Prior Authorization (PA) for Repetitive, Scheduled, Non-Emergent Ambulance Transports (RSNAT)
CMS implemented a prior authorization process to help ambulance suppliers ensure repetitive, scheduled, non-emergent transports comply with Medicare coverage, coding, and billing requirements under Part B. Repetitive ambulance services are defined as ambulance transportation that is medically necessary which is furnished 3 or more round trips in a ten-day period or at least one round trip per week for at least 3 weeks. The process is voluntary; however, the 4th round trip will be subject to pre-payment medical review.
To submit a request through myCGS:
Once logged into myCGS and under a Part B registered user ID, select the FORMS tab.
- Under the "Select a Topic" drop-down box, click "Prior Authorization."
- The "Select a Type" drop-down will default to "PA Ambulance."
- Select the "PA Ambulance: PAA-J15-B-1000" link at the bottom of the page.
Request Details: Select whether this is an initial or resubmission request.
- Initial Request: The first PAR sent to us for review and decision.
- We will review the form and attached documentation and send a decision within 10 business days.
- Resubmission Request: Subsequent PAR resubmissions to correct an error or omission identified after a PA decision has been made by CGS.
- Enter the most recent 14-digit Unique Tracking Number (UTN) and click the "Get Previous Submission Information" button so that details from the previous decision will populate. An error message will display if there are problems with the number you enter or it is not recognized.
- Enter the most recent 14-digit Unique Tracking Number (UTN) and click the "Get Previous Submission Information" button so that details from the previous decision will populate. An error message will display if there are problems with the number you enter or it is not recognized.
- Expedited Request: You may submit a request for an expedited review of a PAR if delays in receipt of a PA decision could jeopardize the life or health of the beneficiary. Enter the reason and details for the expedited PA decision. Upon receipt, a decision will be made within 2 business days.
Next, check the box for HCPCS code A0428 or A0426. Enter applicable origin/destination modifiers, start date, and the number of transports for which prior authorization is being requested.
Ambulance Supplier Information: This section identifies your name, identifiers, and address associated with your myCGS user ID. From the drop-down box, select the state where your vehicle is garaged.
Beneficiary Information: Enter the beneficiary's Medicare Beneficiary Identifier (MBI), name, and date of birth.
NOTE: Verify the information is correct by referring to the beneficiary's Medicare card.
Certifying Physician Information
Enter the certifying physician/non-physician practitioner's name, identifiers (NPI/PTAN), and complete address.
Requestor Information
This section auto-populates with your name, phone number, and email address associated with your myCGS user ID. If you would like to receive your PAR decision via fax, check the box and enter the fax number.
Questions: Service-related questions will display. The answers will help support medical necessity. Enter comments as appropriate.
You must include ALL supporting documentation with your request. Attachments must be in a PDF format and no larger than 40MBs in size each. Click the 'Choose File' button to locate the PDF document on your system.
When the form is complete, click SUBMIT to send the request. Once submitted, the eSignature box will display. Clicking OK is your confirmation that all information is correct and allows you to electronically sign the form.
If you need some additional time to complete and send the form, click Save.
A confirmation message with display.
To complete a saved form go to your Messages tab, at the Saved Forms sub-tab, to continue working on the form. Click on the link and the form will load.
If you have questions, please send an email to j15bpriorautheducation@cgsadmin.com.
REFERENCE: