-
Ambulance Billing Guide
- Ambulance Duplicate Claim Denials
- Ambulance Transports Included in SNF Consolidated Billing
- Ambulance Physician Certification Statement Guidelines
- Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport
- New York State Ambulance Services in Rural Areas (for JK providers only)
- Coverage of Rural Air Ambulance Services
- Ambulance Transports Excluded from SNF Consolidated Billing
- Ambulance Medical Necessity Reminder for ESRD Patients
- Related Content
-
Related Articles
- Claim Denials for Medically Unnecessary Ambulance Transports: Avoiding Reason Code 55B10
- Ambulance Medical Necessity
- Ambulance Rural ZIP Code Search
- Billing for A0426 or A0428
- Medical Necessity of Ambulance Services
- Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports
- Responsibility of Providing a Properly Executed Physician Certification Statement/Certificate of Medically Necessity
Proper Claim Submission for Repetitive, Scheduled, Non-Emergent Ambulance Transports
The CMS implemented the prior authorization of RSNAT.
- NGS J6 states Illinois, Minnesota, and Wisconsin were added to the RSNAT Model effective with dates of service on and after 4/1/2022.
- NGS JK states Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont were added to the RSNAT Model effective with dates of service on and after 6/1/2022.
Ambulance suppliers that provide repetitive and non-emergent transports will submit a prior authorization request to NGS, once NGS affirms the prior authorization, a UTN is delivered to the ambulance supplier. The UTN is required on the claim to document the prior authorization was provisionally affirmed.
When submitting a paper CMS-1500 claim form, the UTN must populate the first 14 positions in item 23. All other data submitted in item 23 must begin in position 15.
When submitting an electronic 837 professional claim for a prior authorized service, the UTN must be submitted in the 2300 Claim Information loop in the prior authorization reference (REF) segment where REF01 = “G1” qualifier and REF02 = UTN. A UTN submitted in this loop applies to the entire claim unless it is overridden in the REF segment in the 2400 Service Line loop. This is in accordance with the requirements of the ASC X12 837 Technical Report 3 (TR3).
Recently, NGS has received claims with the 2300 REF segment (G1 qualifier) for prior authorization, however, the value entered in REF02 is a ZIP code instead of the UTN. Claims with a ZIP code in the 2300 REF segment for prior authorizations will reject.
NGS is asking ambulance suppliers to work with their vendors/clearinghouse to ensure only the UTN is in this segment.
Resources
Reviewed 11/4/2024