Information posted May 30, 2013 Ambulance providers must not complete any portion of the Non-emergency Ambulance Prior Authorization Request form to ensure the integrity of the submitted form.  Prior authorization must be obtained by the facility or the physician’s staff for all non-emergency transports. The non-emergency Ambulance Prior Authorization Request form must be filled out and submitted by the facility or the physician’s staff that is most familiar with the client’s condition.

For more information, providers may refer to articles titled “Ambulance Services Benefit Criteria to Change April 1, 2013,” which was published on this website February 1, 2013. For more information, call the TMHP Contact Center at 1-800-925-9126.