Physician Certification Statement (PCS) Forms Requirements for Transportation Providers

Date: 05/02/25

Meridian would like to remind providers of the requirement to submit Physician Certification Statement (PCS) forms for non-emergent transportation trips.

The PCS (HFS 2270 (PDF)) certifies that the appropriate level of transportation is being requested and is necessary for payment and verification of the level of service for members. This form is completed by the attending physician or facility representative prior to transport and furnished to the transportation provider at time of transport.

For services billed directly to Meridian:

The completed PCS is then submitted by the transportation provider via fax to (833) 728-0122 for validation.

Claims received without a corresponding PCS maybe be subject to recoupment of claims payment. Affected providers will be notified prior to recoupment if their PCS form was not received and allowed 60 days to submit the necessary documentation.

For services via Non-Emergency Medical Transportation (NEMT) vendor MTM:

Once the facility completes the PCS form, a copy of the form will need to be provided to the transportation provider. The PCS form must be submitted to MTM for the claim to process appropriately.

For questions, please contact Provider Services at 866-606-3700 or reach out to your Provider Relations contact.

All billing guidelines for transportation can be found in Section XII of the latest IAMHP billing guide (PDF) on the IAMHP website.