Certification of Ambulance Transportation (CAT) Form Revision (IB24-38)

Date: 10/22/24

Louisiana Healthcare Connections is sharing a recent revision to made to the Certification of Ambulance Transportation (CAT) Form (IB24-38).

The CAT form required for all non-emergency ambulance transportation (NEAT) services. The revised form collects all of the information required by both Medicare and Medicaid, allowing ambulance providers to utilize one form for both programs.

NEAT claims with dates of service prior to January 1, 2025 may be submitted using either the CAT form with revision date June 4, 2021 or the new CAT form with revision date October 1, 2024.

A grace period is being allowed for ambulance providers to transition to the use of the revised CAT form until January 1, 2025. Medicaid will deny claims submitted utilizing the June 4, 2021 version of the CAT form for NEAT claims with a date of service on or after January 1, 2025.

The new CAT form may be accessed on the Medical Transportation webpage at https://www.ldh.la.gov/, under the section labeled “Related Information.” For a direct link to the form, use the link below:.

Certification of Ambulance Transportation form - Revised 10.01.2024

All inquiries regarding fee-for-service (FFS) claims should be directed to the FFS transportation broker.

Questions regarding the new form may be directed to MedicaidTransportation@la.gov.