Medical, Dental & Pharmacy
- Medical
- Ambulatory Surgical Services
- Children's Services
- Chiropractic
- Clinic Services
- Community First Services and Supports (CFSS)
- Early Intensive Development and Behavioral Intervention (EIDBI)
- Equipment and Supplies
- HCBS
- Hearing Services
- Home Care Services
- Hospice Services
- Hospital Services
- Housing Stabilization Services
- Immunizations and Vaccinations
- Laboratory/Pathology, Radiology, and Diagnostic Services
- Language Interpreter Services
- Long-Term Care
- Medication Reconciliation
- Mental Health Services
- Optical Services
- Personal Care Assistance (PCA) Services
- Physician and Professional Services
- Recuperative Care
- Rehabilitation Services
- Renal Dialysis
- Restricted Recipient Program
- School-Based Community Services
- Substance Use Disorder
- Telehealth Services
- Transportation
- Tribal and Federal Indian Health Services
- Dental
- Pharmacy
PrimeWest Health-Administered Non-Emergency Medical Transportation (NEMT) Services
PrimeWest Health covers non-emergency medical transportation (NEMT) services for eligible members who do not have access to their own transportation to get to and/or from the site of a PrimeWest-covered medical service. PrimeWest Health provides members with the safest, most appropriate, and cost-effective mode of transportation available.
PrimeWest Health members must contact the PrimeWest Health Transportation Contact Center directly at 1-888-814-6643 to schedule and coordinate NEMT. Transportation providers should not accept NEMT requests directly from PrimeWest Health members. Any PrimeWest Health member who does contact a transportation provider directly should be directed to call the PrimeWest Health Transportation Contact Center at 1-888-814-6643. Rides must be requested at least two business days in advance of the requested ride date. In the event that a member is unable to provide notice two business days in advance, rides will be scheduled based on provider availability.
PrimeWest Health contacts transportation providers directly to schedule rides. Transportation providers are expected to be responsive when contacted by PrimeWest Health staff so that rides may be set up timely and efficiently.
For questions, please contact the PrimeWest Health Transportation Contact Center at 1-888-814-6643.
Eligible Members
PrimeWest Health members enrolled in the following programs may be eligible for NEMT if they do not have access to their own transportation:
- Families and Children
- Minnesota Senior Care Plus (MSC+)
- Special Needs BasicCare (SNBC)
- Prime Health Complete (HMO SNP)
- PrimeWest Senior Health Complete
Eligible Providers
All transportation providers (assisted or unassisted) must be certified by the Minnesota Department of Transportation (MnDOT) for Special Transportation Services (STS). Providers must submit proof of STS certification to PrimeWest Health when submitting the Provider Participation Agreement and must provide proof of renewal on an annual basis. Evidence of renewal must be submitted to PrimeWest Health within 30 days of the MnDOT certification renewal date. Protected transportation services must meet additional driver and attendant training requirements. Transportation services are covered when the services are necessary to enable a member to obtain a covered health service.
Verification requirements
Transportation providers must notify PrimeWest Health immediately of any of the following:
- Changes to the counties served and addition or removal of provider locations, including dispatch offices
- Any changes to current ownership information or ownership structure. (Complete the Disclosure of Ownership and Control Interest Statement).
Transportation of an Unaccompanied Minor
Transportation of minors (members ages 18 and under) requires a signed parental consent form if the parent or legal guardian is unable to accompany the minor. Transportation providers should keep the signed Unaccompanied Minor Transport Form in their records. The signed form is valid for one year.
Pharmacy Transports
PrimeWest Health allows transportation to pharmacies when it is the only option available based on pharmacy requirements or absence of other means to obtain the prescription(s). All means to obtain pharmacy items must be used and included, but are not limited to the following:
- Obtaining a prescription from an out-patient pharmacy at a medical facility or office location
- Using a mail, delivery, or courier service
- Obtaining prescription(s) on return to residence or work from a medical appointment (additional mileage is reimbursable for this purpose)
- Obtaining prescription(s) while other activities of daily living are completed
If pharmacy-only transport is required, the following criteria must be met:
- All prescriptions must be coordinated for pick-up on the same date
- Multiple trips per week or per month are not allowed
Wait Time (For PrimeWest Health-Contracted Providers Only)
Wait time is time the driver spends on a round trip waiting on a member after the member has been dropped off at the medical facility until the member is picked up for the return trip. Wait time cannot be billed if the driver leaves after the member is dropped off at the medical facility and the driver comes back to pick up the member as part of a round trip. Reimbursement is allowed for time waiting on the member after the first 60 minutes with a limit of 4 units (1 unit = 30 minutes). Wait time should never exceed the mileage back to the garage location.
Rides Provided on Nights, Weekends, or Holidays for Discharge
Providers who receive requests for rides from a member, a hospital discharge planner, or a nursing home during nights, weekends, or holidays. In these cases, the provider must provide the following information to PrimeWest Health via secure email to transportation@primewest.org within one business day:
- Member name
- PrimeWest Health member ID number
- Date the ride was provided
PrimeWest Health reserves the right to deny the claim if the notification does not include the required information or is not received within one business day.
Out-of-state NEMT services will be denied.
Documentation
Trip documentation must be consistent with requirements listed in MN Stat. 256B.0625, subd. 17b. Transportation providers must keep trip documentation/records for five years from the date of service. Trip documentation must be in English and be neat, concise, and legible according to the standards of a reasonable person. If a provider is billing for an activity on a claim, documentation must support that billing. Documentation must include the following:
- Member first and last name and PrimeWest Health ID number must be on each page of the record
- The date on which the entry was made and the date of the trip
- Pick-up and drop-off times with a.m. and p.m. designations
- Address of the member’s pick-up and drop-off locations. If no address is available, a detailed description of the location is required.
- License plate number of the vehicle used to transport the member
- Odometer readings at the start and end of the trip
- Driver’s license number of the driver completing the trip
- Driver’s printed last name, first name, and middle initial
- Driver’s National Provider Number (NPI) or Unique Minnesota Provider Identifier (UMPI) number
- Unloaded, or no-load, mileage must be clearly documented on the trip log and must match the shortest distance between the driver’s garage location and the member’s pick-up address. Documentation for unloaded miles must identify the starting location of the driver.
- All activity connected to a no-show of a member must be clearly documented on the trip log
- Completed assisted transportation trip log that includes the mode of transportation in which the service is provided:
- Mode 3: Unassisted transport
- Mode 4: Assisted transport
- Mode 5: Wheelchair, lift-equipped, ramp transport
- Mode 6: Protected transport
- Mode 7: Stretcher transport
- Other: Describe transportation.
- Document mileage by identifying the electronic source used to calculate driving directions and mileage. Show and label all loaded and unloaded miles.
- If billing wait time, the trip log must include the drop-off time and pick-up time and clearly identify the number of minutes that the driver waited on the trip log.
- Name of extra attendant when an extra attendant is used to provide Mode 7 stretcher transportation services
- For non-ambulance providers, when applicable, transportation providers should receive a signature from the health care provider serving the member (public transportation is excluded from this requirement)
- The signature of the driver attesting to the following: "I certify that I have accurately reported in this record the trip miles I actually drove and the dates and times I actually drove them. I understand that misreporting the miles driven and hours worked is fraud for which I could face criminal prosecution or civil proceedings."
- The signature of the member or authorized party attesting to the following: "I certify that I received the reported transportation service.", or the signature of the provider of medical services certifying that the member was delivered to the provider.
Fraud and Abuse
PrimeWest Health is committed to identifying, preventing, correcting, and reporting fraud, waste, and abuse. Providers are responsible for ensuring the following:
- Providers should not submit claims for any non-covered services
- Providers and drivers cannot offer or accept bribes, kickbacks, payments, or anything of value from any other driver, provider, PrimeWest Health employee, or member
- Providers and drivers should notify PrimeWest Health immediately of suspected fraudulent or abusive activity by a member, driver, PrimeWest Health employee, or provider
- Providers and drivers cannot direct PrimeWest Health members to a particular provider or driver
- Providers and drivers should notify PrimeWest Health immediately if any individual working for the transportation company is terminated for fraudulent or abusive practices
Providers must check each driver’s status in each of the following databases at the time of hire and monthly thereafter to ensure the person is not excluded from participation in a Federal or State health care program:
- Office of Inspector General (OIG) Excluded Individuals/Entities (LEIE)
- System for Award Management (SAM)
- Minnesota Health Care Programs (MHCP)
Providers must immediately notify PrimeWest Health upon learning that any such person is under investigation or has been excluded from Federal or State health care program participation.
Driver Roster Form Requirements and Billing
PrimeWest Health requires driver's license numbers of drivers providing transportation for all PrimeWest Health-administered Non-Emergency Medical Transportation (NEMT) modes 3 – 7 services.
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 without a driver's license number or claims without all license characters will be denied.
In addition, all PrimeWest Health NEMT providers submitting claims for modes 3 – 7 will be required to complete a Non-Emergency Medical Transportation (NEMT) Driver Roster and submit it electronically to PrimeWest Health on the first day of each month. PrimeWest Health will not accept paper copies.
The roster can be found in the Quick Links menu on the provider page of our website. Download the roster, complete it in its entirety, and click Submit. An email will automatically open with the roster attached. Click Send.
The following must be included on the roster:
- Printed name of driver
- Driver’s license number
- Driver's Unique Minnesota Provider Identifier (UMPI)
- Driver’s license state of issue
- Driver’s license expiration date
- Driver's employment start date
- Driver’s employment end date (if applicable)
The Non-Emergency Medical Transportation (NEMT) Driver Roster must be submitted monthly to ensure timely payment for NEMT services. If the roster is not received, PrimeWest Health may deny your claims.
PrimeWest Health-Administered NEMT Vehicle Requirements
All PrimeWest Health-administered NEMT vehicles must display identification on both sides of the vehicle, including:
- Provider’s business name
- Provider’s United States Department of Transportation (USDOT) number, or the
- MnDOT special transportation services (STS) certificate number preceded by the letters “STS” if you do not have a USDOT number
The name and numbers must be:
- Marked in a color that sharply contrasts with the background
- Easily read during daylight hours from a distance of 50 feet while the vehicle is stationary
- Maintained so they continue to be easy to read. Markings may be removable devices if they meet the identification and legibility requirements
A statement of medical necessity is required for NEMT to be approved. The statement of medical necessity must indicate the medical necessity for the person to be present at the medical facility and the rationale of need for special transportation. The transportation coordinator will contact the person for information required to send to the treating provider requesting a statement of medical necessity for the transport, ancillary services, or medical provider destination. Once the transportation coordinator receives the medical necessity information, they will forward it to PrimeWest Health Appeal & Grievance staff for review.
PrimeWest Health-administered NEMT includes the following services.
- Common Carrier: (mode 2 and 3)
- Volunteer drivers (Mode 2 – volunteer driver mileage)
- Bus, taxicab, dial-a-ride, light rail, or other commercial carriers (Mode 3 – unassisted and Mode 4 - assisted)
- Ramp or lift-equipped (wheelchair, scooter) (Mode 5)
- Protected (Mode 6)
- Stretcher transports (Mode 7)
Assisted transportation: Assisted transport (Mode 4) is a PrimeWest Health-administered NEMT service. The NEMT provider is responsible for billing PrimeWest Health for reimbursement for the transportation services.
Ramp or lift-equipped vehicle transportation: Mode 5 – A member who needs a wheelchair-accessible vehicle (ramp or lift-equipped) is defined as a member with severe permanent or temporary mobility impairments who meets all of the following:
- Is unable to walk or move from one place to another without a wheelchair
- Cannot transfer independently from the wheelchair to a regular transport seat
- Has a condition that requires the use of a vehicle lift or ramp, as in a wheelchair-accessible van
A member who transfers independently from the wheelchair to a vehicle seat is considered ambulatory and is not eligible for wheelchair transport.
A wheelchair-accessible van must operate under the authority and in compliance with the official regulations of the MnDOT, and be registered as such by MnDOT. The reimbursement rate for members who need a wheelchair-accessible van is higher than for those who do not need a wheelchair-accessible van. PrimeWest Health will not pay claims submitted with the wheelchair van base rate and mileage codes unless they meet all of the following criteria:
- The member is documented as a wheelchair user with wheelchair and there is a PrimeWest Health-administered NEMT certification on the member file
- The provider record with PrimeWest Health has the wheelchair code indicator
Stretcher transportation: Mode 7 – Stretcher (gurney) transport is a PrimeWest Health-administered NEMT covered service.
Protected transportation: Mode 6 – PrimeWest Health-administered NEMT transport level of service. It is intended for use by a member who received a transportation level-of-service (LOS) assessment, and whose assessment determined that other forms of transportation are not appropriate. This assessment is generally performed by the local crisis response team. The member must require transport by a provider who meets both of the following criteria:
- Has a protected vehicle that is not an ambulance or police car and has safety locks, a video recorder, and a transparent thermoplastic partition between the passenger and the vehicle driver
- Is a provider certified by MnDOT as a protected transport provider
Mental health crisis teams certify the member for protected transportation services using the Protected Transport Level-of-Service Assessment (DHS-6715). They base certification on the specific situation and needs of the member at the time of the protected transportation request. Protected transport certification is for a single date and a single transport (one trip or one trip leg).
Refer to the mental health crisis contact numbers for the crisis team contact for each county.
Once the mental health crisis team or licensed health care provider within a hospital has completed the protected transportation LOS assessment and approved the member for protected transportation, they must fax or send a secure or encrypted email of the completed assessment to PrimeWest Health within 48 hours. PrimeWest Health will authorize the transport.
If the protected transport LOS assessment determines protected transportation is not appropriate, the mental health crisis team or the hospital will fax or send a secure or encrypted email of the denied protected transportation LOS assessment form to PrimeWest Health for storage.
Billing for Protected Transports
Protected transport requires a driver and an attendant be in the vehicle during each transport. Additional payment for the attendant is not a separately reimbursable charge. If the member has been stabilized in an emergency department immediately before the transport and the total trip is under 100 miles, an attendant is not required.
Bill protected transportation using the service code and modifier combinations as follows:
- Bill “T2003 UA” for the base (pickup) service
- Bill “S0215 UA” for mileage reimbursement
Protected Transportation Provider Service Requirements
Protected transportation providers must deliver the level of assistance the member needs at the time of transport. This includes, but is not limited to, the following:
- Getting from inside the member’s residence or pickup location to the vehicle
- Getting into and out of the vehicle
- Fastening seat belts
- Getting into and out of the member’s medical facility
- Getting to or from the member’s appropriate medical appointment desk inside the medical facility
- Using a vehicle that meets protected transportation requirements
- Having a driver and an attendant in the vehicle while transporting the member. If the member has been stabilized in an emergency department immediately before the transport and the total trip is under 100 miles, an attendant is not required.
PrimeWest Health-Administered NEMT Vehicle Requirements: All protected transportation vehicles must meet MnDOT certification requirements in Minnesota Statutes 174.29 and 174.30. This includes all other MnDOT vehicle identification requirements for a MnDOT-certified provider.
Rural Urban Commuting Area (RUCA) Adjustments Add-Ons
Transport of members in urban, rural, and super-rural areas will, in some situations, allow additional reimbursement or add-on to the provider.
Transport Base RUCA Adjustments
The base rate, when paid for nonemergency medical transportation services in areas defined under RUCA to be super-rural, is equal to 111.3 percent of the respective base rate if applicable for modes 1 through 7.
Transport Mileage RUCA Adjustments
The mileage rate for nonemergency medical transportation services in areas defined under RUCA to be rural or super-rural areas is as follows:
- For a trip 17 miles or less, the mileage rate is equal to 125 percent of the respective mileage rates for modes 1 through 7
- For a trip between 18 and 50 miles, the mileage rate is equal to 112.5 percent of the respective mileage rate for modes 1 through 7.
- For a trip billed with 51 or more miles on the claim service line, RUCA add-on adjustment calculations do not apply.
For reimbursement for nonemergency medical transportation RUCA adjustments for modes 1 through 7, the zip code of the provider conducting the transport determines whether the urban, rural, or super-rural reimbursement rate adjustment applies.
PW_11-19_601
Updated_12/08/2025
