Prior authorization for ambulance transports is for repetitive transports

The program and process relating to First Coast’s prior authorization for Repetitive, Scheduled Non-Emergent Ambulance Transports (RSNAT) allows documentation to be submitted in advance for affirmation of coverage for future ambulance transports that are repetitive and have been scheduled. Upon submitting a prior authorization request (PAR) for repetitive, scheduled transport along with the required medical records, a response will be issued within ten business days of receipt. 

A repetitive service is defined as medically necessary ambulance transportation that is furnished three or more times during a ten-day period OR at least once per week for at least three weeks. Repetitive ambulance services are often needed by beneficiaries receiving dialysis or cancer treatment.

Data indicates that claims are being submitted for affirmation of non-repetitive transport. Upon identifying a RSNAT submission for a non-repetitive, unscheduled transport, First Coast will complete prepayment medical record review, which may include an additional documentation request (ADR). When corresponding documentation is submitted, First Coast will make a claim determination within 30 calendar days.

The prior authorization process does not alter Medicare’s guidelines regarding ambulance services. For all ambulance transport services, the appropriate documentation is needed – guidance is available via the CMS IOM Pub. 100-04, Medicare Claims Processing Manual, Chapter 15