Authorization requirement for non-emergent ambulance transfer

To: All providers Subject: Authorization requirement for non-emergent ambulance transfer Effective: April 1, 2016 Texas Children’s Health Plan members who require the use of an ambulance for non-emergent transport must have the request for authorization submitted by the member’s physician, facility or health-care provider. The request will be reviewed to determine if alternate means of transportation can be utilized for transport to a scheduled medical appointment or to and from a treating facility. Texas Children’s Health Plan does not accept authorization requests from ambulance/medical transportation vendors for non-emergency transport. Requests will need to be made prior to the transport. Texas Children’s Health Plan will not approve retro authorization requests for non-emergent transportation. Providers will need to complete a Texas Children’s Health Plan request for authorization form located at: http://www.tchp.us/sites/default/files/pdf/Prior_Authorization_Request_Form_2015.pdf You can find the standardized form at: http://www.tchp.us/sites/default/files/pdf/20150410_Standard%20Prior%20Auth%20Form.pdf Please contact Texas Children’s Health Plan Provider Relations with any questions at 832-828-1008 or 1-800-731-8527.