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Non-Emergency Ambulance Transportation Prior Authorization Form Page 1 of 2 Please return completed form to the Utilization Management Department at (401)4596023. Please refer to Neighborhoods Clinical
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How to fill out non emergency ambulance transportation
How to fill out non emergency ambulance transportation:
01
Gather necessary information: Begin by collecting all essential details, such as the patient's name, contact information, and date of birth. Also, make sure to note the reason for transportation and any pre-existing medical conditions.
02
Contact the appropriate provider: Reach out to the ambulance service or transportation company that handles non emergency cases. Verify their availability, inquire about the procedure, and ask for any required forms or documentation.
03
Complete the necessary forms: Most non emergency ambulance transportation providers will have specific forms to be filled out. Pay careful attention to the instructions and provide accurate information. Include details about the pickup and drop-off locations, the patient's condition and mobility, and any specific requirements or accommodations.
04
Verify insurance coverage: Check whether the patient's insurance covers non emergency ambulance transportation. If it does, ensure that you have all the relevant insurance information that needs to be provided on the forms.
05
Confirm transportation details: Coordinate with the transportation company to determine the pickup time and any preferences or special instructions. Ensure that the destination address, contact person, and any additional stops or requirements are communicated clearly.
06
Review and sign: Before submitting the forms, carefully review all the information provided. Double-check for accuracy and completeness. Once satisfied, sign the necessary sections and make copies for your records, if required.
Who needs non emergency ambulance transportation:
01
Individuals with medical conditions: Non emergency ambulance transportation is often required for individuals with medical conditions that do not warrant immediate emergency care but still necessitate professional medical assistance during transportation. This includes patients with chronic illnesses, postoperative patients, individuals needing dialysis treatments, or those requiring regular medical check-ups.
02
Patients with limited mobility: Non emergency ambulance transportation is essential for patients with limited mobility, such as the elderly, disabled individuals, or those recovering from injuries. The specialized transportation services cater to their specific needs, ensuring they can safely access medical facilities or attend appointments.
03
Medical facility transfers: There are instances when patients need to be transferred between medical facilities for various reasons, such as seeking specialized care or continuing treatment in a different location. Non emergency ambulance transportation is commonly used in such cases, ensuring a comfortable and medically supervised journey between facilities.
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What is non emergency ambulance transportation?
Non emergency ambulance transportation is the transportation provided to individuals who do not require immediate medical attention.
Who is required to file non emergency ambulance transportation?
Non emergency ambulance transportation providers are required to file for reimbursement.
How to fill out non emergency ambulance transportation?
You can fill out the non emergency ambulance transportation form online or by mail with all the required information.
What is the purpose of non emergency ambulance transportation?
The purpose of non emergency ambulance transportation is to safely transport patients who do not require immediate medical care.
What information must be reported on non emergency ambulance transportation?
The information that must be reported includes the patient's name, date of service, reason for transportation, and the provider's information.
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