Traditional Medicaid TMHP Form

Texas Standardized Form   (Parkland Community Health Plan, Aetna Better Health, UnitedHealthcare Community Plan)

Amerigroup Ambulance Prior Auth Form Amerigroup Ambulance Exception Form (180-day PA)

Molina Healthcare Prior Auth Form (Texas Standardized Form) Molina Medicare HMO Prior Auth Form

Superior Healthplan STAR+PLUS MMP Plan -Prior Auth Form Superior Healthplan Advantage (Medicare)-Auth Form– Superior Medicaid

BC/BS (Blue HMO) Medicaid (STAR), STAR Kids and CHIP

Scott & White Health Plan

Community First Health- Authorization Process

Community Health Choice- Reference Guide (call 713.295.2295 for authorization)

Texas Children’s Health Plan- Auth Form

UnitedHealthcare Community Plan- Auth Information

Sendero Health Plan- Auth Form

Cook Children’s Health Plan- Auth Form

Seton Health Plan- Auth Form

Wellcare Auth Form

Cigna HeathSpring Auth Form

WellMed

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 Acadian Ambulance Service of Texas, LLC

NPI #: 1750676870

Texas Provider Identifier (TPI) #318533201

Tax ID #72-0701964

Dispatch # (800)-259-1111

Acadian Transport Assistance Center (ATAC) # (737)-209-6665

ATAC Fax # (337)-291-2271

Learn more about Acadian Ambulance

Click here for a complete list of participating health plans

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