9.1.1 Medicaid Managed Care Enrollment Prior Authorization Emergency Ambulance Services

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1 Section 9Ambulance Enrollment Medicaid Managed Care Enrollment Reimbursement Benefits and Limitations Prior Authorization Emergency Ambulance Services Emergency Transport Billing Nonemergency Ambulance Services Nonemergency Ambulance Transports Nonemergency Ambulance Transport Prior Authorization Prior Authorization Process Authorization of Retroactive Eligibility Prior Authorization Types, Definitions Supporting Documentation Claim Denials and Appeals Ambulance Disposable Supplies Oxygen Waiting Time Extra Attendant or Registered Nurse Night Call Membership Fees Types of Transport Multiple Client Transports Out-of-Locality Transports Air or Boat Transports Pregnancy Transports Transports to or From State Institutions Transports for Nursing Facility Residents No-Transport Medicare/Medicaid Coverage Medicare Paid Medicare Denied Relation of Service to Time of Death Ambulance Procedure Codes Claims Information Modifiers on Ambulance Claims Claim Filing Resources

2 Section Enrollment To enroll in the Texas Medicaid Program, ambulance providers must operate according to the laws, regulations, and guidelines governing ambulance services under Medicare Part B; equip and operate under the appropriate rules, licensing, and regulations of the state in which they operate; acquire a license from the Texas Department of State Health Services (DSHS), approving equipment and training levels of the crew; and enroll in Medicare. A hospital-operated ambulance provider must be enrolled as an ambulance provider and submit claims using the ambulance Texas Provider Identifier (TPI), not the hospital TPI (see Medicare/Medicaid Coverage on page 9-7). Reminder: When ambulance providers enroll in Medicaid, they accept Medicaid payment as payment in full. They cannot bill clients for Texas Medicaid-covered benefits. Refer to: Provider Responsibilities on page 1-4 for more information about enrollment procedures Medicaid Managed Care Enrollment Certain providers may be required to enroll with a Medicaid Managed Care health plan to be reimbursed for services provided to Medicaid Managed Care clients. Contact the individual health plan for enrollment information. Note: Services for STAR+PLUS Program Medicaid Qualified Medicare Beneficiaries (MQMBs) must be prior authorized and processed by TMHP. Refer to: Managed Care on page 7-1 for more information. 9.2 Reimbursement Ambulance services are reimbursed according to a reasonable charge payment methodology in accordance with Title 1 Texas Administrative Code (TAC) Ambulance providers are reimbursed for the transport plus mileage. Refer to: Reimbursement on page 2-2 for more information about reimbursement methodologies. Medicaid Program Limitations and Exclusions on page 1-15 for information on Medicaid exclusions. 9.3 Benefits and Limitations Medicaid reimburses for emergency and nonemergency (for the severely disabled) transports. For ground transportation, providers must bill procedure codes A0428 and A0425, or A0429 and A0425 with modifier ET. Providers must bill the appropriate mileage with the appropriate base rate procedure code. For air transportation, providers must bill either with procedure codes A0430 and A0435, or A0431 and A0436. Providers must bill the appropriate mileage with the appropriate base rate procedure code. When submitting a claim for water transport services, providers are to use procedure code A0999. The claim suspends for manual review and pricing. Night calls are no longer paid separately. The payment rates represent a global payment. It is inappropriate to bill for any supplies or other services related to the transport, unless otherwise specified in this section. The integrity of the information regarding the client s condition requiring the transport and the medical necessity of the transport are the responsibility of the ambulance provider. The ambulance provider may be sanctioned, including exclusion from the Medicaid Title XIX programs, for completing or signing a claim form that includes false or misleading representations of the client s condition or the medical necessity of the transport Prior Authorization All nonemergency transports require prior authorization. Emergency transports do not require prior authorization. However, all out-of-state (air and ground) transports require authorization before the transport is considered for payment. To initiate the prior authorization process, providers are to call (toll-free; from 7 a.m. to 7 p.m., Monday through Friday, Central Time) before the transfer or on the first workday following transfers that occur after hours, on weekends, or on holidays. TMHP is responsible for processing prior authorization requests for all Medicaid clients, Primary Care Case Management (PCCM) clients, and all STAR+PLUS MQMBs Emergency Ambulance Services According to 1 TAC , an emergency transport is a service provided by a Medicaid-enrolled ambulance provider for a Medicaid client whose condition meets the definition of an emergency medical condition. Conditions requiring cardio pulmonary resuscitation (CPR) in transit or the use of above routine restraints for the safety of the client or crew are also considered emergencies. Facility-tofacility transfers are appropriate as emergencies if the required emergency treatment is not available at the first facility. Examples of conditions considered for emergency transports include, but are not limited to, acute and severe illnesses, untreated fractures, loss of consciousness, semiconsciousness, seizure or with receipt of CPR during transport, acute or severe injuries from auto accidents, and extensive burns. 9 2

3 Ambulance Emergencies include medical conditions for which the absence of immediate medical attention could reasonably be expected to result in serious impairment, dysfunction, or failure of one or more organs or body parts, and the required emergency treatment is not available at the first facility. Claims for such transports must document the aforementioned criteria. Emergency transports do not require prior authorization Emergency Transport Billing When billing emergency transports electronically, a minimum of one diagnosis description or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code must be written on the claim form or in the diagnosis code field for electronic billers. A claim that has see attached as the only information in the diagnosis block is not processed for payment consideration. Important: Emergency transports that are denied cannot be accepted on appeal as nonemergency transports. Note: Emergency and nonemergency claims may be billed electronically to Medicaid. For electronic billers, the hospital s TPI must be entered in the facility ID field. Providers should consult with their software vendor for the location of this field on the electronic claim form. All emergency claims submitted on paper are required to have the following documentation: Distance of transport traffic patterns Time of transport Acuity of client Place of Service Codes National place of service codes 41 and 42 are accepted by the Texas Medicaid Program. Condition Codes Electronic billers should use as many Condition Codes as needed to fully describe the patient s condition. The following condition codes are accepted by the Texas Medicaid Program: Condition Code Condition Code 60 is used to notify TMHP that the patient was taken to the nearest facility. Origin and Destination Codes Emergency transports billed as nonemergency services are denied. These transports may be appealed as emergency claims only. All claims submitted on paper or electronically must include the two-digit origin and destination codes. The origin is the first digit, and the destination is the second digit. The following are the origin and destination codes accepted by the Texas Medicaid Program: Origin and Destination Codes D E G H I J N P R S X Nonemergency Ambulance Services According to 1 TAC , nonemergency transport is defined as a transport to or from a medical appointment for a Medicaid client who requires treatment in another location and is so severely disabled that the use of an ambulance is the only appropriate means of transport. Severely disabled is defined as the physical condition of a Medicaid client that limits mobility and requires the client to be bed-confined at all times, unable to sit unassisted at all times, or requires continuous life-support systems (including oxygen or intravenous infusion). A round-trip transport from the client s home to a scheduled medical appointment (for example, an outpatient or freestanding dialysis or radiation facility) is a covered service when the client meets the definition of severely disabled. All nonemergency ambulance transfers to a scheduled doctor s appointment require the doctor s name and address, the diagnosis, and the treatment rendered at the time of visit. Nonemergency transports of clients with conditions that do not meet the severely disabled criteria and are not prior authorized are not a covered Medicaid service. Refer to: Medical Transportation on page I-1 for more information about nonemergency transportation Nonemergency Ambulance Transports Medicaid health care providers (for example, physicians, hospitals, nursing facilities) are responsible for providing or arranging nonemergency transportation for their severely disabled Medicaid clients. Arranging nonemergency transportation for these clients is required by the Medicaid program and includes obtaining prior authorization for the transport. Health care providers must request prior authorization before contacting the ambulance provider for the transport. Note: Ambulance providers may choose to bill healthcare providers who fail to provide appropriate authorization (the prior authorization number) for nonemergency transports. Ambulance providers may assist hospitals, physicians, and other healthcare providers in obtaining prior authorizations. Providers may contact the TMHP Ambulance Unit at or their provider relations representative with questions about the nonemergency ambulance transport policy. To request prior authorization for a nonemergency transport, providers are to fax the request to the TMHP Ambulance Unit at

4 Section Nonemergency Ambulance Transport Prior Authorization Prior authorization is required for all nonemergency ambulance transports. TMHP responds to prior authorization requests within 48 hours of receipt of the request. It is recommended that all requests for a prior authorization number (PAN) be submitted in sufficient time to allow TMHP to issue the PAN before the date of the requested transport. Documentation of a client s condition that meets the severely disabled definition must be provided at the time of request. Prior authorization is a condition for reimbursement but is not a guarantee of payment. The client and provider must meet all the Medicaid requirements such as eligibility and filing deadlines. These prior authorization requirements also apply to Medicaid providers participating in PCCM. Medicaid providers participating in one of the Medicaid managed care HMO plans must follow the requirements of their plan. Prior authorizations for nonemergency transports require supporting documentation. The TMHP Ambulance Unit reviews the documentation to determine if the client meets the definition of severely disabled. Incomplete information may cause the request to be denied. The following information assists TMHP in determining the appropriateness of the transport: A detailed explanation of the severity of the client s physical condition that established the medical necessity for transport. If the client is bed-confined, documentation must clearly state the reasons for the confinement The necessary equipment, treatment, or personnel used during the transport The origination and destination points of the client s transport Important: TMHP continues to require prior authorization for all out-of-state ambulance transfers. When the client does not meet the severely disabled criteria, nonemergency ambulance services are not covered Prior Authorization Process Medicaid health care providers and TMHP follow the following prior authorization process: 1) The ambulance provider seeks prior authorization for a nonemergency transport. The client s physician, nursing or ICF-MR facility, health care provider, or other responsible party faxes a copy of the Ambulance Fax Cover Sheet on page B-6 to the TMHP Ambulance Unit at Information and documentation listed on the form must be sent with the request before the transport to the initial or next medical appointment. Documentation requirements are outlined in this section under Supporting Documentation on page ) TMHP reviews all information and documentation received and a letter of approval or denial is faxed to the requesting provider. The client is notified by mail if the authorization request is denied or downgraded. Reasons for denial include documentation that does not meet the severely disabled criteria or the client is not eligible for the dates of services requested. Clients may appeal prior authorization request denials by contacting TMHP Client Notification at ) The requester contacts the transporting ambulance company and provides the company with the (PAN) and the dates of service approved. 4) Ambulance providers must attempt to obtain the PAN before transporting the client. Claims submitted without the PAN are denied and must be appealed in writing by the provider. The appeals must be accompanied by supporting documentation. The ambulance provider must document attempts to obtain the PAN from the client or the health care provider before transporting the client. When the ambulance provider is unable to obtain the PAN, the provider can do one of the following: Transport the client and appeal the denied claim with documentation of severe disability and evidence of a previous and timely PAN request Transport the client and bill the healthcare provider who failed to provide the appropriate authorization 5) Hospitals may call TMHP at or fax to to obtain a PAN when discharging a client or transporting the client to another facility. Ambulance companies may provide documentation to assist hospitals in obtaining authorization, by fax only. Important: Claims submitted without the PAN are denied and must be appealed by the provider Authorization of Retroactive Eligibility Prior authorization is issued to clients who meet Medicaid eligibility and the severely disabled criteria. If a request for a PAN is received and the client s Medicaid coverage is pending, the request will be denied. The client s eligibility may be granted retroactively. The requestor has 95 days from the date the eligibility is added to TMHP s files to contact the Ambulance Unit and request authorization to be reconsidered. To inquire about Medicaid eligibility, providers are to contact the Automated Inquiry System (AIS) at Prior Authorization Types, Definitions Short Term Short-term prior authorizations are issued to a client whose condition meets the severely disabled criteria for a short period of time. The length of the prior authorization is determined based on the treating physician s or 9 4

5 Ambulance surgeon s prognosis of recovery. If a recovery period cannot be determined at the time the prior authorization is requested, the TMHP Ambulance Unit defaults the authorization to 60 days with the option for an extension based on updated documentation received before the 60 days have lapsed. Hospital-to-hospital and hospital-tooutpatient medical facility transports are issued a PAN for that transport only. If the client already has a short-term or annual PAN, the PAN may be used for the ambulance transport. The hospital is responsible for obtaining the prior authorization. Annual Annual prior authorizations are issued to a client who meets the severely disabled criteria and whose condition is not expected to improve within the year. These authorizations are valid for a 12-month period as long as all other eligibility criteria are met. 180-Day 180-day prior authorizations are issued to a client and are granted within 24 hours from the time received, excluding weekends and holidays for authorization of nonemergency ambulance services. The request must be effective for a period of 180 days from the date of issuance if the request includes a written statement from a physician. Requests can be submitted up to 60 days before the date of service. The provider requesting this authorization is required to complete the certification form on page B-70 in its entirety. Incomplete forms are not considered as a valid authorization request and are returned with a denial letter. The Physician Certification form is not considered documentation after the service is rendered and should not be sent with a claim or an appeal Supporting Documentation Providers must submit supporting documentation (examples follow) with all prior authorization requests. Admit and discharge records with prognosis, including emergency room records A history and physical completed within six months or a care plan detailing daily activities from a facility or home health agency A letter on the health care provider s letterhead including the patient s primary mode of mobility and diagnosis history In hospital-to-hospital transports or hospital-to-outpatient medical facility transports, the Ambulance Unit considers information by telephone from the hospital. Beginning June 1, 2005, providers are no longer required to fax medical documentation to TMHP; however, in certain circumstances, TMHP may request the hospital fax the supporting documentation Claim Denials and Appeals Ambulance claims submitted without the PAN are denied and must be appealed on paper by the provider. The appeal must be accompanied by supporting documentation. Clients may appeal PAN request denials by contacting TMHP Client Notification at Important: All ambulance denials (air or ground) must be appealed on paper. Telephone and electronic appeals are not accepted. For claims or appeals related to prior authorization denials for the 180-day authorization request, the Physician Certification Form is not considered as documentation after the service is rendered. On appeal, supporting documentation is critical for determining the client s condition. Ambulance providers who file paper claims must include all information that supports the reason for the transport and attach a copy of the run sheet to the claim. The emergency medical technician (EMT) who transported the client must sign the documentation. Refer to: Supporting Documentation on page Ambulance Disposable Supplies Reimbursement for disposable supplies is separate from the established global fee for ambulance transports. Providers should use one procedure code, 9-A0382, to combine all payable disposable supplies used (for example, gauze, bandages, tape, suction catheter, gloves, and mask) during emergency and nonemergency ambulance transports. Reimbursement for this procedure code is limited to a maximum of $20.30 per transport (one-way) and $40.60 round trip. A maximum of two-supply procedure codes are allowed per round trip. In situations involving multiple transports on the same date of service, the provider may appeal claims denied because they exceed two-supply procedure codes per claim. When billing for nonpayable supplies, providers must bill the appropriate national code. Providers must provide medically necessary supplies for the client s safe transport Oxygen Reimbursement for oxygen is the lesser of the provider's customary profile, the prevailing profile, or the provider's actual charge in accordance with 1 TAC A maximum of two oxygen procedure codes are allowed per round trip. In situations involving multiple transports on the same date of service, the provider may appeal claims that have denied for this two-code limit. Provider's must bill the appropriate national code Waiting Time Procedure code 9-A0420, may be billed when it is the general billing practice of local ambulance companies to charge for unusual waiting time (longer than 30 minutes). Providers must use the following procedures: 9 5

6 Section 9 Separate charges must be billed for all clients, Medicaid and non-medicaid, for unusual waiting time. The circumstances requiring waiting time and the exact time involved must be documented in Block 24 of the CMS-1500 claim form. The amount charged for waiting time must not exceed the charge for a one-way transfer. Important: Waiting time is reimbursed up to one hour Extra Attendant or Registered Nurse Charges for an extra attendant or registered nurse (in addition to the two-person crew) for an ambulance transfer are reimbursed when the claim documents the medical necessity of advanced life-support services (for example, procedure code 9-A0424). Without documentation of the medical need of the third attendant, the third attendant s services are not reimbursable. Medicaid does not reimburse based on each ambulance provider s internal policy Night Call The Medicaid program does not reimburse an extra charge for a night call. 9.4 Membership Fees The Texas Insurance Code does not apply to ambulance providers who finance, in part or in whole, the ambulance service by subscription. HHSC s Bureau of Emergency Management and Bureau of Policy and Operations have specific guidelines about these subscription plans. For more information, providers may contact their regional EMS program administrator or the HHSC Emergency Medical Services Division at Types of Transport Multiple Client Transports Multiple client transports occur when more than one client with Medicaid coverage is transported in the same vehicle simultaneously. A claim for each client must be completed and must reference multiple transfers with the names and Medicaid numbers of other clients sharing the transfer in Block 19 of the CMS-1500 claim form. Providers must enter charges on a separate claim for each client. TMHP adjusts the payment to 80 percent of the allowable base rate for each claim and divides mileage equally among the clients who share the ambulance. Important: Mileage determinations are based on the Official State Mileage Guide. Refer to: Claims Filing Instructions on page Out-of-Locality Transports Transports to out-of-locality providers are covered if a local facility is not adequately equipped to treat the condition. Out-of-locality refers to one-way transfers of 50 or more miles from point of pickup to point of destination. Important: Transports may be cut back to the closest appropriate facility Air or Boat Transports Air ambulance transport services, by means of either fixed or rotary wing aircraft, may be covered only if one of the following conditions exists: The client s medical condition requires immediate and rapid ambulance transportation that could not have been provided by ground ambulance. The point of client pick-up is inaccessible by ground vehicle. Great distances or other obstacles are involved in transporting the client to the nearest appropriate facility. Important: Air transport claims may be submitted on paper with supporting documentation. Claims may be submitted electronically with a short description of the client s physical condition in the comment field. If the client s condition cannot be documented, providers must file a paper claim Pregnancy Transports Transporting a pregnant woman may be covered as an emergency transfer if the client s condition is documented as an emergency situation at the time of transfer. Claims documenting a home delivery or delivery en route are considered emergency transfers. Premature labor and early onset of delivery (less than 37 weeks gestation) also may be considered an emergency. Active labor without more documentation of an emergency situation is not payable as an emergency transport. Important: First day of last menstrual period (LMP) or estimated due date (EDD) must be in Block 14 of the claim form and on the documentation. If the pregnant client is transported in an ambulance on a nonemergency basis, all criteria for nonemergency prior authorization must be met Transports to or From State Institutions Ambulance transports to or from a state-funded hospital for admission or following discharge are covered when nonemergency transfer criteria are met. Ambulance transfers of clients while they are inpatients of the institution are not covered. The institution is responsible for routine nonemergency transportation. 9 6

7 Ambulance Transports for Nursing Facility Residents Transports from a nursing facility to a hospital are covered if the client s condition meets emergency criteria. Nonemergency transfers for the purpose of required diagnostic or treatment procedures not available in the nursing facility (such as dialysis treatments at a freestanding facility) are also allowable only for clients meeting the definition of severely disabled. Transports of nursing facility residents for rehabilitative treatment (for example, physical therapy) to outpatient departments or physicians offices for recertification examinations for nursing facility care are not reimbursable ambulance services. The nursing facility is responsible for providing routine nonemergency transportation for services not provided in the nursing facility. The cost of such transportation is included in the nursing facility vendor rate. Claims for services to nursing facility residents must indicate the medical diagnosis or problem requiring treatment, the medical necessity for use of an ambulance for the transport, and the type of treatment rendered at the destination (for example, admission or X-ray). If a client is returned by ambulance to a nursing facility following hospitalization, the acute condition requiring hospitalization must be noted on the ambulance claim form. This transport is only considered for payment if the client meets the severely disabled criteria. Nursing facilities are responsible for providing or arranging transportation for their residents. Arranging transportation for Medicaid clients includes obtaining prior authorizations for nonemergency ambulance transports. Ambulance providers may assist nursing facilities in obtaining prior authorizations. Ambulance providers may only bill a nursing facility or client for a nonemergency ambulance transport under the following circumstances: Providers are to bill the nursing facility when the nursing facility requests the nonemergency ambulance transport without a prior authorization number. Providers are to bill the client only when the client requests transport that is not an emergency, and the client does not meet the severely disabled criteria. The provider must advise the client of acceptance as a private pay patient at the time the service is provided, and the client is responsible for payment of all services. Providers are encouraged to have the client sign the Private Pay Agreement. Providers may refer questions about a nursing facility s responsibility for payment of a transport to the TMHP Ambulance Unit at or TMHP provider relations representatives. result in a transport, the provider should have the client sign an acknowledgment statement and bill the client for services rendered. 9.6 Medicare/Medicaid Coverage Medicaid is the secondary payor to other health insurance sources including Medicare. Ambulance claims for Medicaid and Medicare Part B claims must be filed with Medicare first. MQMBs are eligible for Medicaid benefits such as ambulance transports. Qualified Medicare Beneficiaries (QMBs) are not eligible for Medicaid benefits. The Medicaid program is only required to pay for coinsurance and/or deductible for QMBs. Therefore, providers should not request prior authorization for ambulance services for these clients. Important: Providers must use national procedure codes when billing Medicaid. Refer to: Medicare/Medicaid Clients on page Medicare Paid Assigned claims filed with and paid by Medicare are automatically transferred to TMHP for payment of the deductible and coinsurance liability. Providers must submit Medicare-paid claims that do not cross over to TMHP for the coinsurance and deductible. Providers must send the Medicare Remittance Advice (RA) with the client information circled in black ink Medicare Denied All claims denied by Medicare for administrative reasons must be appealed to Medicare before sending to Medicaid. An assigned claim denied by Medicare because the client has no Part B benefits, or because the transport destination is not allowed, can be submitted to TMHP for consideration. Providers must send claims to TMHP on a CMS-1500 with the ambulance TPI, unless they are a hospital-based provider. If so, providers must file the claim on a HCFA (UB-92) with the hospital TPI. Note: All claims for STAR+PLUS clients with Medicare and Medicaid should follow the same requirements noted in Prior Authorization on page 9-2, including obtaining prior authorization for Medicaid-only services from TMHP. The STAR+PLUS HMO is not responsible for reimbursement of these services No-Transport The Medicaid program does not reimburse providers for services that do not result in a transport to a facility, regardless of any medical care rendered. If a client contacts an ambulance provider, but the call does not 9.7 Relation of Service to Time of Death Medicaid benefits cease at the time of the client s death. However, if the client dies in the ambulance while en route to the destination, Medicaid covers the transport. If a 9 7

8 Section 9 physician pronounces the client dead after the ambulance is called, Medicaid covers the ambulance service (base rate plus mileage) to the point of pickup. Providers must Indicate the date and time the client died in Block nine of the CMS-1500 claim form. If a physician or coroner pronounces the client dead before the ambulance is called, the service is not covered. Important: Equipment and supplies are included in the base rate. They are not separately reimburseable, but are considered part of another procedure. Therefore, equipment and supplies cannot be billed to the client. 9.8 Ambulance Procedure Codes Use the following procedure codes when billing for ambulance services provided to Medicaid-eligible clients: Emergency Code Limitations 9-A0382 Maximum allowable fee of $20.30 is per transport, not to exceed $40.60 round trip. Maximum Fee $ A0420 * 9-A0422 * 9-A0424 * 9-A0425 Use modifier ET to denote * with modifier ET emergency services. A0425-ET is denied if it is billed without A A0429 * 9-A0430 $1, A0431 $ A0435 $ A0436 $ A0999 Use for water ambulance services. MP *Reimbursed at reasonable charge, which is the lesser of the provider s customary profile, the prevailing profile, or the provider s actual charge in accordance with 1 TAC Nonemergency Code Limitations 9-A0382 Maximum allowable fee of $20.30 is per transport, not to exceed $40.60 round trip. Maximum Fee $ A0420 * 9-A0422 * 9-A0424 * *Reimbursed at reasonable charge, which is the lesser of the provider s customary profile, the prevailing profile, or the provider s actual charge in accordance with 1 TAC Nonemergency Code Limitations 9-A0425 A0425 is denied if it is * billed without A A0428 * 9-A0430 * 9-A0431 * 9-A0435 * 9-A0436 * *Reimbursed at reasonable charge, which is the lesser of the provider s customary profile, the prevailing profile, or the provider s actual charge in accordance with 1 TAC Claims Information Providers must submit ambulance services to TMHP on a CMS-1500 claim form. Providers must purchase CMS-1500 claim forms from a vendor of their choice; TMHP does not supply them. Providers may file emergency and nonemergency ambulance services claims to TMHP in an approved electronic format. Nonemergency claims filed electronically must include the PAN in the appropriate field. Reminder: Providers must submit multiple transports for the same client on the same date of service through one claim submission. Refer to: Reimbursement on page Modifiers on Ambulance Claims Ambulance providers may see the HH modifier on their Remittance and Status (R&S) reports, which indicates the transfer is from a noncontracted to a contracted hospital. It does not affect claim payment or processing. Modifier TG may be used to indicate ALS services were provided when billing BLS procedure codes Claim Filing Resources Maximum Fee Providers may refer to the following sections or forms when filing claims: Page Resource Number Automated Inquiry System (AIS) xi TMHP EDI General Information 3-1 CMS-1500 Claim Filing Instructions 5-18 Communication Guide A-1 Ambulance Claim Example 1 D-3 Ambulance Claim Example 2 D-4 Ambulance Claim Example 3 D-4 Acronym Dictionary F-1 9 8