Criteria for PAN, McPAN, and PCS Documents in AngelTrack

A thorough explanation of how AngelTrack decides it's recommendation on whether or not a dispatch needs one of the above documents

Criteria for PAN, McPAN, and PCS

AngelTrack automatically decides whether each dispatch needs a PAN, McPAN, and/or PCS, based on the circumstances of the call and the patient's insurance on file.

The criteria used in making this determination are as follows.

Criteria for 'Emergent'

A trip is emergent if any of the following are true:

• Dispatcher booked it as ‘emergent’ or ‘critical’, so that the next available crew will respond; or
• Crew reported that their enroute driving was ‘emergent’; or
• Crew reported that their transport driving was ‘emergent’.

This is how AngelTrack implements the CMS Medicare Benefit Policy Manual chapter 10 which states:

 Emergency response is a BLS or ALS1 level of service that has been 
provided in immediate response to a 911 call or the equivalent. An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.

Prior Authorization Number [PAN]

AngelTrack reports that a dispatch needs a prior authorization if all of the following are true:

• ☑ Billable is checked.
• The call is insurable, meaning any of the following is true:
  • ☑ Bill insurance is checked and no Payor is set yet (AngelTrack will assume it will be claimed), or
  • Payor is "Insurance", or
  • An "Insurance Claim" payment event is on file.
• The call is not emergent.
• The patient record is not marked ☑ Never needs prior auth.
• The patient's record is marked ☑ Always needs prior auth or has primary insurance set to any of:
  • Private;
  • Workers' Compensation; or
  • Medicare and all of the following are true:
    • the service provided is BLS+;
    • the priority is "Scheduled"; and
    • you have ticked the ☑ Medicare requires prior authorization for non-emergent transport checkbox under Preferences.
• The "PAN unnecessary" button has not been clicked to indicate that the patient's insurance does not require prior authorization.
• No applicable PAN document is attached in AngelTrack to the dispatch, or to its return-trip paired dispatch, or to the patient.

When all of those conditions are met, then it is almost certainly necessary to submit a prior authorization request.

AngelTrack expects to receive a copy of the request or the reply, with or without a scan of the document. Until such record is created, AngelTrack will report that the dispatch still needs a prior authorization.

Medicaid Prior Authorization Number [McPAN]

When AngelTrack is configured to track Medicaid prior authorizations, it will report that a dispatch needs a McPAN if all of the following are true:

• ☑ Billable is checked.
• The call is insurable, meaning any of the following is true:
  • ☑ Bill insurance is checked and no Payor is set yet (AngelTrack will assume it will be claimed), or
  • Payor is "Insurance", or
  • An "Insurance Claim" payment event is on file.
• Service level provided is wheelchair, gurney, or BLS+.
• The call is not emergent.
• The patient has Medicaid as their primary or secondary insurance.
• No applicable McPAN document is attached in AngelTrack to the dispatch, or to its return-trip paired dispatch, or to the patient.

Physician Certification Statement [PCS]

PCS documents protect your agency in case an audit raises questions about the medical necessity of your BLS+ transports.

AngelTrack reports that a dispatch needs a PCS document if all of the following are true:

• ☑ Billable is checked.
• The call is insurable, meaning any of the following is true:
  • ☑ Bill insurance is checked and no Payor is set yet (AngelTrack will assume it will be claimed), or
  • Payor is "Insurance", or
  • An "Insurance Claim" payment event is on file.
• Service level provided is BLS+.
• The call is not emergent.
• The patient has Medicare as primary or secondary insurance, or the patient's insurance is unknown, or the PCS Collection setting is "Always".
• No applicable PCS document is attached in AngelTrack to the dispatch, or to its return-trip paired dispatch, or to the patient (covering a date range).

When all of those conditions are met, then a PCS document is almost certainly necessary. To learn more about PCS documents and their tricky legal requirements, read the PCS Requirements Guide.

Collection of PCS by crews while on-scene

When the above criteria suggest that a dispatch needs a PCS document, and no such document is yet recorded in AngelTrack, then AngelTrack will prompt the crew to collect one while on-scene.

Whether this prompt is also a demand (required in order to send their run report onward to QA) is determined by your PCS completion mode setting. Depending on that setting and on the circumstances of the transport, AngelTrack may permit a one-shot PCS document to be signed by a PA, NP, CNS, RN, or discharge planner. In that case it is usually quick and easy to get a PCS signed during patient pickup.

Thanks to 2015 revisions to Medicare regulations, AngelTrack can collect electronic signatures on electronic PCS forms. This means a crew member can load the form on their mobile device, and then just pass the device to the discharge planner or LVN or whoever to fill out. The mobile device must have a touchscreen and GPS capability.

You can also use paper PCS forms, and use a mobile device photograph them into AngelTrack while on-scene. Or the paper forms can be carried back to headquarters for scanning. What happens to the paper form afterward is a matter for you to dictate in agency policy.

Document Requirements Chart

This chart visualizes the documentation requirements for different insurance types, for non-emergent dispatches that are marked ☑ Bill insurance:

Patient insurance (primary or secondary)	Documents needed
Medicare	✓ PCS ✓ PAN if all of the following are true: Medicare is the primary insurance; the service provided is BLS+; the priority is "Scheduled"; and you have ticked the ☑ Medicare requires prior authorization for non-emergent transport checkbox under Preferences.
Medicaid	✓ PCS if the PCS Completion setting is "Always" ✓ McPAN if ☑ Medicaid requires prior authorization for non-emergent transport is checked
Private	✓ PAN if the Private insurance policy is the primary ✓ PCS if the PCS Completion setting is "Always"
Workers' Comp	✓ PAN if the Workers Comp policy is the primary ✓ PCS if the PCS Completion setting is "Always"
Other government coverage	✓ PAN if the Other Government policy is the primary ✓ PCS if the PCS Completion setting is "Always"
[Not recorded]	✓ PCS, in case the patient turns out to have Medicare

Using the Prior Authorization Queue to track missing documents

The Prior Authorization Queue is designed specifically to help you identify and track down missing PANs, McPANs, and PCS documents. The queue uses the above rules, plus filters for date range and originating facility, so that you can quickly resolve all missing documents for each contracted facility with just one phone call.

To learn more, read the Prior Authorization Guide.

Collection and Storage

You don't need a copy of the actual document in order to tell AngelTrack that it has been filed; Billers are permitted to upload documents to AngelTrack without providing any scanned images. However, it is better if you do obtain a copy of it and upload a scan to AngelTrack: that way it can appear in the run reports of all applicable dispatches, ensuring that they are approved by the insurance carrier.