CurrentSecurity Health Plan of Wisconsin, Inc.Policy N/A

Ambulance: Land and Air Transportation

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This policy governs coverage, prior authorization, destination requirements, and administrative handling for emergency and non-emergency land ambulance, air/helicopter, and hospital-to-hospital transportation across applicable Health Plan products.

Policy Summary

PayerSecurity Health Plan of Wisconsin, Inc.

PolicyAmbulance: Land and Air Transportation

Policy CodePolicy N/A

Change TypeMaterial update

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization for non-emergent transportation, air/helicopter hospital-to-hospital transport, or transport to a more distant facility.

SourceLink

POLICY UPDATE CHANGES

Align, Align DSNP, and Great Plains Medicare Advantage health plans were added to the policy effective January 1, 2026.

The Medicare section was clarified to state that Medicare follows Medicare guidelines.

The policy clarified that intrahospital system transfers are covered when care has begun at the admitting hospital but the required further treatment cannot be provided in the current setting.

The Health Plan's clinical criteria were transitioned to InterQual format, with review completed through InterQual.

BadgerCare non-emergency transportation and nursing home transportation claim guidance was updated.

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CurrentSecurity Health Plan of Wisconsin, Inc.Policy N/A

Ambulance: Land and Air Transportation

Customize your policy alerts

Sign up for all security_health_plan_of_wisconsin_inc policy alerts

Know when security_health_plan_of_wisconsin_inc releases new policies or updates existing guidance.

Monitor payer policy activity

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Policy Summary

PayerSecurity Health Plan of Wisconsin, Inc.

PolicyAmbulance: Land and Air Transportation

Policy CodePolicy N/A

Change TypeMaterial update

Effective DateJanuary 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization for non-emergent transportation, air/helicopter hospital-to-hospital transport, or transport to a more distant facility.

SourceLink

POLICY UPDATE CHANGES

Align, Align DSNP, and Great Plains Medicare Advantage health plans were added to the policy effective January 1, 2026.

The Medicare section was clarified to state that Medicare follows Medicare guidelines.

The policy clarified that intrahospital system transfers are covered when care has begun at the admitting hospital but the required further treatment cannot be provided in the current setting.

The Health Plan's clinical criteria were transitioned to InterQual format, with review completed through InterQual.

BadgerCare non-emergency transportation and nursing home transportation claim guidance was updated.

Ambulance Transportation Coverage Criteria

Nearest capable facility

Ambulance transportation follows Medicare guidelines when applicable criteria are met.

Medicare ambulance destination: Transport is to the nearest medical facility able to provide the required level of care.

If the nearest facility cannot provide the needed level of care, transport may be directed to a more distant facility when prior authorization is obtained.

Intrahospital system transfers

Intrahospital system transfers are covered when the stated conditions are met.

Intrahospital system transfer: Care has been initiated at the admitting hospital and further treatment is needed that cannot be provided in the current setting.

The transfer is covered when both conditions are present.

Authorization and Transport Requirements

Prior Authorization

Non-Emergency and Air Transport Authorization

Prior authorization is required for non-emergency medical transportation and air/helicopter hospital-to-hospital transportation.

Applies to non-emergent land transportation and air/helicopter hospital-to-hospital transport.

Prior Authorization

Transport to a More Distant Facility

Ambulance transportation should be arranged to the nearest medical facility able to provide the required level of care. Transportation to a more distant facility requires prior authorization when the nearest facility cannot provide that level of care.

Call the Health Plan at 1-800-991-8109 before transporting to a more distant facility.

Prior Authorization

Prior Authorization Submission

Submit prior authorization requests through the Health Plan provider portal or call the Health Plan at 1-800-991-8109.

Policy Background

Ambulance transportation coverage is evaluated under applicable Medicare or plan-specific criteria. Providers should review the member’s Summary Plan Description or other applicable benefit documents to confirm coverage, limitations, and exclusions; where applicable, review is completed through InterQual. For Medicare members, transportation generally follows Medicare guidelines and is directed to the nearest medical facility able to provide the required level of care.

Denial Risk

Destination and Authorization Conditions

Transportation may be affected when it is provided to a facility other than the nearest facility able to provide the needed level of care or when required prior authorization is not obtained. Confirm the destination and authorization status before transport.

The Health Plan follows Medicare guidelines when criteria are met.
For a more distant destination, document that the nearest facility could not provide the needed level of care and obtain prior authorization.