MedicaidPrior AuthHigh impact
26-954 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 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, and air transport. Missing or incomplete forms will result in authorization delays or denials. The PCS form must be faxed to the Care Ride Unit before scheduling transportation.
Action Required
Immediately: Billing team and providers must implement the following: (1) Download the PCS CVH Form from the Medi-Cal Provider Library and ensure all staff have current copies; (2) Add a workflow requirement that ALL NEMT service requests for Medi-Cal members in Fresno, Kings, and Madera counties require a completed, signed PCS form BEFORE authorization can be obtained; (3) Update billing system/EMR templates to flag NEMT claims for PCS form verification and fax submission to Care Ride Unit at 833-701-0051; (4) Train providers and practitioners on PCS form completion requirements; (5) Establish a 12-month tracking system for authorization renewals, requiring resubmission of PCS forms upon expiration if services continue. Consequences of inaction: Claims will be denied and transportation services cannot be scheduled without prior authorization via completed PCS form. This applies to Physicians, Practitioners, PPGs, Hospitals, Ancillary Providers, Community Supports Providers, Enhanced Care Management Providers, and Behavioral Health Providers.