Billing

PrimeWest Health ambulance providers bill PrimeWest Health directly for transport services.

Billing Requirements

1. Use the electronic 837P format
2. Use the HCPCS code that best describes the services rendered. Use the code that reflects the level and type of service provided, not the type of vehicle used
3. Use appropriate modifier(s) on both base and mileage claim lines
4. Bill the most direct mileage, rounded only to the nearest mile (e.g., for .6 miles to .9 miles, round up to the next mile; for .1 to .5 miles, round down to the closest number of miles)
5. Bill miles only when transporting a qualified passenger
6. Do not use zone or regional mileage calculations
7. Use commercially available software or Internet-based applications to determine the most direct mileage route

Mileage Billing

Bill the destination and return trip on separate lines. Enter the same modifiers used for the base rate code on the mileage claim lines. Billing is limited to two base limits per line.

Example of billing lines:

Place of Service Codes

41 – Ambulance Land
42 – Ambulance Air or Water
99 – Place of service for special transportation

HCPCS origin and destination codes (for more than one modifier on the same line item, the first position indicates the origin and the second position indicates the destination)

PrimeWest Health-Administered Non-Emergency Medical Transportation (NEMT) Services (Modes 2 – 7) Documentation Requirements

Retain transportation records for five years from the date the service is first billed to PrimeWest Health.

Trip documentation sheets must be consistent with the following MN Stat. 256B.0625, subd. 17b, requirements:

1. The record must be in English and must be legible according to the standard of a reasonable person
2. The member's name must be on each page of the record
3. Each entry in the record must document the following:
   1. The member’s name and PrimeWest Health member ID number.
   2. The date, or dates, the service is provided if different than the date the entry was made.
   3. The printed name of the driver sufficient to distinguish the driver of service and also the driver’s UMPI number.
   4. The date and signature of the driver attesting the record accurately represents the services provided and actual miles driven; and acknowledging that misreporting information that results in ineligible or excessive payments may result in civil or criminal action.
   5. The date and signature of the member or authorized representative attesting that transportation services were provided as indicated on the transportation trip record, or the signature of the medical services provider certifying the member was transported to the medical services provider destination. If both the medical services provider and member, or authorized party, refuse or are unable to provide signatures, the driver must document on the transportation trip record that signatures were requested and not provided.
   6. The address, or the description if the address is not available, of both the origin and destination, and the mileage for the most direct route from origin to destination.
   7. The name or number of the mode of transportation in which the service is provided.
   8. The license plate number of the vehicle used to transport the member.
   9. The time of the member pick-up.
   10. The time of the member drop-off.
   11. The odometer reading of the vehicle used to transport the member taken at the time of pick-up.
   12. The odometer reading of the vehicle used to transport the member at the time of drop-off.
   13. The name of the extra attendant when an extra attendant is used to provide special transportation service.
   14. Documentation indicating the method that was used to determine the most direct route.

For NEMT Modes 2 – 7, a destination provider or recipient signature is required. The driver at the medical facility must obtain a signature that indicates a scheduled medical appointment and that the member was taken to the appropriate medical appointment desk.

Record all required trip information on your trip sheet and make this information available for review.

A sample NEMT Provider Travel Log is available for use by NEMT providers on the PrimeWest Health website.

Wait Time Billing

• Procedure code: T2007
• 1 unit = 30 minutes
• Reimbursement: $10.00/unit
• Limit: 2 units/day

Wait time billing is available to all members eligible for NEMT except for non-pregnant MinnesotaCare adult members.

Billing for Trips with Multiple Riders

• Only bill mileage (no-load and loaded) for the member in the vehicle with the longest trip
• No-load miles are not billable after the first member is picked up

Driver Roster Requirements

Driver rosters must be maintained and be available upon request.

Trip Log Requirements

• Trip logs must comply with MN Stat. sec. 256B.0625, subd. 17b
• Failure to maintain complete trip logs may result in payment denial and/or investigation into Fraud, Waste, and Abuse (FWA)

Address Submission Requirement for Modes 3–7 (effective for claims received on or after March 1, 2025)

Claims for Modes 3–7 must include both the pick-up address and the drop-off address in order for claims to be processed. 

Non-Emergency Medical Transportation (NEMT) Driver UMPI Requirements

Effective June 1, 2025, claims for Non-Emergency Medical Transportation (NEMT) must include the NEMT driver’s Unique Minnesota Provider Identifier (UMPI) as follows: 

• Modes 4 – 7: The driver’s UMPI must be used as the rendering provider. Claims submitted on or after June 1, 2025, without the driver’s UMPI will be rejected.
• Mode 3: If the driver has a UMPI, it must be used as the rendering provider. If the driver does not have a UMPI, the driver's license number must be added to the 837P claim form in the SV101-7 description field and include all characters without dashes or spaces. Claims submitted on or after June 1, 2025, without a UMPI or a driver's license number that includes all license characters will be rejected or denied. Public transit companies are excluded from this requirement.
• For more information, review Driver Roster Form Requirements and Billing in the PrimeWest Health-Administered NEMT section of the PrimeWest Health Provider Manual

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Updated_07/07/2025