Authorization for Fixed Wing Air Ambulance Transportation
This document governs the authorization request process for fixed wing (air) ambulance transport for HealthPartners members, detailing required form fields, clinical documentation, and submission/contact instructions for providers and vendors.
No material clinical or coverage changes in this revision.
Authorization Clinical Criteria and Required Fields
Authorization clinical criteria and required fields
Authorization requires completed form fields and supporting clinical justification addressing the following:
ALL of the following
- Will waiting the standard review time seriously jeopardize member's health, life or ability to regain maximum functioning? (Yes/No)
- If urgent, provide the clinical reason for urgency (not scheduling issues).
- Anticipated date of transport.
- Procedure code(s) and number of unit(s) requested (e.g., A0430, A0435).
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