Documentation required for Ambulance Transports & Chiropractic Services

Ambulance Transports

•    Please be sure documentation submitted is legible.
•    Please submit records for all dates of service on the claim.
•    Please ensure that the medical records submitted provide proof that the service(s) was ordered and rendered. Also, ensure the medical records provide justification supporting medical necessity for the service by submission of the following documentation: 
o    Trip/run sheet for the date of service.
o    If required, a Physician Certification Statement (PCS).
o    Credential of the attendants.
o    For hospital-to-hospital transports, the record should clearly indicate precise treatment and/or procedure, date and legible identity of the observer, certification and rationale of necessity for non-emergent transfers.
o    Signatures/credentials of professionals providing services.
o    Any other records that may support medical necessity.


Chiropractic Services

•    Please be sure documentation submitted is legible.
•    Please submit records for all dates of service on the claim.
•    Please ensure the medical records submitted provide proof the service(s) was ordered and rendered. Also, ensure the medical records provide justification supporting medical necessity for the service by submission of the following documentation:
o    Progress notes.
o    Initial and subsequent visits.
o    Treatment record including plan of care.
o    Abbreviation list.
o    Signatures/credentials of professionals providing services.
o    Any other documentation a provider deems necessary to support medical necessity of services billed, as well as documentation specifically requested in the Additional Documentation Request (ADR) letter.