Library: Policy

317:30-5-336. General coverage

Revised 12-21-06

     OHCA covers ground and air ambulance transportation services, within certain limitations.

• (1) Ambulance and stretcher transportation is covered only when medically necessary and when due to the member's condition any other method of transportation is contraindicated.

• (2) As a general rule ambulance transportation to the nearest appropriate facility in the locality is covered.  OHCA utilizes the locality areas as defined by Medicare.

(b) OHCA recognizes different levels of ambulance medical services by qualified ambulance staff according to the standards established by law and regulation through the Oklahoma Emergency Response System Development Act of 2005, '63 OS 1-2503.

(c) Ambulance medical services are divided into different levels for payment purposes.  Payment is made according to the medically necessary services actually furnished.  That is, payment is based on the level of service furnished, not simply on the vehicle used.

(d) Ambulance providers must maintain documentation of the medical necessity and appropriateness of service in the member's file.

(e) Clinical decisions can be made without delay if documentation to support coverage and medical necessity is submitted as part of the initial claim form.  This may be accomplished by submitting supporting detailed documentation regarding the member's condition and need for ambulance/stretcher transport.