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Medicare Joins New Jersey Medicaid In Mandating Pre-Authorization for Non-Emergency Ambulance Transports

August 7, 2014 | No Comments
Posted by Beth Christian

CMS has announced that it will be transitioning to us of a prior authorization requirement for repetitive non-emergency ambulance transports.  New Jersey Medicaid already has a pre-authorization requirement. Under the prior authorization requirement, ambulance suppliers will need submit a request for provisional affirmation of coverage before a non-emergency, repetitive ambulance transport is rendered to a Medicare beneficiary and before a claim for payment may be submitted.  A repetitive ambulance service is defined as medically necessary ambulance transport services that are furnished 3 or more times in a 10 day period or at least 1 per week for 3 weeks.  Repetitive services typically arise for patients who receive dialysis, wound care or cancer treatment.  New Jersey is one of 3 states where the pre-authorization program will be initially implemented.

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