Ambulance Prior Authorization: Jurisdiction J

Published 12/02/2021

Prior authorization helps ambulance suppliers ensure that their services comply with applicable Medicare coverage, coding and payment rules before services are rendered and before claims are submitted for payment.

Prior authorization does not create new clinical documentation requirements. Instead, it requires the same information that is already required to support Medicare payment, just earlier in the process. Prior authorization allows providers and suppliers to address issues with claims prior to rendering services and submitting claims for payment, which has the potential to reduce appeals for claims that may otherwise be denied.

The Centers for Medicare & Medicaid Services (CMS) announced the following implementation date for Jurisdiction J for the nationwide expansion of the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model.

The model will begin no earlier than February 1, 2022, in Alabama, American Samoa, California, Georgia, Guam, Hawaii, Nevada, Northern Mariana Islands and Tennessee.

Resources: Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport.