Beneficiaries with a Representative Payee: Prior Authorization Program

The Ambulance Prior Authorization program did not apply to beneficiaries who had a 'Legal Representative Payee' on file for transports provided prior to April 1, 2016.

The exclusion of claims for beneficiaries with a representative payee from the repetitive scheduled non-emergent ambulance transport prior authorization program was discontinued. Beneficiaries with a representative payee have been included in prior authorization for claims with dates of service on or after April 1, 2016.

If you receive a decision letter in response to a prior authorization request for a date of service prior to April 1, 2016, and the letter indicates the beneficiary has a representative (rep) payee on file, these claims should be submitted without the UTN indicated on the letter. If the UTN is submitted for these dates of service, the claim(s) may be denied or rejected or you may receive a development letter.