Using and billing air ambulance services appropriately

When using or billing air ambulance services, please remember:

• To facilitate timely and accurate claim processing of air ambulance services, include the facility’s record (emergency department record, or if an inpatient, the discharge or transfer summary) along with your run sheet. Providing this information will greatly facilitate timely review of medical necessity.
• Regarding the practice of using air ambulance services solely because use of ground transport would temporarily deplete local area Emergency Medical Services (EMS) availability, while EMS availability is always a local EMS concern, please understand that this reason alone does not meet medical necessity criteria for our members.
• Lastly, excess miles flown to keep a patient within the sending facility’s health system, when another closer capable receiving hospital has capacity, does not meet medical necessity criteria. Determination of medical necessity, including mode of transportation, is determined in accordance with the Anthem Blue Cross clinical guidelines and medical necessity criteria. These determining guidelines include only approving the distance to the closest capable facility with capacity.

Taking the above into consideration will result in faster processing and lower denials of your air ambulance service claims. For your reference, see CG-ANC-04 Ambulance Services: Air and Water.

If you have questions, contact your local provider relationship management representative.

We look forward to working together to achieve improved outcomes.