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F00045 Page 1 of 4 Revised Date: 02/01/2016 Effective Date: 04/01/2016 Texas Medicaid and Children with Special Health Care Needs (CSH CN) Services Program
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What is nonemegency ambulance prior authorization?
Nonemergency ambulance prior authorization is a process where approval must be obtained before transporting a patient who does not require immediate medical attention.
Who is required to file nonemegency ambulance prior authorization?
Nonemergency ambulance prior authorization must be filed by the ambulance service provider or the healthcare facility requesting the transportation.
How to fill out nonemegency ambulance prior authorization?
Nonemergency ambulance prior authorization can be filled out by providing the necessary patient information, medical necessity, and reason for transportation.
What is the purpose of nonemegency ambulance prior authorization?
The purpose of nonemergency ambulance prior authorization is to ensure appropriate use of ambulance services and to prevent unnecessary transportation costs.
What information must be reported on nonemegency ambulance prior authorization?
Information that must be reported on nonemergency ambulance prior authorization includes patient demographics, medical condition, reason for transportation, and insurance information.
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