TMPPM 2008 > Texas Medicaid Services > Ambulance > Benefits and Limitations

8.3.2.4 Prior Authorization Types, Definitions

Short-Term

Short-term prior authorization requests are made for a client whose medical condition is such that use of an ambulance is the only appropriate means of transport. The authorization period for a short-term request is from 0 to 60 days. If the client already has a short-term or long term PAN, the PAN may be used for the ambulance transport.

Clients requiring a hospital-to-hospital and hospital-to-outpatient medical facility transports are issued a PAN for that transport only. The originating hospital is responsible for obtaining the prior authorization.

Long-Term

A 180-day prior authorization is issued to a client and is granted within 24 hours of the time received, excluding weekends and holidays, for the authorization of non-emergency ambulance services. The request will be effective for a period of 180 days from the date of issuance if the request includes a written statement from a physician. An online authorization request may be submitted on the TMHP website at www.tmhp.com. Alternatively, a provider may request this authorization by completing the "Physician's Medical Necessity Certification for Nonemergency Ambulance Transports (Texas Medicaid Program)" (certification form) in its entirety and fax the form to the TMHP Ambulance Unit at 1-512-514-4205. Incomplete forms are not considered a valid authorization request and are returned with a denial letter. The certification form is not considered documentation after the service is rendered and should not be sent with a claim or an appeal. Texas Medicaid no longer approves authorizations for a year.