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February 14, 2023

Medical Documentation for RSNAT Prior Authorization and Claims

The prior authorization process for repetitive scheduled non-emergent ambulance transport (RSNAT) in jurisdiction 15 began August 1, 2022. This process did not change the documentation requirements for demonstrating medical necessity.

Physician Certification Statement (PCS) for Repetitive Services

  • Must be signed by a physician and properly credentialed (MD or DO)
  • Signed within 60 days prior to the requested or start of service date
  • Ambulance company’s responsibility to maintain a current PCS

Prior Authorization Request Reviews

The documentation requirements for prior authorization requests need to support the PCS and be as current and up to date as possible. Medical documentation for prior authorization requests consists of the PCS and may include one or more of the following:

  • Physician progress notes
  • Nursing progress notes
  • Skilled Nursing Facility documentation
    • Completed and signed MDS
    • Activities of Daily Living (ADL) sheets
    • Therapy progress notes
  • PT/OT evaluations
  • Home Health medical documentation
  • Any medical documentation outside of the ambulance company

RSNAT Prepay/Post-pay Claim Reviews

The documentation requirements for prepay/post-pay claim reviews are slightly different. When responding to documentation requests, ambulance providers should submit the following:

  • A valid PCS to coincide with the date of service on the claim
  • The same types of medical documentation listed for prior authorization requests
  • Ambulance transportation/run sheets

Non-Medical Documentation

Non-medical documentation which cannot be accepted for prior authorizations or claim reviews include:

  • Any letter from a family member, physician, nurse, etc.
  • Email communications
  • A generalized note/side note
  • Anything that is outside acceptable medical documentation



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