Medicaid Non-Emergency Medical Travel (NEMT)

Individual Instructional Videos:

• Welcome to the online NEMT Portal
• How to Enroll
• How to submit Travel Claim and view Claim Status
• How to view Correspondence

Entity Instructional Videos:

• Welcome to the online NEMT Portal
• How to Enroll
• How to add Admin/User
• How to submit Travel Advances (TA) and view TA Status
• How to view Correspondence

Submit an Online claim to NEMT

NOTE: Before you begin, review the appropriate instruction video on the NEMT website.

• Before your appointment, print an NEMT Appointment Verification Form. You should take this form with you to your medical appointment. The medical facility must FULLY complete and sign the form.
• After your trip is complete, log onto the NEMT Portal, enter and submit your claim. Make sure to attach the NEMT Appointment Verification form and any other required documentation to your online claim before submitting to NEMT.

Using the NEMT Portal will allow you to:

• Update and maintain your personal and banking information.
• Submit claims online.
• Track the status of your claim.
• Receive and review correspondence and Paid Claims Statements.

Submit a Paper claim to NEMT

• Before your appointment, print a NEMT Reimbursement Form (day trip or overnight). You should take this form with you to your medical appointment. The medical facility must FULLY complete and sign Medical Section of the form.
• This form, along with any necessary documentation, may be turned in at your local DSS office or you may fax, email, or mail your form directly to the address listed on the NEMT form.

• Eligibility:
  The recipient must be enrolled in a medical assistance program that provides Medicaid coverage.

• Travel Requirements:
  Travel must be to the closest medical facility or provider capable of offering the necessary services, unless the recipient has a written referral or authorization from their medical provider.

• Service Requirements:
  The service must be covered by Medicaid and provided by a medical provider enrolled in the medical assistance program.

• Eligibility Date:
  Trips made prior to your eligibility date are not eligible for reimbursement.

• Specialty Care:
  Trips to medical specialty providers (other than your Primary Care/Care Connect/BabyReady Provider) require a referral.

• Claim Submission:
  A NEMT claim along with any necessary documentation must be submitted for each medical trip. Please refer to the "How to Submit a NEMT Claim" guide for detailed instructions on the submission process.
  

• Reimbursement:
  Reimbursement will be provided once the claim, along with any necessary documentation, has been received and processed.
  
  
• Submission Deadline:
  The completed claim must be submitted to the NEMT program within six months from the date the service was provided.

• Eligibility:
  A recipient must be enrolled in a medical assistance program that provides Medicaid NEMT coverage at the time of service.

• Travel Distance and Coverage:
  Travel is reimbursable when it’s from an eligible recipient’s city of residence to a medical provider in another city, between medical providers in different cities, or from a medical provider back to the recipient’s city of residence.
  Mileage is reimbursed for the actual distance between cities and does not include travel within city limit.
  
  
• Primary Care, Care Connect, and BabyReady Provider Travel:
  Travel to the closest Primary Care Provider (PCP), Care Connect Provider (CCP) or BabyReady Provider is reimbursable.
  Travel to a provider other than the closest PCP, CCP or BabyReady Provider will only be reimbursed if a “good cause” exception I approved by Medical Services.
  
  
• Lodging and Meals (PCP, CCP and BabyReady Provider):
  Lodging and meals are not reimbursable for travel to a PCP, CCP and BabyReady
  
  
• Lodging and Meals (Specialty Care):
  Lodging and meals are reimbursable when:
  • The provider is at least 150 miles from the recipient’s city of residence.
  • The trip is for specialty care or treatment that results in an overnight stay.
    Meals and lodging are limited to the recipient and, if medically necessary, one escort or volunteer driver.
    
    
• Meal Reimbursement:
  Meals will only be reimbursed if an overnight stay is medically necessary and meets the lodging criteria.
  
  
• Inpatient Reimbursement:
  A recipient is not eligible for lodging or meal reimbursement for days they are an inpatient in a hospital or medical facility.
  
  
• Denial of Coverage:
  The Department of Social Services reserves the right to deny reimbursement requests that do not meet the general guidelines outlined above.

The NEMT Program may reimburse you for mileage, lodging and meals at the current rate of payment.

• Reimbursement rates

Prior Authorization Requirements

Services that require prior authorization must have an approved prior authorization from the Division of Medical Services before travel assistance can be authorized, regardless of whether the travel is within South Dakota or outside of South Dakota. For additional information regarding prior authorization requirements, visit the Division of Medical Services Prior Authorization webpage.

Out-of-State Travel for South Dakota Medicaid Recipients

For recipients with South Dakota Medicaid, an out-of-state Prior Authorization request must be submitted to and approved by the Division of Medical Services before travel assistance can be authorized. Approval is required for all out-of-state medical services. Services must be Medicaid-covered and provided by the closest medical facility or provider capable of delivering the necessary care, unless otherwise authorized.

In-State and Out-of-State Travel for Recipients with Medicare or Other Private Health Insurance

Recipients who have Medicare or other private health insurance in addition to South Dakota Medicaid must submit a NEMT Prior Authorization Request form to the NEMT Program for review and approval. The NEMT Prior Authorization Request Form must be approved by the Department before travel expenses can be reimbursed through the NEMT Program, even when South Dakota Medicaid is not primary or responsible for reimbursement of the medical service. This information applies only to NEMT travel‑related services for the medical recipient and does not replace coverage requirements for medical services.

To obtain approval, a completed NEMT Prior Authorization Request form must be submitted to the NEMT Program along with medical records and any other pertinent documentation. The completed form and supporting documentation may be submitted by:  Fax: 605.773.8461 or Email: DSS.EBTStateOffice@state.sd.us

Additional medical records may be required to make an accurate determination. Letters from physicians are not a substitute for required medical records.

Note: If the recipient has private health insurance, all requirements of the primary insurance carrier must be followed in addition to obtaining any required South Dakota Medicaid approvals as the secondary payer.

Enrollment

You must enroll with NEMT and select a payment option before submitting claims to NEMT.

Enroll using the NEMT Portal.

• Once you enroll using the NEMT Portal you will have access to update and maintain your personal and banking information and submit claims.
• Before you begin using the NEMT Portal, select the appropriate instructional video that will help you navigate the NEMT Portal.

If you choose to enroll using paper, you will need to complete the NEMT Payment Authorization form and submit it to NEMT. This form can be found in the NEMT Forms section below.

Payment Options

NEMT travel reimbursements can be made to you by either Direct Deposit into your bank account or by electing to receive a MasterCard® branded debit card.

Direct Deposit features:

• Cash benefits or payments can be deposited into your current checking or savings account.
• You can avoid trips to the bank to deposit paper checks.
• You can be sure your payments will arrive on time, every time.
• You can withdraw cash benefits or payments by writing checks against your checking account, withdrawing money from your savings account, or withdrawing cash at your ATM.

Way2Go Card® features:

• Easy to get – there is no cost to enroll, no credit checks* and no bank accounts required
• Widely accepted – make purchases anywhere debit cards are accepted (in stores, restaurants, online, over the phone, etc.
• Save time and money – no expensive check cashing fees or trips to the bank
• Safe – you don’t need to carry cash with you. If you lose your card, it can be replaced. Your funds are protected by MasterCard® Zero Liability** and are FDIC insured
• 24/7 access – call Cardholder Services

About the Way2Go Card®

• It is a reloadable MasterCard® prepaid debit card that provides an electronic option for receiving your NEMT warrants. It is not a credit card, but works similarly to other debit cards. Once funds are added to the card account, it may be used to make purchases everywhere debit cards are accepted. The card can be used for online, phone and mail order purchases. You can also withdraw cash at ATMs, banks or credit unions or by getting cash back with purchases at participating merchants. The amounts of purchases or cash withdrawals are automatically deducted from the available balance on the card.
• Way2Go Card® FAQs

* Successful identity verification required. To help the government fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. If necessary, we may also ask to see your driver’s license or other identifying documents.
** MasterCard’s Zero Liability policy protects cardholders from permanent financial loss due to fraud. You must notify Way2Go® immediately of any unauthorized use. Other conditions may apply. See your cardholder agreement for details. The Way2GoCard® Debit Mastercard Card is issued by Comerica Bank, pursuant to a license by Mastercard International Incorporated. Mastercard and the Mastercard Brand Mark are glistered trademarks of Mastercard International Incorporated. Conduent® and Conduent Agil Star®, Way2Go Card® and Go Program® are trademarks of Conduent Business Services, LLC in the United States and/or other counties. Conduent is the payment solutions provider for Go Program.

• Additional Lodging Form
• Appointment Verification Form
• Day Trip Reimbursement Form
• HIPAA Authorization
• Prior Authorization Request Form
• Overnight Trip Reimbursement Form
• Payment Authorization Form | Spanish
• Primary Care/Care Connect/BabyReady Provider Questionnaire

Mail:
Department of Social Services
EBT and NEMT
700 Governors Drive
Pierre, SD 57501

Phone:
Local: 605.773.6527
Toll-free: 866.403.1433
Fax: 605.773.8461
Email: DSS.EBTStateOffice@state.sd.us