Transportation Services
Provider Handbook
Illinois Department of Healthcare and Family Services
Issued August 25, 2021
Provider Specific Policies
Page 2
Handbook for Transportation
Providers
Date:
August 25, 2021
Revision History
Date
Reason for Revisions
Policies and procedures as of
December 21, 2018
Published: December 21,
2018
Updated information since last Transportation Handbook
issued – 2008.
August 25, 2021
Medicaid Long Term Services and Supports (MLTSS);
Physician Certification Statement (PCS); and Program
Integrity topics added; Post-Authorization Request
information revised to require receipt within 30 calendar
days post-service instead of 20 business days; reference
added regarding secure safety car coverage by managed
care plans; clarified base rate reimbursement is
determined by the county in which the provider(s) are
registered with the Department; clarified elective or non-
medically necessary transportation services from long-term
care facility to long-term care facility is non-covered;
clarified prior authorization for non-emergency hospital to
hospital transport to a higher level of care is not required;
clarified new provider IMPACT enrollment is needed in the
buyout/change in ownership process; general cleanup of
text and formatting.
Provider Specific Policies
Page 3
Handbook for Transportation
Providers
Date:
August 25, 2021
Transportation Services
Table of Contents
Foreword........................................................................................................................................... 5
201 Provider Enrollment .................................................................................................................. 6
201.1 Enrollment Requirements .......................................................................................... 6
201.2 Enrollment Approval ................................................................................................... 7
201.3 Enrollment Denial ....................................................................................................... 7
201.4 Provider File Maintenance ......................................................................................... 8
202 Provider Reimbursement.......................................................................................................... 8
202.1 Charges....................................................................................................................... 8
202.2 Claim Preparation and Submittal............................................................................... 9
202.2.1 Paper Claim Submittal .......................................................................................... 9
202.2.2 Electronic Claim Submittal.................................................................................. 10
202.3 Payment .................................................................................................................... 10
202.3.1 Helicopter and Fixed Wing Transports .............................................................. 10
202.3.2 Ambulance Transports ....................................................................................... 11
202.3.3 Critical Care Transports ..................................................................................... 12
202.3.4 Medicar Transports............................................................................................. 12
202.3.5 Service Car Transports ...................................................................................... 12
202.3.6 Taxi Transports……………………………………………………………………..12
202.3.7 Private Auto Transports……………………………………………………………12
202.4 Fee Schedule............................................................................................................ 13
202.5 MLTSS Claims.......................................................................................................... 13
203 Covered Services ................................................................................................................... 13
204 Non-Covered Services ........................................................................................................... 15
205 Record Requirements............................................................................................................. 16
205.1 Physician Certification Statement........................................................................... 17
206 General Limitations and Considerations ............................................................................... 18
206.1 Additional Passengers ............................................................................................. 18
206.2 Car Seats .................................................................................................................. 18
206.3 Residents of Long-Term Care Facilities.................................................................. 18
206.4 Hospital Based (Owned) Transportation Services ................................................. 18
206.5 Screening Assessment and Support Services ....................................................... 19
206.6 Coverage of an Employee Attendance and a Non-Employee Attendant .............. 19
207 Authorization for Non-Emergency Transportation ................................................................ 20
207.1 Prior Authorization for Non-Emergency Transportation ........................................ 20
207.2 Prior Authorization for First Transit, Inc.................................................................. 21
207.2.1 Single Trip Requests .......................................................................................... 21
207.2.2 Standing Orders.................................................................................................. 21
Provider Specific Policies
Page 4
Handbook for Transportation
Providers
Date:
August 25, 2021
207.3 Prior Authorization Changes ................................................................................... 23
207.4 Post Authorizations.................................................................................................. 23
207.4.1 Post Authorization Requests within 30 Calendar Days....................................... 23
207.4.2 Post Authorization Requests after 30 Calendar Days......................................... 23
207.5 Prior Approval Notification....................................................................................... 24
208 Buy-Out/Change in Ownership Procedures .......................................................................... 24
209 Program Integrity .................................................................................................................... 25
Provider Specific Policies
Page 5
Handbook for Transportation
Providers
Date:
August 25, 2021
Foreword
The Department of Healthcare and Family Services (HFS) or “Department” is the
agency that administers Illinois’ Medical Assistance (Medicaid) Program, as well as
other public healthcare programs. This handbook, along with recent provider notices
and Chapter 100, Handbook for Providers of Medical Services, General Policy and
Procedures, will act as effective guides to participation in the Department’s Medical
Programs. It is important that both the provider of services and the provider’s billing
personnel read all materials prior to initiating services to ensure a thorough
understanding of the Department’s Medical Programs policy and billing procedures.
Revisions and supplements to the handbook are released as necessary based on
operational need and State or federal laws requiring policy and procedural changes and
are posted on the Provider Handbooks webpage. The Department encourages
providers to utilize the All Providers Handbook Supplement for guidance in claim
submittal.
Providers are held responsible for compliance with all policy and procedures contained
herein. Providers should register to receive e-mail notification when new provider
information has been posted by the Department.
Charges for covered non-emergency services provided to participants enrolled in a
HealthChoice Illinois managed care organization (MCO) must be billed to the MCO.
Providers should always verify eligibility before providing services, both to determine
eligibility for the current date and to discover any limitations to the participant’s coverage. It
is imperative that providers check HFS electronic eligibility systems regularly to determine
eligibility. The Recipient Eligibility Verification (REV) System, the Automated Voice
Response System (AVRS) at 1-800-842-1461, and the Medical Electronic Data
Interchange (MEDI) systems are available.
Providers submitting X12 electronic transactions must refer to the Handbook for Electronic
Processing. This handbook identifies information specific to conducting Electronic Data
Interchange (EDI) with the Illinois Medical Assistance Program and other health care
programs funded or administered by the Illinois Department of Healthcare and Family
Services.
Transportation provider services are classified as “emergency” or “non-emergency”. Both
emergency and non-emergency (NEMT) services can include the use of ambulances and
fixed wing transports. Non-emergency services also include medicar, taxicab, service car,
private automobile, bus, train, and commercial airplane transports.
Non-emergent behavioral health transport services via “secure safety cars” are services
that MCOs may render to eligible members. This service is currently not a covered service
under Medicaid fee-for-service.
Inquiries regarding fee-for-service coverage of a service or billing issues may be directed to
the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Provider Specific Policies
Page 6
Handbook for Transportation
Providers
Date:
August 25, 2021
201 Provider Enrollment
The web-based provider enrollment system is known as Illinois Medicaid Program
Advanced Cloud Technology (IMPACT). Both MCO and FFS transportation providers must
be enrolled in IMPACT. When enrolling in IMPACT, all required information must be
included. Provider Type Specialty must be selected. A Provider Type Subspecialty may or
may not be required. The table of IMPACT Provider Types, Specialties and Subspecialties
is a reference guide that provides important information for providers enrolling via IMPACT.
All information for each transportation vehicle must be included in IMPACT.
201.1 Enrollment Requirements
Transportation providers eligible to be considered for participation are those who own or
lease, and operate any of the following:
• Ambulances licensed by the Illinois Secretary of State and inspected annually by the
Illinois Department of Public Health (Vehicle Registration Type Ambulance).
• All air ambulances possessing a special EMS license and an FAA Air Carrier
Certificate issued by the United States Department of Transportation.
• Medicars licensed by the Illinois Secretary of State and the Illinois Department of
Public Health if the provider provides and bills for a stretcher.
• Taxis licensed by the Illinois Secretary of State and, where applicable, by local
regulatory agencies.
• Service cars licensed by the Illinois Secretary of State as livery or public
transportation.
• Private automobiles licensed by the Illinois Secretary of State.
• Other specialized modes of transportation, such as buses, trains and commercial
airplanes.
Drivers and vehicles must meet the Illinois Secretary of State licensing requirements, as
well as applicable insurance requirements and adhere to any other municipal regulations.
Ambulance providers who provide services within Illinois must be in compliance with the
EMS Systems Act (210 ILCS 50). Other transportation provider types based outside of
Illinois must provide a valid license, permit or certification from the state where the business
is headquartered.
Providers billing for stretcher services must meet the Illinois Department of Public Health
licensing requirements found at 77 Ill. Admin. Code Section 515.835.
Safety Training Certification Requirement - As required under Public Act 095-0501 and
89 Ill. Admin. Code Section 140.490(f), all providers of non-emergency Medicar, taxi, and
service car transportation must certify that all drivers and employee attendants have
completed a safety program approved by the Department, prior to transporting participants
of the Department’s Medical Programs.
Provider Specific Policies
Page 7
Handbook for Transportation
Providers
Date:
August 25, 2021
The safety training certification is required every three years for all transportation
employees. It is the provider’s responsibility to ensure their employees are recertified by a
Department approved safety training program. Medicar, taxi, and service car providers
must maintain documentation of their driver and employee attendant certifications. Failure
to produce the documentation upon request from the Department shall result in recovery of
all payments made by the Department for services rendered by a non-certified driver or
attendant.
Medicar and service car providers receiving federal funding under 49 U.S.C. 5307 (pdf) or
49 U.S.C. 5311 are not subject to the safety training program certification requirement
during the period of federal funding. Documentation of the federal funding period must be
made available to the Department upon request.
A list of certified safety training providers is maintained on the Department’s website.
Enrollment approval is not transferable - Change in ownership or corporate structure
necessitating a new Federal Tax Identification Number terminates the participation of the
enrolled provider. Claims submitted by the new owner using the prior owner’s assigned
provider number may result in recoupment of payments and other sanctions.
Fingerprint-Based Criminal Background Checks - As part of the enrollment process,
non-emergency transportation providers, excluding vendors owned or operated by
governmental agencies and private automobiles, must submit to a fingerprint-based
criminal background check as set forth in 89 Ill. Admin. Code 140.498.
201.2 Enrollment Approval
When enrollment is approved, the provider will receive a computer-generated notification,
the Provider Information Sheet, listing certain data as it appears on the Department’s files.
The provider is to review this information for accuracy immediately upon receipt. If all
information is correct, the provider is to retain the Provider Information Sheet for
subsequent use in completing billing statements to ensure that all identifying information
required is an exact match to that in the Department file.
Enrollment of a provider is subject to a provisional period and shall be conditional for one
year unless otherwise specified by the Department. During the period of conditional
enrollment, the Department may terminate or disenroll the provider from the Medical
Assistance Program without cause.
201.3 Enrollment Denial
When enrollment is denied, the provider will receive written notification of the reason for
denial. Within ten calendar days after the date of this notice, the provider may request a
hearing. The request must be in writing and must contain a brief statement of the basis
upon which the Department's action is being challenged. If such a request is not received
within ten calendar days, or is received, but later withdrawn, the Department's decision
Provider Specific Policies
Page 8
Handbook for Transportation
Providers
Date:
August 25, 2021
shall be a final and binding administrative determination. Department rules concerning the
basis for denial of enrollment are set out in 89 Ill. Admin. Code Section 140.14. Department
rules concerning administrative hearing process are set out in 89 Ill. Admin. Code Section
104 Subpart C.
201.4 Provider File Maintenance
The information in the Department’s files for participating providers must be maintained on
a current basis. The provider and the Department share responsibility for keeping the file
updated. The provider should ensure that all information in the IMPACT system is accurate
and up to date at all times. Provider Enrollment Services (PES) is the section within the
Department of Healthcare and Family Services that is responsible for reviewing and
approving any modifications to provider enrollment records. All providers must be
registered in the HFS IMPACT system.
Provider Responsibility
The information contained on the Provider Information Sheet is the same as in the
Department’s files. Each time the provider receives a Provider Information Sheet, it is to be
reviewed carefully for accuracy. The Provider Information Sheet contains information to be
used by the provider in the preparation of claims; any inaccuracies found must be corrected
by submitting a modification in IMPACT.
Provider change information must be updated via the on-line application available on the
IMPACT Provider Enrollment web page. The on-line modification function is available to
notify the Department of updates to required enrollment information. Failure of a provider to
properly update the IMPACT provider enrollment system with corrections or changes may
cause an interruption in participation and payments.
Department Responsibility
When a provider submits a modification in IMPACT, the Department will review the request
and either reject or approve the modification. The Department will generate an updated
Provider Information Sheet reflecting the modification and the effective date of the
modification, if appropriate. The updated sheet will be sent to the provider’s office address
and to all billing providers associated to the provider in IMPACT.
202 Provider Reimbursement
202.1 Charges
Transportation providers are to submit charges to the Department only after services have
been rendered. Charges are to be the provider’s usual and customary charges to the public
for the services provided. To be eligible for reimbursement, all claims, including claims that
are corrected and resubmitted, must be received within 180 days of the date of service, or
within 24 months from the date of service when Medicare or its fiscal intermediary must first
Provider Specific Policies
Page 9
Handbook for Transportation
Providers
Date:
August 25, 2021
adjudicate the claim unless one of the exceptions to the timely filing rule applies. Refer to
the Timely Filing Override Submittal Instructions for a list of exceptions to the 180-day rule
and billing instructions for each.
202.2 Claim Preparation and Submittal
For information on policy and procedures regarding claim submittal, including billing for
Medicare covered services and submittal of claims for participants eligible for Medicare
Part B, refer to HFS Chapter 100 Handbook for Providers of Medical Services General
Policy and Procedures. For technical guidelines for claim preparation and submittal refer to
the Handbook Supplement.
202.2.1 Paper Claim Submittal
The Department no longer accepts paper claims that do not require an attachment for
processing. Paper claim forms received without a valid attachment will be returned to the
billing provider address submitted on the paper claim form.
The Department uses a claim imaging system for scanning paper claims. The imaging
system allows efficient processing of paper claims and also allows attachments to be
scanned. The Department offers a claim scannability/imaging evaluation. Turnaround on a
claim scannability/imaging evaluation is approximately seven to ten working days, and
providers are notified of the evaluation results in writing. Please send sample claims with a
request for evaluation to the following address:
Healthcare and Family Services
201 South Grand Avenue East 2nd Fl - Data Preparation Unit
Springfield, Illinois 62763-0001
Attention: Vendor/Scanner Liaison
For a non-routine claim submittal, use HFS 2248, Special Approval Envelope. A
non-routine claim is any claim to which any other document is attached. Non-routine claims
may not be electronically submitted.
If envelopes are unavailable, the claims can be mailed to:
Non-Routine Claims:
Illinois Department of Healthcare and Family Services
Attn: Transportation Consultant
P.O. Box 19115
Springfield, IL 62794-9115
HFS 2209 Transportation Invoice:
Illinois Department of Healthcare and Family Services
Post Office Box 19126
Springfield, IL 62794-9126
Provider Specific Policies
Page 10
Handbook for Transportation
Providers
Date:
August 25, 2021
HFS 3797 (Medicare Crossover Invoice) with attachments:
Illinois Department of Healthcare and Family Services
Post Office Box 19109
Springfield, IL 62794-9109
Providers must use the Department’s original claim forms. Carbon copies, photocopies,
facsimiles, or downloaded forms are not acceptable. Forms and envelopes should be
requested on the Department’s Paper Medical Forms Request page.
202.2.2 Electronic Claim Submittal
Any services that do not require attachments or accompanying documentation must be
billed electronically. Further information concerning electronic claims submittal can be
found in Chapter 100, Handbook for Providers of Medical Services General Policy and
Procedures, the 5010 Companion Guide, and the MEDI webpage.
Providers billing electronically should take special note that Form HFS 194-M-C, Billing
Certification Form, must be signed and retained by the provider for a period of three (3)
years from the date of the remittance advice (voucher). Failure to do so may result in
revocation of the provider’s right to bill electronically, recovery of monies or other adverse
actions. Form HFS 194-M-C can be found on the last page of each Remittance Advice that
reports the disposition of any electronic claims.
202.3 Payment
Payment made by the Department for allowable services will be made at the lower of the
provider's usual and customary charge or the maximum rate as established by the
Department. Base rate reimbursement is determined by the County in which the provider(s)
are registered with the Department.
All claims processed by the Department are assigned a 12-digit Document Control Number
(DCN). The DCN format is YDDDLLSSSSSS:
Y - Last digit of year claim was received
DDD - Julian date claim was received
LL - Document Control Line Number
SSSSSS - Sequential Number
Adjudicated claims are identified on the HFS 194-M-2, Remittance Advice. The Remittance
Advice is sent to the provider’s payee address on file with the Department. Refer to
Appendix 3 of the General Policy and Procedures handbook for payment procedures
utilized by the Department and explanations of Remittance Advice detail provided to
providers.
202.3.1 Helicopter and Fixed Wing Transports
Provider Specific Policies
Page 11
Handbook for Transportation
Providers
Date:
August 25, 2021
Providers of emergency helicopter and fixed wing services must maintain the air flight
record, a physician’s written statement that indicates the patient’s diagnosis and medical
need for each service. A general statement such as “transport ordered by an M.D.” or
“transport to a higher level of care,” is not sufficient. Non-emergency fixed wing transports
require prior authorization.
Emergency helicopter trips will be reimbursed using an all-inclusive rate depending upon
whether the services are for transport team only, helicopter only, or transport team and
helicopter services.
Helicopter transportation providers, who own the helicopter and provide their own transport
team, will be reimbursed at the Department’s maximum rate per trip or the provider’s usual
and customary charges, whichever is less. To be reimbursed for a team and helicopter, a
U3 modifier must be used in addition to the procedure code.
If a hospital provides the transport team but does not own the helicopter, the Department
will equally divide the established reimbursement rate or the usual and customary charges
of the providers, whichever is less, between the hospital and the helicopter provider.
Hospitals that own their own helicopter and report its costs on their cost reports will not be
paid for helicopter transportation services. The Department will not cover the services of
helicopter transportation providers that have entered into payment agreements with
receiving facilities.
The Department does not pay for international transports.
202.3.2 Ambulance Transports
Ambulance trips will be reimbursed a base rate, oxygen rate, and a loaded mileage rate,
pursuant to 89 Ill. Admin. Code 140.492 for Basic Life Support (BLS) and Advanced Life
Support (ALS) trips. As of April 1, 2021, all emergency ambulance (COS 050) claims
should be billed to HFS as fee-for-service claims, even when the participant is in an MCO.
This change affects Medicare-Medicaid Alignment Initiative (MMAI), YouthCare for DCFS
youth in care, and Medicaid Managed Care Plan (HealthChoice Illinois) billing.
In August, 2019, the Department introduced a supplemental payment methodology that
would allow publicly owned transportation providers that deliver ambulance services in the
Medical Assistance program to receive supplemental payments for ground emergency
medical transportation (GEMT) above the fee schedule rates they currently receive, if their
cost to provide the services exceeds the reimbursement the providers currently receive
based on the HFS fee schedule. Questions regarding the program should be directed to
HFS.GEMT@illinois.gov.
Provider Specific Policies
Page 12
Handbook for Transportation
Providers
Date:
August 25, 2021
202.3.3 Critical Care Transports
Critical Care Transport (CCT) often referred to as Specialty Care Transport (SCT) trips will
be reimbursed a base rate, a loaded mileage rate, and oxygen rate when medically
necessary. Ancillary charges are included in the base rate established by the Department
pursuant to 89 Ill. Admin. Code 140.492. Payment for CCT/SCT is only made to providers
who are certified for the service by the Illinois Department of Public Health.
202.3.4 Medicar Transports
Medicar trips will be reimbursed a base rate and a loaded mileage rate, pursuant to 89 Ill.
Admin. Code 140.492. Refer to Topic 206.1 for the Department’s policy on billing mileage
for additional passengers. Payment for an attendant, who is a person other than the driver,
and non-emergency stretcher, will be made at a maximum rate established by the
Department, pursuant to 89 Ill. Admin. Code 140.492. Refer to Topic 206.6 for the
Department’s policy regarding attendants. If a stretcher is billed, the provider must meet the
licensing requirements as established at 77 Ill. Admin. Code 515.835 and 515.840,
regarding the Illinois Department of Public Health’s rules for Stretcher Van Provider
Licensing Requirements, as well as 210 ILCS 50/3.86.
202.3.5 Service Car Transports
Service Car trips will be reimbursed at a base rate and a loaded mileage rate pursuant to
89 Ill. Admin. Code 140.492. Refer to Topic 206.6 for the Department’s policy on billing
mileage for additional passengers. Payment for an attendant, who is a person other than
the driver, will be made at a maximum rate established by the Department, pursuant to 89
lll. Admin. Code 140.492. Refer to Topic 206.6 for the Department’s policy regarding
attendants.
202.3.6 Taxi Transports
Taxis will be reimbursed at the community rate, as set by local government or if no
regulated local government rates exist, at a maximum rate established by the Department,
pursuant to 89 Ill. Admin. Code 140.492. Payment for an attendant, who is a person other
than the driver, will be made at a maximum rate established by the Department, pursuant to
89 Ill. Admin. Code 140.492. Refer to Topic 206.6 for the Department’s policy regarding
attendants.
202.3.7 Private Auto Transports
Private Auto trips will be reimbursed at a loaded mileage rate as set by the Department,
pursuant to 89 Ill. Admin. Code 140.492.
Provider Specific Policies
Page 13
Handbook for Transportation
Providers
Date:
August 25, 2021
202.4 Fee Schedule
The fee schedule of allowable procedure codes and special billing information is available
on the Department’s website.
202.5 Managed Long-Term Services and Supports (MLTSS) Claims
The information below provides transportation reimbursement policy clarification for
participants who are eligible under Managed Long-Term Services and Supports (MLTSS).
The MCO MLTSS covers the non-emergency transportation categories of service listed
below:
• 051 Non-Emergency Ambulance
• 052 Medicar
• 053 Taxi
• 054 Service Car
• 055 Private Auto
• 056 Other Transportation
If a non-emergency transportation service is allowed by Medicare and Medicare makes a
payment, reimbursement of the Medicare cost-sharing is the responsibility of the
HealthChoice Illinois managed care plan.
Cost sharing for MLTSS emergency transportation after Medicare adjudication should be
billed to the Department.
203 Covered Services
A covered service is a service for which payment can be made by the Department in
accordance with 89 Ill. Admin. Code 140.3. The services covered in the Medical Assistance
Program are limited and include only those reasonably necessary medical and remedial
services that are recognized as standard medical care required for immediate health and
well-being because of illness, disability, infirmity, or impairment.
If the transportation is subject to prior approval or post-approval authorization by the
Department, payment will be made only if approved.
Transportation of a patient to or from a covered source of medically necessary care to the
nearest, appropriate, available medical provider is covered and payment can be made only
if a cost-free mode of transportation is not available or is not appropriate. It is the
responsibility of the referring medical provider to validate that the participant is being
referred to the closest appropriate Medicaid provider.
Provider Specific Policies
Page 14
Handbook for Transportation
Providers
Date:
August 25, 2021
Oxygen usage is a covered service when medically necessary and administered in the
transport of a patient by ambulance.
The use of an attendant in the transport of a patient by a medicar, service car, or a taxi is a
covered service when medically indicated. The use of an attendant for transport is subject
to the Department’s transportation prior authorization process.
The use of a stretcher in a medicar is a covered service for non-emergency transport when
the medical need of the patient does not require a higher level of special medical services,
i.e., paramedics, emergency medical technicians; medical equipment and supplies; or the
administration of drugs or oxygen. The requirements for operation of a stretcher van are
provided in 77 Ill. Admin. Code 515.860 and 210 ILCS 50/3.86
Basic Life Support (BLS) services, as defined in 77 Ill. Admin. Code 215.100, are covered
when the patient’s medical condition requires a BLS level of service. A BLS ambulance
provides transportation plus the equipment and staff for basic services such as giving first
aid, controlling bleeding, administering oxygen, treatment of shock, taking vital signs or
administering cardiac pulmonary resuscitation (CPR).
Advanced Life Support (ALS) services, as defined in 77 Ill. Admin. Code 215.100, are
covered when the patient’s medical condition requires an ALS level of service. An ALS
ambulance provides all basic ambulance services and typically has complex life-sustaining
equipment and radio or telephone contact with a physician or hospital. An ALS ambulance
will have equipment and staff to provide services such as administration of appropriate
drugs, intravenous therapy, airway intubation, or defibrillation of the heart.
Critical Care Transport (CCT), often referred to as Specialty Care Transport (SCT), may be
provided by: Department-approved critical care transport providers, not owned or operated
by a hospital, utilizing EMT-Paramedics with additional training, nurses, or other qualified
health professionals as defined by the Illinois Department of Public Health at 77 Ill. Admin.
Code 515.860.
Ambulance services must be billed at the appropriate level of service (BLS, ALS, or
CCT/SCT).
Emergency air transport service is a covered service when the patient’s medical condition
is such that immediate and rapid transportation cannot be provided by ground ambulance.
An emergency may include, but is not limited to:
• Life threatening medical conditions;
• Severe burns requiring treatment in a burn center;
• Multiple trauma;
• Cardiogenic shock; and
• High-risk neonates.
Provider Specific Policies
Page 15
Handbook for Transportation
Providers
Date:
August 25, 2021
204 Non-Covered Services
Services for which medical necessity is not clearly established are not covered by the
Department’s Medical Programs. Refer to 89 Ill. Admin. Code 140.6 for a general list of
non-covered services.
The Department does not reimburse for transportation provided in connection with any
service not reimbursed by the Department’s Medical Programs, such as Early Intervention
services, sheltered workshops, day care programs, social rehabilitation programs or day
training services. In these instances, transportation providers must verify reimbursement
sources prior to delivery of services with the entity requesting the service.
Additionally, payment will not be made by the Department for the following:
• Non-emergency transportation where Department prior approval or post-approval
authorization is required but has not been obtained.
• Non-emergency transportation beyond the nearest, appropriate, available, medical
provider.
• Services medically inappropriate for the patient’s condition (e.g., a taxi when public
transportation is available and medically appropriate or a Medicar when a service
car is warranted).
• Services of a paramedic, emergency medical technician, or nurse in addition to the
BLS, ALS, or CCT/SCT rates.
• “No Show” trips (i.e. patient not transported).
• Trips for filling a prescription or obtaining medical supplies, equipment or any other
pharmacy-related item.
• Charges for mileage other than loaded miles.
• Transportation of a person who has been pronounced dead by a physician or where
death is obvious before transport transpires.
• Charges for waiting time, meals, lodging, parking, tolls.
• Transportation provided in vehicles other than those owned or leased and operated
by the provider.
• Elective or non-medically necessary transportation services from Long-Term Care
Facility to Long-Term Care Facility.
• Transportation services provided for a hospital inpatient that is transported to
another medical facility for outpatient services not available at the hospital of origin
and the return trip to the inpatient hospital setting. In this instance, the transportation
provider must seek payment from the inpatient hospital. Emergency Services
provided in an Emergency Department are not considered outpatient services under
this section.
• Transportation to receive services when a patient is a current member of a Managed
Care Organization (MCO). The provider must work with the appropriate plan and/or
third-party administrator. Exceptions: Emergency ground ambulance services for
HealthChoice Illinois managed care plan members are covered by the Department
Provider Specific Policies
Page 16
Handbook for Transportation
Providers
Date:
August 25, 2021
and MLTSS crossover payments for emergency transportation services are also
covered by the Department.
• Medical transportation provided for patients who reside in State Operated Facilities
(i.e. State Operated Developmental or Mental Health Center). In this instance, the
transportation provider must seek payment from the State Operated Facility.
• Services provided by a hospital owned and operated transportation provider where
the transportation costs are reported in the hospital’s cost report for the following:
• Transportation services provided on the date of admission and the date of
discharge.
• Transportation services provided on the date that an Ambulatory Procedures
Listing (APL) service is performed, or an emergency room visit is made.
• Non-emergency transportation rendered to All Kids Premium Level 2 participants
(except for SASS-eligible youth, whose services are covered even with All Kids
Premium Level 2).
• Non-emergency transportation rendered to Veterans Care participants without any
other form of medical coverage.
• Ambulance trips when the participant was not transported. For example, the
ambulance is dispatched but the participant does not require transport.
• Transportation of family members to visit a hospitalized patient.
Out-of-state transportation requests must be submitted to First Transit for prior
approval authorization and will require review by the Department.
205 Record Requirements
Record requirements for medical transportation services are provided in 89 Ill. Admin. Code
140.494. Refer to the Chapter 100 Handbook for information regarding the maintenance of
records and the retention of records.
When appropriate, records must also contain the following documents:
• FAA Air Carrier Certificate issued by the U.S. Department of Transportation.
• A physician’s statement indicating the patient’s diagnosis and medical necessity.
• The air flight record for air transport services.
Ambulance providers must document medical necessity for the transport on the patient
care report. Providers of Advanced Life Support and Critical Care Transport/Specialty Care
Transport must include a copy of the Emergency Medical Services Patient Care Report
(PCR) or other form as required by the Illinois Department of Public Health.
The Department and its professional advisors regard the preparation and maintenance of
adequate records as essential for the delivery of quality medical care. In the absence of
proper and complete records, no payment will be made, and payments previously made will
be recouped. Lack of records or falsification of records may also be cause for a referral to
the appropriate law enforcement agency for further action.
Provider Specific Policies
Page 17
Handbook for Transportation
Providers
Date:
August 25, 2021
205.1 Physician Certification Statement
For all non-emergency transports originating at a hospital or long term care facility (LTC), a
HFS 2270 Physician Certification Statement (PCS) form must be completed by the LTC or
hospital. A PCS form is not required for non-emergency hospital to hospital transport to a
higher level of care.
The PCS form is considered the standardized medical necessity form for non-emergency
ground Ambulance, Medicar/Wheelchair Van and Service Car transports. The form must be
submitted, or the provider’s documented attempt to obtain the requested certification must
be submitted in order to receive prior or post approval of transportation.
Completion of the form is required prior to each transport and must be submitted to First
Transit for approval. A copy of this form must also be provided to the transportation
provider at the time of transport.
This PCS form certifies that the appropriate level of transportation is being requested and is
necessary for payment and/or verification of the level of service. This applies to participants
covered under fee-for-service programs as well as HealthChoice Illinois Managed Care
Organization plans.
LTC and hospitals are required to:
• Develop a policy requiring a physician or their designee to complete the PCS;
• Maintain a copy of the PCS in the patient’s medical record; and
• At the request of the transportation provider, assist in completing the PCS if it is
incomplete.
In cases when a PCS is not completed prior to or at the time of transport, the PCS must be
provided at no charge within 10 calendar days of the request of the transportation provider.
The PCS form is required for repetitive trips. One PCS form may be valid for recurring
ground ambulance transports for up to 60 days, while one PCS form may be valid for
recurring medi-car/wheelchair van and service car transports for up to 180 days. However,
if medical necessity or the level of transportation changes, a new PCS form will be
required.
The licensed medical professional who signs the PCS must check the appropriate box
indicating their certification. Licensed medical professionals include the Physician (MD/DO),
Physician Assistant, Clinical Nurse Specialist (CNS), Registered Nurse (RN), Nurse
Practitioner (NP), Discharge Planner, Licensed Clinical Social Workers (LCSW) and
Licensed Practical Nurses (LPN).
The PCS is not required prior to transport if a delay in transport can be expected to
negatively affect the patient outcome. In these cases, the form must be provided at no
charge within 10 calendar days of the request of the transportation provider.
Provider Specific Policies
Page 18
Handbook for Transportation
Providers
Date:
August 25, 2021
206 General Limitations and Considerations
Transportation approval will be given for the nearest available appropriate provider, by the
least expensive mode that is adequate to meet the individual's need. When public
transportation is available and is a practical form of transportation, payment will not be
made for a more expensive mode of transportation, pursuant to 89 Ill. Admin Code
140.491 (a).
206.1 Additional Passengers
Anytime more than one passenger is transported in the same vehicle for any portion of a
trip, the transportation provider may only charge mileage for the first passenger. The base
rate and attendants, if provided, may be charged for each passenger.
Procedure:
• A separate claim must be filed for each passenger.
• Base rate and attendants, if provided, may be charged for each passenger.
• Mileage may only be charged for the first passenger picked up. The mileage charge
is limited to the most direct (shortest) route between the origination address and the
destination address for the first passenger, no matter how far the first passenger
travels.
206.2 Car Seats
It is the transportation provider’s responsibility to confirm with the child’s parent or
guardian that they will supply an appropriate car seat for the transport. Providers may
choose to provide a car seat; however, it is ultimately the parent/guardian’s responsibility
and should be discussed when the trip is being arranged.
206.3 Residents of Long-Term Care (LTC) Facilities
Prior approval or post approval authorization is required for non-emergency transportation
of participants who reside in a Long-Term Care (LTC) Facility.
The Department may not be billed when a participant who is a resident of a LTC facility is
transported for a service other than a covered medical service. Examples of non-covered
services include, but are not limited to, transportation to a sheltered workshop, day training
center, or transport from one LTC facility to another LTC facility. The transportation
provider must verify reimbursement source (i.e., the day training center, sheltered
workshop or LTC facility) prior to transport.
206.4 Hospital-Based (Owned) Transportation Services
Hospitals that own and operate medical transportation vehicles as a corporation separate
from the hospital entity must enroll in IMPACT as a Transportation
Provider Specific Policies
Page 19
Handbook for Transportation
Providers
Date:
August 25, 2021
Facility/Agency/Organizations (FAO), Ambulance – Non-Hospital Based and select the
applicable sub-specialty(s). All policies and procedures contained in this handbook apply.
Hospitals that own and operate medical transportation vehicles included as a cost center
of the hospital entity must enroll in IMPACT as a Transportation (FAO), Ambulance –
Hospital Based and select the applicable sub-specialty(s).
206.5 Screening Assessment and Support Services (SASS)
Participants receiving SASS services are eligible for non-emergency transportation
services. These services require prior authorization. The provider delivering these services
is responsible for assisting in arranging prior authorization in the event the participant or
their family cannot safely transport the participant both at times of crisis and non-crisis.
The prior approval process for non-emergency transportation is separate from the Crisis
and Referral Entry Service (CARES) process.
Hospital Admits - Providers of SASS services are responsible for providing a copy of the
Illinois Medicaid Crisis Assessment Tool (IM-CAT) form and any other documentation
needed to verify the medical necessity and level of transport is to the nearest appropriate
available medical provider. In the event a participant is experiencing a mental health crisis
and requires transportation to a psychiatric inpatient facility, the provider of SASS services
should work with the transportation provider to determine the most appropriate level of
transportation and emergency/non-emergency status of the transport. Non-emergent
transports at the point of crisis will be handled as an “urgent request” by the transportation
approval agent. Additional information regarding transportation for participants receiving
SASS services can be found in the SASS Handbook.
Hospital Discharges - When a SASS participant is being discharged from a hospital and
requires transportation services, prior authorization is required regardless of the level of
transportation needed. Due to the uncertainty of discharge timelines, participants or a
provider working on behalf of a participant may request transportation approval within 24
to 48 hours prior to discharge. It is important to remember that time to process a non-
emergency transportation request is required. Additional medical documentation from the
discharging hospital provider is required to justify the level of transportation requested.
Transportation from inpatient psychiatric facilities must utilize the lowest level of transport
as supported by the participant’s medical necessity.
206.6 Coverage of an Employee Attendant and a Non-Employee Attendant
An employee attendant is defined as a person, other than the driver, who is an employee
of a Medicar, service car, or taxi company. A non-employee attendant is defined as a
family member or other individual who may accompany the participant when there is a
medical need for an attendant.
An attendant is covered by the Department in the following circumstances:
Provider Specific Policies
Page 20
Handbook for Transportation
Providers
Date:
August 25, 2021
• To accompany a patient to a medical provider when needed, such as parent going
with a child to the doctor or when an attendant is needed to assist the patient
• To participate in the patient’s treatment when medically necessary upon review by
the Department
The use of an employee or a non-employee attendant is subject to prior authorization in all
situations and is determined on a case-by-case basis.
207 Authorization for Non-Emergency Transportation
The Department has contracted with a prior authorization agent to operate a centralized
transportation prior and post authorization process.
Prior authorization is required for non-emergency transportation services to and from a
source of medical care covered by the Department’s Medical Programs. Prior authorization
for non-emergency hospital to hospital transport to a higher level of care is not required.
207.1 Prior Authorization for Non-Emergency Transportation
The Department contracts with First Transit Inc. to adjudicate prior authorization requests
and post authorization requests as provided in 89 Ill. Admin. Code 140.491 for non-
emergency transportation services. First Transit assists participants to connect with
transportation providers in their area, utilizing a random selection process.
To request a prior authorization, a participant or their designated representative,
transportation provider, or medical provider should contact First Transit. Requests for
authorizations must be made at least seven (7) business days prior to the date the
transportation service is needed. “Business days” means Monday through Friday and does
not include Saturdays, Sundays or major holidays.
Prior authorization requests must contain enough information to show medical necessity.
First Transit reviews submitted documentation from the medical providers to support the
requested categories of service, appropriate level of transport, and assures that the
medical service requested by the provider is to the nearest, appropriate, available medical
provider. Some transportation requests will require additional information before the
request can be processed.
PassPORT - First Transit uses its PassPORT system to maintain prior authorization
information. PassPORT is a free web portal developed by First Transit for use by providers
to process non-emergency transportation prior approval requests. PassPORT enables
providers to submit Single Trip and Standing Prior Authorizations requests, view the status
of requests, and is available 24 hours a day, 7 days a week, 365 days a year. Information
on how to access PassPORT is available at First Transit’s NETSPAP site.
Provider Specific Policies
Page 21
Handbook for Transportation
Providers
Date:
August 25, 2021
207.2 Prior Authorization for First Transit, Inc.
Trips may be requested as a single trip or a standing prior authorization. Single trip and
standing prior authorization forms are available at First Transit’s NETSPAP site.
First Transit’s regular business hours are Monday through Friday, 8 AM to 5 PM, excluding
major holidays. First Transit can be reached by calling the Provider Line at 866-503-9040
or the Participant Line at 877-725-0569. The TTY Line is 630-873-1449.
207.2.1 Single Trip Requests
Single trip requests can be submitted over the phone, by fax, or providers may also submit
through PassPORT. When submitting a single trip request, First Transit will ask:
• Recipient identification number (RIN)
• Participant name;
• The participant’s authorization to speak with the person calling for them, if that is the
situation;
• Pick up address and phone number;
• The appointment date and time;
• The doctor’s name and general reason for the doctor visit;
• The name of the office/clinic/hospital destination;
• The address and phone number of the destination;
• If there is a medical or non-medical reason why the participant cannot use public or
other transportation;
• If the participant uses a walker, wheelchair, or cane;
• If the participant can travel alone or needs an attendant.
207.2.2 Standing Orders
A standing order or a standing prior authorization (SPA) may be obtained when subsequent
trips to the same medical source are required based on standing orders for specific medical
services at the same location more than three times a month. Please note:
• Standing prior authorization requests are not accepted by telephone.
• Standing prior authorizations requests may be faxed to 630-873-1450 or
transportation providers may also submit requests via PassPORT.
• Standing prior authorization requests should be submitted to First Transit at least
seven (7) business days in advance of the begin date of the medical services. All
medical documentation justifying the level of transportation required by the
participant must be submitted with the standing prior authorization request in order
for validation to occur.
When requesting a standing prior authorization, the patient’s physician or other health
professional may be contacted by First Transit to validate the following:
Provider Specific Policies
Page 22
Handbook for Transportation
Providers
Date:
August 25, 2021
• The participant's name, address, and telephone number;
• Participant’s RIN;
• The name and address of the medical provider;
• The date, time and purpose for the appointment;
• Information to determine the level of transportation;
• Transportation provider name and provider number;
• The necessity for ongoing visits;
• Already established appointment dates; and
• The number and expected duration of the required ongoing visits.
First Transit will review the request and take one of the following actions:
1. If the request is approved, First Transit will issue a Request Tracking Number (RTN), (a
unique number assigned to each request for non-emergency transportation at the time
the request is initially recorded in First Transit’s system). First Transit will submit the
authorization to the Department’s prior authorization system for posting. A Notice of
Approval letter or the PassPORT system will contain information necessary to bill the
Department for the service. To ensure accurate billing, the transportation provider must
wait for the authorization notice before submitting a bill to the Department. The
transportation provider should review and verify the authorization information is correct.
Providers must contact First Transit to correct errors or make changes to transportation
requests.
2. If the request is denied, First Transit will issue an RTN. First Transit will submit the
denial, along with the general reason for the denial, to the Department’s prior
authorization system for posting. A denial letter will be generated to the participant.
Denial information will also be mailed to the NET provider or posted on First Transit’s
PassPORT system.
The status of the approved or denied request by First Transit is displayed in PassPORT
the business morning after the request is adjudicated.
When a claim is submitted to the Department, the information on the claim must match
the prior authorization information or the claim will reject.
Prior authorization to provide services does not include any determination of the patient’s
eligibility and does not guarantee payment. It is the provider’s responsibility to verify the
patient’s eligibility on the day of the trip in MEDI or 800-842-1461 (AVRS) prior to each
transport.
The Department reserves the right for its transportation authorization agent to determine
the appropriate mode of transportation and if requested, provide the participant with a
random selection of transportation providers enrolled with the Department in the
participant’s geographic area.
Provider Specific Policies
Page 23
Handbook for Transportation
Providers
Date:
August 25, 2021
On behalf of the Department, First Transit randomly samples trips to verify the validity of
transportation requests.
207.3 Prior Authorization Changes
When a change or correction to a prior authorization is necessary, First Transit must be
contacted via telephone.
First Transit generates a unique tracking number for all requests.
All dates of service that were billed and paid using the original prior authorization number
should not be rebilled. All remaining trips that have not been billed and reimbursed should
be billed using the new prior authorization number.
Providers should take caution to not rebill claims that were paid using the original prior
authorization number. For billing assistance, please call 877-782-5565 and select the
options to speak with a transportation billing representative, options 1, 2, 4, and 4.
If a scheduled appointment is cancelled by the doctor or clinic and the participant is not
informed and finds out after reaching the destination, the transportation provider can bill for
the trip to and from the appointment. If the participant learns of an appointment
cancellation prior to the trip, every effort should be made to contact First Transit and cancel
the request.
207.4 Post Authorizations
In the event it is not possible to obtain prior authorization for non-emergency transportation,
post authorization must be requested as provided in 89 Ill. Admin. Code 140.491(h).
207.4.1 Post Authorization Requests within 30 Calendar Days
First Transit processes post authorization requests made within 30 calendar days of the
date of service. Requests must include the same information as required for a prior
authorization. Requests submitted to First Transit for transports beyond 30 calendar days
of the date of service will be denied.
Requests for post authorization are subject to the same criteria as those for prior
authorizations.
207.4.2 Post Authorization Requests after 30 Calendar Days
The Department processes post authorization requests submitted beyond 30 calendar days
from the date of service. Providers must submit the post authorization requests to the
Department on either the single trip or standing prior authorization form available at First
Transit’s NETSPAP site. A letter from the provider must accompany the completed form to
indicate which exception applies to the request:
Provider Specific Policies
Page 24
Handbook for Transportation
Providers
Date:
August 25, 2021
a) The Department or the Department of Human Services (DHS) Family Community
Resource Center (FCRC) received the patient’s application for one of the
Department’s Medical Programs, but approval of the application had not been
issued as of the date of service. In such a case, the post authorization request
must be received by the Department no later than ninety (90) calendar days
following the date of the Agency’s Notice of Decision approving the application.
b) The participant did not inform the provider of his or her eligibility for one of the
Department’s Medical Programs. In such a case, the post authorization request
must be received by HFS no later than six (6) months following the date of
service. The request will be considered for prior authorization only if the
provider’s dated, private pay bill or collection correspondence, that was
addressed and mailed to the participant each month following the date of service,
is attached to the request.
Requests for exceptions to the post approval deadline are to be submitted to the
Department by fax at 217-524-6948 or may be mailed to the following address:
Illinois Department of Healthcare and Family Services
Bureau of Professional and Ancillary Services
Post Approval Requests Exceptions
607 East Adams Street, 4
th
floor
Springfield, Illinois 62701
207.5 Prior Approval Notification
If the requested transportation service is approved, the transportation provider will receive a
notice of approval letter for transportation services, listing the approved service(s), if the
provider is not signed up in PassPORT. If the provider is signed up in PassPORT, they can
check status on the PassPORT site.
208 Buy-Out/Change in Ownership Procedures
When a company acquires another transportation company, HFS considers it a buy-out.
Effective with the date of the company’s purchase, the new provider will need to enroll in
IMPACT with a new NPI/Provider Number. The provider must bill for transportation services
with its 10-digit NPI number or provider number if an atypical provider.
The company that was sold cannot bill or be reimbursed for any dates of service after the
end date of enrollment. The new company cannot bill for transportation services with the
purchased company’s NPI; therefore, all the prior approvals with the purchased company’s
NPI and Provider Number that extend beyond the company’s end date must be changed.
New companies must request new prior approvals for all new non-emergent transports.
HFS allows 90 calendar days from the date of provider enrollment to request revisions to
Provider Specific Policies
Page 25
Handbook for Transportation
Providers
Date:
August 25, 2021
current approvals and 180 calendar days from the date of the post-approvals to submit
claims.
Providers should contact a transportation billing representative for further information at
877-782-5565, options 1, 2, 4 and 4.
209 Program Integrity
Providers are expected to obey all laws, civil and criminal, state and federal regulations,
and Department policies pertaining to delivery of and payment for health care. The
Department monitors all claims to identify suspicious activities and providers suspected of
fraud will be criminally investigated and, when appropriate, prosecuted in state or federal
court.
Title XIX of the Social Security Act, under which the Medical Assistance Program is
administered, provides federal penalties for fraudulent acts and false reporting. In addition
to administrative and civil remedies, providers are subject to State and federal laws
pertaining to penalties for provider fraud and kickbacks (305 ILCS 5/8A-3). Program
members, providers or other individuals who have information regarding possible fraud or
abuse should call the Medicaid/Welfare Fraud Hotline, at (844) 453-7283/(844)-ILFRAUD.
Providers suspected of fraud, waste, or abuse shall be subject to the Department’s
sanction authority, including but not limited to payment suspension, payment denial,
monetary penalties, and termination or exclusion from participation in the program. See
Illinois Public Aid Code at 305 ILCS 5/12-4.25 and 89 Ill. Admin. Code 140 Subpart B.
