Facility & Hospital Documents
General Information for Facilities
Medicare & Medicaid Reference Information
- Ambulance & Related Service Fees 2023-24
- Ambulance Transportation Estimate
- Insurance Prior Authorization Contact List
- Texas Standard Prior Authorization Form and Instructions
- Texas Medicaid Non-Emergency Ambulance Prior Authorization Request Form
- Amerigroup Medicaid & Chip Authorization Request Form
- Amerigroup Medicare Non-Emergency Ambulance Prior Authorization Request Form
- Medicare Manual for Part A and Part B Ambulance Services
- Instructions for Physician Certification Statement for Ambulance Transport
- Texas Medicaid Guidance on Provider Assistance Seeking Prior Authorization
- Texas Medicaid Information for Hospitals, Nursing Homes, and Physicians on Requesting Client Transport
- Baylor Scott & White Health Plan Prior Authorization Notice
- Baylor Scott & White Health Plan Prior Authorization Form
Return signed forms to:
Metropolitan Area EMS Authority
2900 Alta Mere Drive
Fort Worth, Texas 76116
(817) 632-0537 – Business Office Fax
(817) 927-9671 – Communications Center Fax
