MedicaidDocumentationMedium impact
Revised Maryland Medicaid Provider Certification Form for Rotary Wing Air Ambulance Transportation beginning May 1, 2024
Maryland Medicaid·MD · Emergency Medicine, Critical Care·Provider Transmittal
Effective date
May 1, 2024
We identified it
Jun 20, 2026
Summary
Maryland Medicaid has revised the Provider Certification Form for Rotary Wing Air Ambulance Transportation effective May 1, 2024. The attending physician at the sending facility must complete this new form in its entirety before air ambulance services are provided, and specific documentation requirements must be met for successful claim processing.
Action Required
Immediately: Sending medical facilities must ensure attending physicians complete the revised Maryland Medicaid Provider Certification Form for all rotary wing air ambulance transports. Update medical record storage procedures to include the completed form. Air ambulance providers must verify they have the completed certification form plus required documentation (patient demographics with Medicaid ID, History and Physical/Discharge Summary with 10 specific elements, and detailed medical interventions description) before submitting claims. Failure to provide complete documentation will result in claim processing delays or denials.