Monday, October 11, 2010

Jursidicatio or payment policy of ambulance vehicle claim


Jurisdiction of the claim is based on whether only one ambulance vehicle or multiple vehicles were used. (See the “Air Ambulance” section of this guide for regulations on jurisdiction for air transports.)

A. One Ambulance Vehicle Used
If only one vehicle is used to transport the patient from the point of initial pickup to the final destination, jurisdiction is with the carrier serving the point of origin, i.e., home station of the vehicle. This carrier has qualification information on the ambulance supplier and in most cases all other pertinent details necessary to adjudicate a claim.


A patient is picked up at the Johns Hopkins Hospital in Baltimore, Maryland and transported to his home in West Virginia by an ambulance dispatched from the area of the patient’s home. The carrier serving the point of origin of the ambulance, the Part B carrier for the State of West Virginia, has jurisdiction of any claim filed. The Carrier for West Virginia should have all the data necessary to make proper payment, i.e., certification of the ambulance company, price information and data pertaining to the nearest appropriate company, price information and data pertaining to the nearest appropriate facility. Had an ambulance whose home station was in Baltimore been used, the carrier servicing Baltimore, Maryland would have had jurisdiction. The Baltimore carrier would then have had to obtain data concerning the nearest appropriate facility to the patient’s home from the West Virginia Carrier.

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