facility, or physician’s office.
• Q: If a member requires ongoing or regular NEMT, what forms must be completed?
  • A: When members require recurring or frequent NEMT, a Standing Order form must be completed along with a PCS form. A Standing Order can be arranged by calling the reservation line, online for select facilities and members, or by fax by completing a Standing Order form along with a completed PCS form.
• Q: When is a Standing Order form needed?
  • A: A Standing Order form is used when a member requires recurring or frequent NEMT. A Standing Order allows for a one-time request for NEMT for two or more days per week for at least three months. A Standing Order is valid for three months and will be recertified by ModivCare’s staff to make sure the trip continues to be necessary. The member’s treating facility or provider is responsible for responding to ModivCare outreach when attempting to verify the service need.
• Q: If a member and provider confirm that NEMT is not or no longer required, how do IPA/PMGs and contracted providers inform ModivCare?
  • A: Providers and delegates can notify ModivCare if NEMT is no longer required by email at CAExceptions@modivcare.com.

For more information pertaining to ModivCare or to access forms and other frequently asked question, visit modivcare.com/facilities/ca/.