Ambulance
Effective for dates of service beginning Jan. 1, 2022, non-emergency ground ambulance services have been carved out from the HealthChoice Illinois (HCI) managed care plans’ contracts. Providers must obtain a prior approval number for managed care customers for non-emergency ground ambulance services. Providers can request prior approval using Transdev’s PassPORT system or by phone at 866-503-9040.
When a hospital discharges in an ambulance:
- The ambulance provider enters a single trip request through PassPORT
- The medical provider submits a PCS form to Transdev and gives a copy to the ambulance provider
- The ambulance provider faxes a Run Report to Transdev
Additional Information
- Get detailed billing instructions for changes to non-emergency ground ambulance services for managed care customers in the Provider Notice Issued Dec. 14, 2021. (Effective January 1, 2022)
- Click here to review FAQs for non-emergency ground ambulance transition from Managed Care Organization (MCO) Plans to Fee-for-Service (FFS).
- Review the workflow for an MCO customer requesting ambulance transport
- Read the letter from Illinois Healthcare and Family Services explaining the change for non-emergency ground ambulance services for managed care customers
Appeals
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For your reference, here’s the link to the HFS provider notice issued on 1/31/23 regarding the informal ambulance appeal review timely filing requirements:
https://hfs.illinois.gov/medicalproviders/notices/notice.prn230131a.html
Additional key points to keep in mind:
- Post authorization requests must be filed within 30 calendar days from the date of service. If your initial request is denied, you may resubmit it again through PassPORT as long as you’re still within the 30-day deadline. If it’s after 30 days, you must submit an appeal.
- Appeals must be filed within 90 calendar days from the date of service. If you chose to submit appeals via mail, the filing date is the date when Transdev receives them, not the date that they’re mailed.
- Transdev has 60 calendar days to process appeals.
Forms
- For transport originating at a hospital or long-term care facility – HFS 2270, Physician Certification Statement (PCS) for Ambulance Transport or Medicar/Service Car Transport. If the form does not open in your browser – right-click on the link, select Save Link As (or Save Target As), save the file to your computer, then open the saved file in Adobe Acrobat.
- For residential transports – CTS Form (please see provider notice dated 4/22/22 for instructions on when to use). If the form does not open in your browser – right-click on the link, select Save Link As (or Save Target As), save the file to your computer, then open the saved file in Adobe Acrobat.
- HFS 2270 Physician Certification Statement and Transportation Provider Complaint Portal
- Transportation PowerPoint Presentation for HFS 2270, Physician Certification Statement
- PassPORT Requirements for Non Emergency Ambulance Hospital Discharges, Notice to ambulance providers issued 01/24/2014
- 89 IL Administrative Code 140.491(c): Requirements for non-emergency ambulance services for discharging patients, medical certifications and orders, for dates of service beginning July 1, 2013.
- 89 IL Administrative Code 140.Table A: Criteria for non-emergency ambulance transportation