Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerPolicy UpdatesClinical/Medical PolicyDHA Emergency Transport Prior Auth | OpenPayer
    Ask Trek AI about this page
    ModifiedDHAPolicy 2.0

    Emergency and Medical Transportation

    Customize your policy alerts

    Sign up for DHA Policy 2.0 alerts

    Get alerted when Policy 2.0 changes without checking for updates manually.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    This DHA policy manual publication addresses patient transport and ambulance services. The available document window includes ECHO coverage criteria, authorization, documentation, and termination requirements.

    Policy Summary
    PayerDHA
    PolicyEmergency and Medical Transportation
    Policy CodePolicy 2.0
    Change TypeAdded
    Effective DateSep 1, 2005
    Next Review DateN/A
    Key ActionThe contractor must authorize requested ECHO services and items before they are provided.
    SourceLink
    POLICY UPDATE CHANGES

    For beneficiaries residing outside the 50 United States and the District of Columbia, the TRICARE Overseas Program contractor is responsible for authorizing ECHO benefits.

    1Patient Transport section identified
    1Ambulance Service section identified
    3ECHO authorization conditions
    3Authorization termination events
    50 states + DCStandard contractor coverage area
    RequiredAuthorization before claims adjudication

    ECHO Benefit Authorization Criteria

    ECHO benefit authorization

    Authorization is based on all of the following conditions.

    ECHO authorization conditions

    • Beneficiary registration: The beneficiary is registered in the ECHO.
    • Benefit allowability: The requested service or item is allowable as an ECHO benefit.
    • Public facility use: The requested service or item meets public facility use requirements when applicable.

    Authorization ends when the beneficiary is no longer eligible for the ECHO, when the authorized ECHO service or item is no longer appropriate or required by the beneficiary, or when the authorized service or item becomes a benefit through the TRICARE Basic Program.

    Policy Summary
    PayerDHA
    PolicyEmergency and Medical Transportation
    Policy CodePolicy 2.0
    Change TypeAdded
    Effective DateSep 1, 2005
    Next Review DateN/A
    Key ActionThe contractor must authorize requested ECHO services and items before they are provided.
    SourceLink
    On This Page
    ECHO Benefit Authorization CriteriaAuthorization Requirements

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Authorization Requirements

    Prior Authorization

    Obtain ECHO Authorization

    The contractor must authorize requested services and items under the Extended Care Health Option (ECHO) before they are provided, except where an applicable authorization exception or waiver applies. For beneficiaries residing outside the 50 United States and the District of Columbia, the TRICARE Overseas Program (TOP) contractor is responsible for authorizing ECHO benefits.

    Documentation Required

    Include Required Authorization Details

    The authorization must provide exact identification of the approved benefit by specifying the service or item’s type, scope, frequency, duration, dates, amounts, requirements, and limitations, along with the provider’s name and address and all other information necessary to deliver the approved benefit.

    • Type and scope
    • Frequency and duration
    • Dates and amounts
    • Requirements and limitations
    • Provider name and address
    • Any other information needed for exact identification of approved benefits
    Denial Risk

    Meet Authorization Conditions

    Authorization is based on all applicable eligibility and benefit conditions. Authorization may not be granted unless the beneficiary is registered in ECHO, the requested service or item is an allowable ECHO benefit, and the public facility use requirements are met when applicable.

    • Beneficiary is registered in ECHO
    • Requested service or item is allowable as an ECHO benefit
    • Public facility use requirements are met when applicable
    Billing Rule

    Complete Authorization Before Claims Adjudication

    Claims cannot be adjudicated without a precise authorization containing all required identifying information. The contractor or TOP contractor may waive the required written authorization for rendered services or items that would otherwise be allowable ECHO benefits, and may waive the required public facility use certification when appropriate.

    • Authorization must precisely identify the approved benefit before claims adjudication.
    • Written authorization may be waived when the service or item would otherwise be allowable as an ECHO benefit.
    • Public facility use certification may be waived when the waiver is appropriate.