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

8.3.3 Claim Denials and Appeals

Ambulance provider claims submitted for nonemergency transports without the PAN are denied and must be appealed on paper by the provider. The appeal must be accompanied by supporting documentation. Clients may appeal PAN request denials by contacting TMHP Client Notification at 1-800-414-3406.

All ambulance denials (air or ground) must be appealed on paper. Telephone and electronic appeals are not accepted.

For claims or appeals related to prior authorization denials for the 180-day authorization request, the certification form is not considered as documentation after the service is rendered.

On appeal, supporting documentation is critical for determining the client's condition. Ambulance providers who file paper claims must include all information that supports the reason for the transport and attach a copy of the run sheet to the claim. The emergency medical technician (EMT) who transported the client must sign the documentation.

Refer to: "Supporting Documentation" .