CMS announced a 3-year long Medicare Prior Authorization model for repetitive, scheduled non-emergent ambulance transports in New Jersey, Pennsylvania, and South Carolina.
The model goes in to affect 12/1/14 and all transports submitted that fit this service description will require a prior authorization on or after 12/15/14. PN, NJ, and SC EMS providers can officially start submitting prior authorization requests to their Medicare contractor (Novitas/Palmetto) on 12/1/14.
The following are Medicare contractor links where you can find additional details on the new model:
For Novitas News on the Prior Authorization Initiative: Click here
For Palmetto News on Prior Authorization Initiative: Click here
Novitas has scheduled an educational webinar on 11/21/14 for NJ and PA suppliers, which should provide an overview of the process and requirements. Additional information on the event is located in the Novitas link provided above.
We encourage you to keep a close eye on the progress of this model, as industry experts are predicting the program to expand in to other states.