Supporting documentation is required to be maintained by both the ambulance provider and the requesting provider, including a physician, health-care provider, or other responsible party.
An ambulance provider is required to maintain documentation that represents the client's medical conditions and other clinical information to substantiate medical necessity and the level of service and mode of transportation requested. This supporting documentation is limited to documents that are developed or maintained by the ambulance provider.
Physicians, health-care providers, or other responsible parties who request ambulance transport are required to maintain physician orders and the Nonemergency Ambulance Prior Authorization Request form in the client's medical record. Requesting providers must also maintain documentation of medical necessity for the ambulance transport.
