Non-Emergency Ambulance Transportation

Special Open Door Forum Announcements

Non-Emergency Ambulance Transportation

You can use the printable clinical templates and suggested clinical data elements (CDEs) for the order / physician certification statement, progress note, and prior authorization request to assist with documenting your medical records to support the need for Non-Emergency Ambulance Transportation (NEAT).

Health IT Vendors: To use the suggested CDEs, download or print and use as guidance in creating or enhancing existing electronic clinical templates within your electronic health record (EHR) system.

Providers: To use a printable clinical template, download and/or print the template, complete as applicable and file in the patient’s medical record.

We planning a series of Special Open Door Forum calls in 2018 so you can give us feedback on the draft templates and CDEs.

Type of Documentation Download

Order / Physician Certification Statement (PCS)

Non-Emergency Ambulance Transportation Order-PCS CDEs (PDF) Draft R1.0e 7/20/2018
Template (PDF) Draft R1.0e 7/20/2018

Progress Note

Non-Emergency Ambulance Transportation Progress Note CDEs (PDF) Draft R1.0e 7/20/2018
Template (PDF) Draft R1.0e 7/20/2018

Prior Authorization (PA) Request

Non-Emergency Ambulance Transportation PA Request CDEs (PDF) Draft R1.0e 7/20/2018
Template (PDF) Draft R1.0e 7/20/2018

We want to hear from you! Email us your comments and suggestions about the draft templates and CDEs.

Page Last Modified:
07/24/2018 03:21 PM