Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2020 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
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.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 06/15/2018