Authorization for Fixed Wing Air Ambulance Transportation
Customize your policy alerts
Sign up for all HealthPartners policy alerts
Know when HealthPartners releases new policies or updates existing guidance.
Monitor payer policy activity
Forms and prior authorization process for fixed-wing air ambulance transport for HealthPartners members; governs requests submitted by providers, facilities, or transportation vendors to Utilization Management.
No material clinical or coverage changes in this revision.
Coverage Criteria for Fixed-Wing Air Ambulance
Authorization submission criteria
Authorization requires submission of the form with clinical support and answers to transport justification questions.
ALL of the following
- Specify whether the receiving facility is the nearest facility capable of treating the member; if not, provide explanation.
- Explain why the member cannot be transported by ground ambulance.
- Explain why the member's medical condition requires uninterrupted care and attendance by qualified medical staff during transport.
- Describe the specialty care the member will receive at the accepting facility that cannot be provided where the member is currently receiving care.
- Indicate if the request is related to a transplant and provide explanation if yes.
Relevant Procedure Codes
Prior Authorization and Submission Requirements
Prior authorization and submission requirements
Submit the completed authorization form and supporting clinical documentation by fax to (952)853-8714 or contact Utilization Management at (952)883-6333. Include anticipated date of transport, procedure code(s) and units (A0430, A0435), whether the receiving facility is the nearest capable facility, explanation why ground transport is not appropriate, and reasons medical attendance is required during transport. If the request is urgent, indicate whether waiting the standard review time would seriously jeopardize the member's health, life, or ability to regain maximum functioning and provide the clinical reason for urgency.
- Fax completed forms to (952)853-8714 or call UM at (952)883-6333.
- Include anticipated date of transport, procedure code(s)/units (A0430, A0435).
- State whether receiving facility is nearest capable facility and explain if not.
- Explain why ground ambulance is inappropriate and why medical attendance is required.
- For urgent requests, state if standard review would seriously jeopardize health/life/function and give clinical reason.
Definitions and Urgent Request Handling
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.