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March 2018

Starting April 2, 2018, non-emergency air ambulance services require authorization for commercial members

Effective for dates of service on or after April 2, 2018, all non-emergency air ambulance transports for Blue Cross Blue Shield of Michigan commercial PPO and Blue Care Network HMOSM commercial members require authorization. Requests for authorization must be submitted to and approved by Alacura Medical Transportation Management LLC before the flight.

Alacura, an independent company working with Blue Cross and BCN, will use the Blue Cross and BCN medical policy titled Air Ambulance Services to determine the appropriateness of non-emergency flights.

Blue Cross defines non-emergency, or non-emergent, as services in which the ordering physician has determined and attested that the patient’s condition is such that transport may safely wait at least six hours from the time the service is requested.

There are no changes to member benefits related to air ambulance services. Non-emergency air ambulance services are eligible for reimbursement if the member has the benefit and if Alacura authorizes the flight.

How to request an authorization

To contact Alacura for a non-emergency flight request, call 844-608-3676. This requirement applies to both in-state and out-of-state air ambulance transports. If you’re required to submit documentation, fax it to Alacura at 844-608-3572.

Reason for this change

Air ambulance transports that aren’t medically necessary or that are flown by noncontracted providers expose Blue Cross and BCN members to significantly greater out-of-pocket costs and are much costlier for the plan. The requirement for authorization before non-emergency flights is expected to lower costs for Blue Cross and BCN members and customers.

Billing air ambulance claims

Instructions for billing emergency and non-emergency air ambulance services for dates of service on or after Jan. 1, 2017, are available.

These instructions apply to both Blue Cross and BCN air ambulance claims. The Blue Cross PPO and BCN provider manuals are being updated with links to this document.

To obtain the instructions, complete the following steps:

  1. Visit bcbsm.com/providers.
  2. Click Login.
  3. Log in to Provider Secured Services.
  4. Click BCN Provider Publications and Resources.
  5. Click Billing/Claims.
  6. Click Air ambulance services.

The instructions document is also available on the BCBSM Provider Publications and Resources page titled Clinical criteria and other resources. Look under the Clinical criteria heading.

In line with standard Blue Cross and BCN claims auditing policies, all air ambulance claims are subject to post-payment audit, to ensure the appropriateness of claims payment.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.