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2012 Texas Medicaid Provider Procedures Manual

Ambulance Services Handbook : 2. Ambulance Services : 2.4 Claims Filing and Reimbursement : 2.4.11 Appeals

2.4.11
Only a denial of prior authorization may be appealed. Clients may appeal prior authorization request denials by contacting TMHP Client Notification at 1-800-414-3406. The Nonemergency Ambulance Prior Authorization Request form is not considered to be documentation after the service has been rendered.
Claims denied due to an inappropriate emergency medical condition code may be resubmitted with the appropriate emergency medical condition code.
On appeal, supporting documentation is critical for determining the client’s condition at the time of transport. 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 EMT who transported the client must sign the documentation.
Refer to:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.