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Ambulance
8.1 Enrollment 8-2
8.2 Reimbursement 8-2
8.3 Benefits and Limitations 8-2
8.3.1 Emergency Ambulance Transport Services 8-2
8.3.1.1 Prior Authorization for Emergency Out-of-State Transport 8-3
8.3.1.2 Emergency Transport Billing 8-3
8.3.2 Nonemergency Ambulance Services 8-9
8.3.2.1 Nonemergency Ambulance Transport Prior Authorization 8-9
8.3.2.2 Nonemergency Prior Authorization Process 8-10
8.3.2.3 Nonemergency Prior Authorization and Retroactive Eligibility 8-10
8.3.2.4 Prior Authorization Types, Definitions 8-10
8.3.2.5 Supporting Documentation 8-11
8.3.3 Appeals 8-11
8.3.4 Ambulance Disposable Supplies 8-11
8.3.5 Oxygen 8-11
8.3.6 Waiting Time 8-11
8.3.7 Extra Attendant or Registered Nurse 8-11
8.3.8 Night Call 8-11
8.4 Subscriptions Plans 8-12
8.5 Types of Transport 8-12
8.5.1 Multiple Client Transports 8-12
8.5.2 Air or Specialized Vehicle Transports 8-12
8.5.3 Transports for Pregnancies 8-12
8.5.4 Transports to or from State Institutions 8-12
8.5.5 Transports for Nursing Facility Residents 8-12
8.5.6 Hospital to Hospital Transport 8-13
8.5.7 Nonemergency Not Medically Necessary Transports 8-13
8.6 Medicare/Medicaid Coverage 8-13
8.6.1 Medicare Services Paid 8-13
8.6.2 Medicare Services Denied 8-13
8.7 Relation of Service to Time of Death 8-13
8.8 Claims Information 8-14
8.8.1 Modifiers on Ambulance Claims 8-15
8.8.2 Claim Filing Resources 8-15
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