Full service claims management and adjudication.

Ambulance claims and adjudication is proving to be a growing challenge for health plans. MTM’s full service approach can help you reduce non-emergent and emergency ambulance costs by up to 25% by rooting out fraud and abuse, introducing comprehensive eligibility confirmation and prior authorization determinations, and establishing strong ambulance networks. With MTM, you’ll receive an unmatched claims control solution that reduces ambulance spending while freeing up your valuable internal resources.

Join Our Ambulance Provider Network

Reducing Ambulance Expenditures

Built on our more than 20 years of non-emergency medical transportation management experience, our automated processes ensure cost savings to your health plan by:

  • Increasing compliance and reducing fraud and abuse
  • Decreasing fragmentation
  • Holding ambulance providers to standardized rates for reimbursement
  • Prior authorizing services
  • Verifying passengers’ need for ambulance transportation
  • Thoroughly reviewing and adjudicating all claims
  • Standardizing payment processes
  • Centralizing data analysis and reporting
Ambulance Provider Network Management

Network Management

By establishing comprehensive networks of credentialed and contracted ambulance providers, MTM increases service quality and passenger satisfaction. Providers must meet our stringent requirements and are contracted to provide trips at a standardized, fair price. Within these networks, we provide ongoing education and outreach to ensure understanding with our expectations, and facilitate regular monitoring for compliance.

Prior Authorization

Prior Authorization

Under MTM’s model, all non-emergent ambulance claims must be prior authorized. We conduct level of need assessments to verify passengers’ need for ambulance services and ensure each transportation request is justified, but never sacrifice passenger safety and wellbeing. Following authorization, we schedule transportation with our network of credentialed providers, supported by our 24/7/365 customer service operations.

Claims Processing

Claims Processing, Adjudication, and Payment

With our claims management solutions, our clients benefit from a centralized model for processing, adjudicating, and paying ambulance claims. We thoroughly review all submitted claims and supporting documentation, including pick-up and drop-off times and passenger signatures, to ensure the service was actually rendered and eradicate inaccurate, fraudulent claims.

Appeals Management

Appeals Management

MTM has processes in place to manage provider claims appeals in an appropriate, fair manner by an unbiased staff member. We maintain thorough, accurate records of all claims documentation, ensuring our staff can assess the denial fairly while protecting against fraud. If the appeal is validated, we immediately issue payment to the provider.