MedicaidPrior AuthHigh impact
26-955 PCS Form Required to Authorize NEMT Services for Medi-Cal Members
Health Net·CA·Prior Authorization
We identified it
Aug 1, 2026
Summary
Medi-Cal (California Medicaid) now requires a completed and signed Physician Certification Statement (PCS) form for all Non-Emergency Medical Transportation (NEMT) services, including wheelchair vans, gurney/stretcher vans, ambulances (all levels), and air transport. The form must be submitted to the Care Ride Unit via fax before scheduling transportation to avoid authorization delays or denials. Authorizations are valid for up to 12 months and require reassessment and resubmission if services continue.
Action Required
Immediately: Billing and clinical teams must implement the following: (1) Obtain the PCS CHPIV Form from the Medi-Cal Provider Library and make it accessible to all ordering providers and practitioners; (2) For all Medi-Cal members in Imperial County requiring NEMT services (wheelchair vans, gurney/stretcher vans, ambulances of any level, or air transport), ensure providers complete and sign the PCS form before scheduling; (3) Designate responsible staff to fax completed forms to Care Ride Unit at 833-701-0051 to obtain authorization; (4) Update internal workflows and encounter templates to require PCS form completion as a prerequisite for NEMT orders; (5) Establish a tracking system to monitor authorization expiration dates (12-month validity) and trigger reassessment and form resubmission when services continue; (6) Train all providers, physician groups, hospital staff, ancillary providers, community supports providers, enhanced care management providers, and behavioral health providers on this requirement. Failure to submit the PCS form will result in authorization delays or claim denials.