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Ambulance Providers May Not Complete and Sign Prior Authorization Forms for Nonemergency Ambulance Transport Services

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The Texas Medicaid Provider Procedures Manual (TMPPM) states that only the requesting provider, which may include a Medicaid-enrolled physician, nursing facility, or health care provider, is authorized to complete and sign the prior authorization form for nonemergency ambulance transport services.

Reminder: Ambulance providers may only provide basic necessary information such as a National Provider Identifier (NPI) number, fax number, and business address to the requesting provider to complete the Prior Authorization form.

Providers may refer to the Texas Medicaid Provider Procedures Manual, Ambulance Services Handbook, section 2.2.3, “Nonemergency Ambulance Transport Services,” for additional information.

For more information, call the TMHP Contact Center at 800-925-9126.

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.