Ambulance PA

The Prior Authorization Demonstration for South Carolina began on December 1, 2014 and expanded to North Carolina, Virginia and West Virginia on January 1, 2016. Ambulance suppliers that are not institutionally (hospital) based that provide Part B Medicare covered ambulance services and are enrolled as an independent ambulance suppliers will be participants. Prior authorization is a process through which a request for affirmation of coverage is submitted for review before a service is rendered to a beneficiary and before a claim is submitted for payment. Prior authorization helps ensure that applicable coverage, payment and coding rules are met before services are rendered.

General Facts About the Program

Basic Instructions

Who

Ambulance service providers that bill Medicare Part B and render Repetitive Scheduled Non-Emergent Ambulance Transportation can receive provisional prior authorization.

What

Providers can receive prior authorization for up to 40 non-emergency scheduled round trips (HCPCS codes A0426, A0428) in 60 days. For scheduled trips beyond the prior authorized number, a second prior authorization request is required.

When
  • Phase I - South Carolina applies to dates of service on or after 12/1/2014.
  • Phase II - North Carolina, Virginia and West Virginia applies to dates of service on or after 1/1/2016.
Where

Providers with ambulances garaged in South Carolina, North Carolina, Virginia and West Virginia should submit prior authorization requests for transports in those states to Palmetto GBA.

Why

The process tests Medicare prior authorization procedures, which are designed to improve quality of service and reduce costs.

How

Submit the prior authorization request. Attach the required documentation. Decision notifications will be issued within 10 business days of receipt of submission.

  • Resubmittal decision notifications will be issued within 20 business days of receipt.
  • The notification will contain a 14-digit unique tracking number (UTN) that should be submitted in Item 23 on applicable paper claims or the electronic equivalent field for electronic claims.

Latest Articles

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Extended Affirmation Period for Beneficiaries with Chronic Conditions Participating in the Repetitive, Scheduled Non-Emergent Ambulance Prior Authorization Model06/10/2019
Important Update: The Medicare Prior Authorization Model for Repetitive Scheduled, Non-Emergent Ambulance Transport Has Been Extended One Year12/03/2018
Ambulance Providers: Temporary Pause in Prior Authorization in States Impacted by Hurricane Florence (North Carolina, South Carolina, and Virginia)09/24/2018
Enhanced eServices Ambulance Prior Authorization Form06/15/2018
Documentation Tips for Ambulance Providers - Paint the Picture02/08/2018
Release of Beneficiary Information to Ambulance Providers of Repetitive Scheduled Non-Emergent Transports02/08/2018
We're All In This Together Flyer - Dialysis Facilities02/06/2018
We're All In This Together Flyer - Skilled Nursing Facilities (SNF)02/06/2018
We're All In This Together Flyer - Wound Care Facilities (WCF)02/06/2018
Beneficiary Non-Affirmation Letter01/16/2018
Frequently Asked Questions: Prior Authorization (PA) Repetitive Scheduled Non-Emergent Ambulance Transports01/09/2018
Ambulance Prior Authorization Request Form12/15/2017
Instructions for Ambulance Providers who Submitted a Prior Authorization Request for a Period that Ended After December 1, 2017 and Palmetto GBA Revised the end Date to December 1, 201712/06/2017
Ambulance Prior Authorization Reminders09/22/2017
Ambulance Suppliers of Repetitive Scheduled Non-Emergent Transports09/22/2017
Non-Affirmed Code Crosswalk: Prior Authorization Request09/22/2017
Expedited Requests: Prior Authorization07/28/2017
Helpful Tips: UTN, Multiple Requests, Documentation07/28/2017
Physician Compliance: Ambulance Prior Authorization Documentation07/28/2017
Ambulance Prior Authorization Documentation Decision Tool07/19/2017
Letter for Patients with a Legal Representative for Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization07/19/2017
Beneficiaries with a Representative Payee: Prior Authorization Program07/18/2017
Smart Edit pAP - Prior Authorization for Ambulance Beneficiaries with a Representative Payee07/18/2017
CMS Physician/Practitioner Letter: Prior Authorization Model for Repetitive Scheduled Non-emergent Ambulance TransportsOpen in New Window06/20/2017
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Provider Contact Center: 855-696-0705

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