Forms & Information

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 Auth form 2021
Superior Healthplan STAR+PLUS MMP Plan -Prior Auth Form
Allwell by Superior Mcr Auth Form 2021
Superior Medicaid
BC/BS (Blue HMO) Medicaid (STAR), STAR Kids and CHIP 
Scott & White Health Plan 
FirstCare by Baylor Scott & White
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
Seton Health Plan- Auth Form
Wellcare Auth Form
Cigna HeathSpring Auth Form
Wellmed Authorization Form 2021

 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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