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Ambulance Services

The Medical Care Unit is responsible for providing prior payment authorization for Ambulance Services.  Forms, provider handbooks, and more information are available through the links to the right. 

To obtain authorization for payment for emergency ambulance services, please fax the following information, in the Boise area to (208) 334-5242 or outside the Boise area to 1 (877) 314-8781. 

If you are a…

Non-Hospital Provider
Hospital Provider
  • CMS-1500 (HCFA-1500)
  • Patient Care Report (PCR)
  • EOB if applicable
  • UB-04
  • Invoice of Charges
  • Patient Care Report (PCR)
  • EOB if applicable
You may also mail this information to:
  • DHW
  • Medicaid Ambulance Review
  • 3232 Elder St.
  • Boise, ID 83705
For non-emergency ambulance services, please note that ALL transports must receive prior authorization BEFORE the actual transport.  To obtain prior authorization for non-emergency ambulance services:
  • Call our Medical Program Specialist toll free at (800) 362-7648 or in the Boise area at (208) 287-1157.  Please refer to the form above for information that will be needed to prior authorize. 
  • FAX updated History and Physical, Progress Reports, Discharge Summary (if available), and any other information that may be needed for Physician Review of medical necessity for transport by ambulance. 
  • After hours, if there are any questions or further information that may be needed, please call and leave all the information on the voice mail, with a return name and phone number. 
For more information, contact our Medical Program Specialist toll free at (800) 362-7648 or in the Boise area at (208) 287-1157.