DOCUMENTS & FORMS

Physician Certification Statement (PCS)

The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports. This can be written authorization from a physician, physician’s assistant, nurse practitioner, clinical nurse specialist, discharge planner, or registered nurses. For an ongoing patient (multiple trips), the PCS must be signed by a physician.

Certification of Transportation Services (CTS)

The Certification of Transportation Services (CTS) form must be completed and signed by a doctor or licensed professional to transport non-emergency medical appointments upon request.

Form Link

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Advanced Beneficiary Notice (ABN)

An ABN form is a written notice from Medicare given to you before receiving certain items or services, notifying you:

• Medicare may deny payment for that specific procedures or treatments.

• You will be personally responsible for full payment if Medicare denies payment.

An ABN allows you to accept or refuse the items or services and protects you from unexpected financial liability in cases where Medicare denies payment. It also offers you the right to appeal Medicare’s decision.

NETSPAP: Non-Emergency Transportation Services Prior Authorization Program

NETSPAP is a Medicaid program dedicated to helping Medicaid Participants who have limited access to non-emergency transportation to and from a Medicaid-covered health care service.