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
Non-Covered Services
PrimeWest Health does not cover the following services as medical transportation service costs (this list is not all inclusive):
- Transportation of a member to a non-covered PrimeWest Health service and those services excluded from transportation payment
- Transportation of a member from his/her residence to or from a Day Training and Habilitation (DT&H) location or Adult Day Program.
- Extra attendant charges for personal care assistants (PCAs) accompanying members for whom they are providing services
- Use of a higher level of transport that is not medically necessary to meet the needs of the member
- Transportation to waiver program services is not covered if the service is medical transportation under the State Medical Assistance (Medicaid) plan or if it is a component of another waiver service. See the Home and Community Based Services Covered Services section for more information
- Transportation to the emergency room, unless it is for a scheduled appointment or the emergency room is the entrance of an urgent care clinic
- Transportation to an additional stop to pick up a parent, guardian, PCA, or additional passenger to accompany the member.
- Transportation to a destination that is different from the originally scheduled drop off. The drop-off destination cannot be changed after the trip is scheduled unless the transportation coordinator at the county approves the change. (The “transportation coordinator” could be the county, tribe, or any entity hired to coordinate NEMT on their behalf.)
- Transportation and ancillary services for hospital visits that are not necessary for making medical decisions
- Transportation to treatment court
Excluded Costs Related to Transportation
The following costs are excluded by PrimeWest Health as medical transportation service costs. PrimeWest Health does not reimburse for these services and the provider cannot bill the member for them:
- Transportation of a member to a hospital or other site of health services for detention ordered by a court or law enforcement agency except when ambulance service is medically necessary
- Transportation of a member to a facility for alcohol detoxification that is not medically necessary
- Additional charges for luggage, stair carry of the member, and other airport, bus, or railroad terminal services
- Additional charges for wait times over what is covered by PrimeWest Health
- Airport surcharge
- Federal or State excise or sales taxes on air ambulance service
PW_11-19_602
Updated_02/24/2023
