Ambulance Prior Authorization Dates Finalized
Published September 2, 2021
In briefThe Centers for Medicare & Medicaid Service (CMS) has announced the implementation dates creating a national expansion of the Prior Authorization Model for Repetitive, Schedule Non-Emergent…
The Centers for Medicare & Medicaid Service (CMS) has announced the implementation dates creating a national expansion of the Prior Authorization Model for Repetitive, Schedule Non-Emergent Ambulance Transports. The first group of states will begin on December 1, 2021, followed by 4 other phases for remaining states and territories.
If an ambulance provider does not submit a prior authorization request by the fourth round trip in a 30-day period, subsequent transport claims will be stopped for prepayment review. CMS will be issuing outreach and education including FAQs.
The phased in implementation dates and grouping of states are as follows:
| Effective December 1, 2021 |
| Arkansas |
| Colorado |
| Louisiana |
| Mississippi |
| New Mexico |
| Oklahoma |
| Texas |
| Effective no Earlier than February 1, 2022 |
| Alabama |
| American Samoa |
| California |
| Georgia |
| Guam |
| Hawaii |
| Nevada |
| Northern Mariana Islands |
| Tennessee |
| Effective no Earlier than April 1, 2022 |
| Florida |
| Illinois |
| Iowa |
| Kansas |
| Minnesota |
| Missouri |
| Nebraska |
| Puerto Rico |
| Wisconsin |
| U.S. Virgin Islands |
| Effective no Earlier than June 1, 2022 |
| Connecticut |
| Indiana |
| Maine |
| Massachusetts |
| Michigan |
| New Hampshire |
| New York |
| Rhode Island |
| Vermont |
| Effective no Earlier than August 1, 2022 |
| Alaska |
| Arizona |
| Idaho |
| Kentucky |
| Montana |
| North Dakota |
| Ohio |
| Oregon |
| South Dakota |
| Utah |
| Washington |
| Wyoming |
The Federal Register announcing the implemtation dates can be found here.
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This article is educational. It is not legal advice and does not create an attorney-client relationship. Facts, contracts, and appeal windows control the next step.