Medicare

  • Erickson Ambulance Physician Certification Statement (Certifying Medical Necessity)-entryready?
  • Medicare Ambulance Guidelines for Medical Necessity
  • Medicare Beneficiary Signature
  • Medicare Coverage of Ambulance Services Booklet www.medicare.gov/Pubs/pdf/11021.pdf

Medicaid

  • Medicaid Ambulance and Medicar Coverage Guidelines
  • Certification of Transportation Services (CTS)
  • Netspap Single Trip Form
  • Netspap Standing Prior Approval Form
  • First Transit Trip Request Instruction in English
  • First Transit Trip Request Instruction in Spanish
  • Psychiatric Services Treatment Plan Form
  • Psychiatric Services Treatment Plan Form for LPHA’s (Provider Type 36)
  • How to Guide for PSTP-36 Form (LPHA)
  • Medical Certification for Non-Emergency Ambulance (MCA)-entry ready

Other Helpful Forms & Documents

  • HIPAA Privacy Form
  • Illinois RN Continuing Education FAQs (Illinois Department of Financial and Professional Regulation)      https://www.idfpr.com/faq/DPR/201201aa_IL_RN_CE_Relicensure_FAQ.pdf
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