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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. Then the model was extended for those four states through December 1, 2020, (based on date of service). 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 December 1, 2014
  • Phase II — North Carolina, Virginia and West Virginia applies to dates of service on or after January 1, 2016
  • The model has been extended for these four states through December 1, 2020
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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Overview of the Repetitive Scheduled Non-emergent Ambulance Prior Authorization Model Open in New Window11/24/2020
Ambulance Prior Authorization eServices Form (HCPCS A0427, A0429) Module Open in New Window08/13/2020
Update: Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport 07/13/2020
Ambulance Fee Schedule and Medicare Transports CMS Booklet Open in New Window05/28/2020
Documentation Tips for Ambulance Providers: Paint the Picture 05/28/2020
Administrative Relief in Response to the 2019-Novel Coronavirus (COVID-19) Pandemic: Pausing Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model 04/01/2020
Jurisdiction M Part B Prior Authorization Extended Affirmation Teleconference Questions and Answers: August 14, 2019 09/24/2019
Extended Affirmation Period for Beneficiaries with Chronic Conditions Participating in the Repetitive, Scheduled Non-Emergent Ambulance Prior Authorization Model 08/28/2019
Release of Beneficiary Information to Ambulance Providers of Repetitive Scheduled Non-Emergent Transports 08/28/2019
We're All In This Together Flyer - Dialysis Facilities 08/28/2019
Enhanced eServices Ambulance Prior Authorization Form 06/15/2018
We're All In This Together Flyer - Wound Care Facilities (WCF) 02/06/2018
Beneficiary Non-Affirmation Letter 01/16/2018
Frequently Asked Questions: Prior Authorization (PA) Repetitive Scheduled Non-Emergent Ambulance Transports 01/09/2018
Ambulance Prior Authorization Request Form 12/15/2017
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, 2017 12/06/2017
Ambulance Prior Authorization Reminders 09/22/2017
Ambulance Suppliers of Repetitive Scheduled Non-Emergent Transports 09/22/2017
Non-Affirmed Code Crosswalk: Prior Authorization Request 09/22/2017
Expedited Requests: Prior Authorization 07/28/2017
Helpful Tips: UTN, Multiple Requests, Documentation 07/28/2017
Physician Compliance: Ambulance Prior Authorization Documentation 07/28/2017
Ambulance Prior Authorization Documentation Decision Tool 07/19/2017
Letter for Patients with a Legal Representative for Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization 07/19/2017
Beneficiaries with a Representative Payee: Prior Authorization Program 07/18/2017
Smart Edit pAP - Prior Authorization for Ambulance Beneficiaries with a Representative Payee 07/18/2017
CMS Physician/Practitioner Letter: Prior Authorization Model for Repetitive Scheduled Non-emergent Ambulance Transports Open in New Window06/20/2017
Important Lessons Learned About the Repetitive Scheduled Non-emergent Ambulance Prior Authorization Model 06/08/2017
Ambulance Mileage 04/18/2017
Prior Authorization Requests for Repetitive Scheduled Non-emergent Transports Documentation 02/10/2017
Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transports 02/17/2016
Overview of the Repetitive Scheduled Non-emergent Ambulance Prior Authorization Model Open in New Window05/05/2015
   

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Provider Contact Center: 855-696-0705

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