Emergency: If a member needs emergency transportation (an ambulance), call 911.
Non-Emergency: WellCare of North Carolina (WellCare) can arrange and pay for transportation to help members get to and from their appointments for Medicaid-covered care. This service is free to members. If the member’s child (18 years old or younger) is a member of the plan, transportation is also covered for the attendant, parent or guardian. Non-emergency transportation includes personal vehicles, taxis, vans, mini-buses, mountain area transports and public transportation. Transportation will be provided to the nearest appropriate medical provider(s) and for Medicaid-covered services. NC Health Choice members are also eligible to receive non-emergency transportation services. WellCare of North Carolina has partnered with One Call, a transportation broker, to provide Non-Emergency Medical Transport services.
Members can call One Call or WellCare Member Services to arrange transportation to and from appointments. We recommend member’s contact us at least two (2) business days before their appointment.
Drivers will wait up to five (5) minutes after arrival for pick-up. If a member no longer needs transportation to an appointment, the member should call One Call directly so they can release the scheduled driver. One Call is also available outside of normal business hours for urgent non-emergency transportation needs by selecting “Urgent Trip Request” when a member calls.
Travel-related expenses can also be covered, including lodging, food, and mileage reimbursement. To receive reimbursement the member must call One Call in advance of their appointment to schedule the trip. One Call will provide the reimbursement forms and how to submit the required documentation to One Call for reimbursement.
If a member needs a wheelchair or stretcher van, or some other form of transportation, the member will need a Level of Need form completed by their primary care physician or treating provider. This form will need to be provided to One Call when the member makes their transportation appointment. In addition, certain transportation services require prior authorization by WellCare, including:
- Trips over 75 miles one-way
- Out-of-state trips (40+ miles over border)
- Air ambulance, and
- Trips requiring hotel, flight, and/or meals
When a member calls One Call to schedule these trips One Call will inform WellCare. WellCare will contact the member’s primary care physician or treating provider to complete the steps for prior authorization. Once approved One Call will follow up with the member to finish scheduling the appointment.
If transportation services are denied, members have the right to appeal our decision. The member will receive a letter from WellCare describing the denial and appeal rights. Members can also call 1-866-799-5318 for more information and assistance on appeals.
Members receiving transportation services are expected to comply with the transportation member conduct and no show policies. The member conduct and no show policies described below are reviewed with members when scheduling NEMT services. These policies are available on our website. The member will receive written communication from WellCare regarding inappropriate behavior, including no shows, and the consequences, which may result in suspension of transportation services. In the case of suspension of transportation services, if the member schedules transportation to Medicaid covered services through One Call in advance and as long as he/she remains otherwise eligible for transportation assistance, the member shall be provided mileage reimbursement.
Our primary goal with NEMT is to transport the member safely and expediently to ensure access to medical services. WellCare and One Call will collaborate to identify and address the unique needs of high needs members requiring NEMT services. Once WellCare has access to the historical claims and historical NEMT information of its assigned population, analysis will be done to stratify members based on their needs. High needs members and others with frequent NEMT services will be assigned either to a WellCare care manager (in-house or delegated) or One Call outreach specialist to make contact with the member or provider before the effective date of their policy to ensure a smooth transition of care from fee-for-service to managed care. NEMT services will be scheduled and reminder notices provided. One Call will also do outreach to facilities and/or providers as needed to ensure a positive experience with NEMT services. This will happen during the transition period as well as on an on-going basis as new or newly eligible members join the plan.