CTR053481_Pricing.pdf
PDF 132 KB Posted
- Attached to
- Master Agreement AZ|CTR053481
- Contract number
- CTR053481
- Issued by
- Arizona
About this file
This document is a Price Sheet for Contract No. CTR053481 associated with the Arizona Health Care Cost Containment System (AHCCCS), which appears to be the state Medicaid agency. The price sheet is linked to a specific webpage for transportation and air ambulance services rates and billing.
The price sheet details two primary service types with their respective rates: Air Transport Services Patient Health Insurance Claim Forms, which will be reimbursed at "Current AHCCCS Rates" per trip, and Coordination of Services, which is set at $40.00 per trip. The Coordination of Services reimbursement is explicitly noted to be based on the number of eligible transports performed. The document is page 24 of a 26-page document, suggesting it is part of a larger contract or procurement document for medical transportation services.
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Text version
PRICE SHEET
CONTRACT NO: CTR053481
PRICE SHEET
https://azahcccs.gov/PlansProviders/RatesAndBilling/FFS/transportationairambulance.html
TYPE OF UNIT RATE PER UNIT UNIT OF MEASURE
Air Transport Services Patient Health Insurance Claim Forms Current AHCCCS Rates Per Trip
Coordination of Services** $40.00 Per Trip
**Reimbursement for Coordination of Services will be based on the number of eligible transports performed.
https://azahcccs.gov/PlansProviders/RatesAndBilling/FFS/transportationairambulance.html
File details come from the government source that posted it. Updated .