Ambulance Agreement Format
The coverage of the service by the [service provider], as described in this Agreement, follows the schedule indicated below: ambulance that is in the possession of a hospital / managed by it to carry out ambulance transports. To create your SLA, simply follow the steps in the template. They will guide you by asking you to add relevant information. There are several ways to write an SLA. Below is a simulated table of contents (TOC) that you can use as a startup template to write your own service level agreements. Members are financially responsible for all air rescue services that are not covered by their BCBSND performance plan, including fees resulting from the use of providers that do not participate in BCBSND. The provider is responsible for billing for services not covered by members. Ambulance services provided by an ambulance must be invoiced on the UB-04 application form using the National Provider Specific Identifier (NPI) assigned to the ambulance. These services should not be billed as part of the acute hospital`s NPPI.
Hospital ambulance services are not allowed in case of hospital claims, since patient transport is not included in hospital reimbursement methods. Requests for emergency services must be submitted separately as outpatient fees. An exception to the billing for ambulance services through the acute hospital`s NPI is explained in the Intra-facility Ambulance Transport section. Now let`s dive deep into service level agreements. Most service providers understand the need for service level agreements with their partners and customers.