April 1, 2013- SNF/Hosp Responsible for Payment

Effective for dates of service on or after April 1, 2013, benefit and prior authorization criteria for non-emergency ambulance transports changed for Texas Medicaid providers that request non-emergency ambulance transports for Medicaid clients, such as nursing home, hospital, residential facility, and physician providers.

Reminder: Texas law (Human Resources Code Chapter 32) states that a provider of non-emergency ambulance transport is entitled to payment from the nursing facility, health-care provider, or other responsible party that requested the service if payment under the Medical Assistance Program is denied because of lack of prior authorization, and the ambulance provider submits a copy of the claim for which payment was denied.

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