Prior Authorization

RSNAT Pre-Pay Review

The RSNAT PA program has two components, PAR or prepayment review, which suppliers are able to use their discretion on the path that best suits their workflow.

If a RSNAT supplier chooses to forgo the PA process for transport services, a beneficiary may receive transport and the claim will be billed accordingly. Due to the absence of a UTN on the claim, the claim will suspend and an ADR will be issued for prepayment review. Suspension of RSNAT claims will occur after:

  • three or more round trips have been furnished in a ten-day period; or
  • at least one trip per week for at least three weeks.

Once the ADR is issued, the supplier has 45 days to submit the suggested list of documentation and NGS has 30 days from receipt to review the records and communicate the claim decision.

NGS will be looking at the same two codes during pre-pay review as we would during the PA process:

  • A0426 - Ambulance service, Advanced Life Support (ALS), non-emergency transport, Level 1
  • A0428 - Ambulance service, Basic Life Support (BLS), non-emergency transport
    • Although PA is not required for the mileage code, A0425, it is treated as an associated code that Ambulance suppliers should bill on the same claim as the transport code.

Submission Process

A list of suggested documentation to submit to NGS is below. Please keep in mind that this is not an all-inclusive list and all documentation to support RSNAT services should be included.

  1. A completed Physician Certification Statement signed and dated
  2. Completed trip sheets with crew signatures (signature log); including origin and destination information.
  3. All records that justify and support the level of care received and ambulance transport. I.G., Ambulance trip sheet, physician documentation, and/or facility documentation if applicable. All documentation must meet signature requirements.
  4. Signature of beneficiary, or that of his or her representative, accepting assignment and submitting to Medicare.
  5. Abbreviation key or acronym keys used.
  6. Credentials of Advanced Life Support personnel, as applicable.
  7. Other supporting documentation.
  8. **If there is an ABN on file please submit the ABN with the requested documentation.**

NGS will accept documentation submitted via Connex, mail, CD/DVD, fax, or esMD. Please include the ADR request with each claim submission. Please see Ways to Submit Requests for mailing and fax information. *Please note: ADR responses and PAR submissions utilize the same submission information.
 

Revised 4/11/2022