Instructions for Ambulance Providers who Submitted a Prior Authorization Request for a Period that Ended After December 1, 2017 and Palmetto GBA Revised the end Date to December 1, 2017

As a follow-up to CMS' December 4, 2017, announcement of a one-year extension of the Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transports, Palmetto GBA would like to provide instructions for providers who submitted a Prior Authorization request for a period that ended after December 1, 2017, and Palmetto GBA revised the end date to December 1, 2017. Please note the following:

  • If the request was affirmed, you may submit only a Prior Authorization request form, including the affirmed UTN for this request, and Palmetto GBA will review the previously submitted documentation for consideration of the originally requested time period and number of transports. You will receive a decision letter with a new UTN for the additional dates of service and transports.
    • NOTE: No new documentation will be required, but the program conditions of a 60 day transport period and maximum of 80 transports will still apply
  • If the request was non-affirmed, please resubmit your request as you would any new resubmission. Your request will be considered for the entire transport period and number of transports requested, accompanied by the necessary medical documentation, under the Prior Authorization program conditions.

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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