Prior Authorization FAQ’s
Yes, all non-emergency ambulance transportation will require a prior authorization number or PAN from Medicaid and Medicare HMO's.
Most insurance carriers do not require a prior authorization for emergency ambulance transportation.
Prior authorizations should be applied for and obtained before scheduling ambulance transportation; however, prior authorization request must be submitted to the insurance carrier no later than the day of transport.
A one-time prior authorization is normally only good for the date of service you listed on the prior authorization form you submitted to the insurance plan.
For patients with recurring appointments (dialysis, wound care, etc) you may request a 60 day authorization. These types of authorizations will typically require the physician signature, a start and end date, and documentation supporting medical necessity.
If a prior authorization is not obtained, the ambulance provider will hold the facility that set-up the transportation financially responsible; therefore, if your the facility that is going to set up the transportation, you should obtain the authorization.
No, the healthcare facility is responsible for payment.
No, the ambulance provider must not assist in the authorization process.
Typically, the insurance carrier will fax a letter to the healthcare facility that applied for the authorization with an approval or denial in 24-72 hours.
It normally takes 24-72 hours to get an approval or denial.
There is normally a reason for denial listed on the denial letter. In most cases they will give you an opportunity to respond or send additional information, and this is normally time sensitive.
Consider alternate modes of transportation, such as wheelchair van transportation.
Several managed care plans have on-line portals. You can find links to a few of those on the home page.
No, the Texas standardized form is only accepted by a few carriers. See forms and information page for a complete listing of prior authorization forms.