Ambulance Prior Authorization Request Form

The request form for prior authorization of scheduled repetitive non-emergent transports in the Forms section of includes the Documentation Decision Tool, which reflects the two paths that can be taken under this coverage. The tool walks you through a series of questions to assist you in determining if the documentation is sufficient. Separator pages help by clearly dividing documentation components and keeping them in an order that streamlines your submission. That equals a faster overall turn-around for you.

Last Updated: 12/11/2020