| MEDICAID CERTIFICATE OF MEDICAL NESSECITY |
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The
Ohio Department of Job
and Family Services has revised the Physicians
Certification Form, JFS 03452 and renamed it,
Ambulette Certification of Medical Necessity,
and has created a new form JFS 01960 titled,
Ambulance Certification of Medical Necessity.
These forms are required for practitioner
certification of medical necessity for ambulette
and ambulance transport. The forms have been
revised or created to ensure consistency with
revisions to documentation requirements in
transportation rule 5101:3-15-02.
The attending practitioner, or with an order
from the attending practitioner a registered
nurse signing for the attending practitioner,
must complete an ODJFS 03452 or ODJFS 01960 for
all medical transportation services except:
- ALS and/or BLS ambulance
transportation to a hospital emergency room in an
emergency situation; or
- Ambulance or ambulette
transfer of a nonambulatory patient from one hospital
to another hospital if the services provided at
the second hospital are covered by Medicaid; or
- Nonemergency ambulance
or ambulette transportation for a hospital discharge.
Click
HERE to view the ODJFS 03452, Ambulette Certification
of Medical Necessity and instructions.
Click
HERE to view the ODJFS 01960, Ambulance Certification
of Medical Necessity and instructions.
Click
HERE to view the Medicare Physician Certification Statement for Non-Emergency
and Repetitive Ambulance Transport.
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