Thursday, November 11, 2010

air ambulance billing process - claim jurisdiction

Air Ambulance Claims Jurisdiction

For Dates of Service prior to January 1, 2008, Air ambulance suppliers must be submitted to the carrier that has jurisdiction for the locality in which its air ambulance is based (i.e. garaged or hangared). Payment of a claim during the transition period (4-1-02 through 12-31-05) is determined in part by the reasonable charge amount established in the carrier jurisdiction where the ambulance is based and in part by the fee schedule amount in the jurisdiction of the point-of-pickup, as represented by its zip code.

For suppliers that provide services in multiple states, no additional enrollment is necessary for claims submission until the end of the transition period unless the supplier has established a base in another state. If the supplier has established a base/hangar in another state, it must enroll with the carrier for the state. The carrier with jurisdiction for the claim has the supplier’s reasonable charge amount and also the fee schedule amounts for the states in which the ambulance supplier provides services to determine the blended payment.

Effective, January 1, 2008 CR 5203 changes ambulance jurisdiction as of 1-1-08. A claim for an ambulance service furnished by a supplier within the United States must be filed with the carrier having jurisdiction for the point of pickup (POP).

Effective April 1, 2007, carriers will begin processing applications from ambulance suppliers that are rendering services in their jurisdiction. For claims with dates of service January 1, 2008 and later, carriers will return claims as unprocessable any claim for a ground or air ambulance service where the POP is not within its jurisdiction.

Where the POP is outside of the United States, the claim for an ambulance service furnished by a supplier must be filed in accordance with the instructions in Publication 100-4 Chapter 1 § 10.1.4.1. Carrier jurisdiction is defined in Publication 100-4 Chapter 1 § 10.1.4.2.

3 comments:

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