Non-Emergent Transportation Claim Submission Requirements
2018/8/1
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Posted by Provider Relations
Beginning August 13, 2018, providers submitting electronic or paper claims for non-emergent transportation services will be required to submit the pick-up and drop-off location zip codes on the claim. Please follow the claim billing guidelines below.
Claim Billing Guidelines:
• Electronic claims – Providers should work with their claim submission vendor for claim requirements for the
837P claim submission.
o If you are using an online claim submission website – Providers should follow the directions for that
specific software application.
• Paper claims – Providers must submit the pick-up and drop-off location zip code(s) in boxes 32A and 32B on the
CMS-1500 claim form.
Non-emergent transportation claims that are billed incorrectly will not be accepted as follows:
• Electronic claims – Will be automatically rejected back to the provider/billing vendor.
• Paper claims – Will be closed in our Claims Processing System and a letter will be sent to the provider with the
rejection reason:
o “The Pick-Up/Drop-Off Zip Codes in Box 32 were invalid or missing”.
o If your claim is rejected, be sure to submit a new claim form with the required zip codes to Fidelis Care
within the timeframe as outlined in your provider agreement.