Enhanced eServices Ambulance Prior Authorization Form

The enhanced ambulance prior authorization form in eServices asks for the same information, but now it includes a decision tree for submitting the appropriate documentation. These questions should look familiar! They are from the Ambulance Prior Authorization Decision Tool. In this format they are called a dynamic tree because the answer selected helps determine the appropriate action. These questions are after all of the other required information is entered on the form.


 
Tasks reference the separator pages that follow the
Ambulance Prior Authorization Form in the Forms section of www.PalmettoGBA.com/JMB. They have been part of the printable form and now they are part of the electronic form in eServices. They refer to different types of documentation that can be submitted in support of the requested transports. Open the printable form and you’ll see what we mean.

Example: Task 2 is for the required signed and dated Physician Certification Statement (PCS). 



Palmetto GBA is pleased to bring you this valuable enhancement.

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