Ambulance Authorization for Medicaid

Let’s talk about Medicaid’s non-emergency ambulance authorization.

In this post, I am going to cover non-emergency ambulance authorization,

when it is required, who requires it and what information is needed.

I am going to give information that will help you receive payment for

any non-emergency Medicaid calls that you receive. Medicaid requires

prior authorization for any non-emergency transport, so as a result if you don’t

obtain this ambulance authorization, you may not receive payment for your transport.

All Medicaid payors require prior authorization before making any

non-emergency ambulance transfer, so it is important to make sure you have the

approved prior authorization before you leave the facility with the patient.

Here are a few Medicaid payors:

  • Medicaid
  • Amerigroup
  • Superior Health
  • United Healthcare
  • BCBS
  • Cigna Healthspring

What transfers should the ambulance authorization cover?

Any non-emergency ambulance transfer, which includes ALS non-emergency,

and BLS non-emergency, requires an authorization from the facility that is

requesting the transport before the ambulance takes the transport.

A Medicaid hospital to hospital non-emergency transfer also has to have an approved authorization in order to receive payment.

What information should go on the ambulance authorization forms?

The requesting facility, when filling out the prior authorization form, must have the following information:

  • Ambulance company name
  • Tax ID number
  • NPI number,
  • TPI (the ambulance Medicaid number)
  • Procedure Codes (A0426 ALS non-emergency and A0425 Mileage or A0428 BLS non-emergency and A0425 Mileage)
  • Diagnosis Code

Who should prepare the ambulance authorization?

The facility requesting the transport should obtain the authorization number for you.

The authorization is received from the insurance company of the patient.

When we file the claim, the information on the authorization must be the same as the information on the claim.

For example:  If the facility requests that the authorization is a

BLS non-emergency run, then that is how we have to bill that run, or it will be denied.  If the

authorization is for an ALS non-emergency run, then that is how it must be billed, or it will be denied.

Therefore, it is important to have the same information on the run report and the authorization.

Most importantly, the facility should be getting the authorization number before you take the patient if at all possible.

Transport Requested after regular business hours.

When a facility requests a transport after business hours, you then have until the end of business on the next business day.

For example: if you have a run at 9:00 pm on Friday, the authorization must be obtained by the end of the business day on Monday.

We always suggest that you get the authorization as early in the day as possible, or you might not receive the authorization

by the time the transport is needed thus not getting paid for the run.

Pre-Authorization Forms

Many payors have their own pre-authorization forms, but if the payor doesn’t have their own form, then use the Texas Standard Form

Here are some ambulance authorization links:

Traditional Medicaid 9-1-2019

Amerigroup 10-2019

Superior 07-2015

Cigna HealthSpring

Texas Standard Form

As of the date of this post, Medicare does not need an authorization number for a non-emergency transport in Texas,

although it may change in the future.  Nothing stays the same in the billing business.

Information Links:

Ambulance Providers Must Submit Prior Authorization Request in Writing – January 31, 2019 

Nonemergency Ambulance Requests Must be Submitted in Writing for Prior Authorization – February 12, 2019

Section 5: Fee-For-Service Prior Authorizations – Texas Medicaid Provider Procedures Manual: Vol. 1 – January 2019

Thank you for your time.

Please feel free to ask any questions or to make any suggestions for future posts.