First Transit's fax number is (630) 873-1450.
Hospital discharges in an ambulance:
- The ambulance provider enters the single trip request through PassPORT
- The medical provider submits the PCS form to First Transit
- The ambulance provider faxes the Run Report to First Transit
Forms and documentation:
- HFS 2270, Physician Certification Statement (PCS) for Ambulance Transport or Medicar/Service Car Transport (replaces the current MCA and CTS forms)
- Notice to Enrolled Transportation Providers; Hospitals; and Nursing Facilities issued on 11/21/18, Physician Certification Statement for All Non-Emergency Transportation
The HFS 2270 Physician Certification Statement (PCS) form replaces the current Medical Certification for Non-Emergency Ambulance (MCA) and Certification of Transportation Services (CTS) forms. The new PCS form is an important document to certify that the appropriate level of transportation is being requested and is necessary for payment and/or verification of the adequate level of service. This applies to participants covered under fee-for-service Medicaid, as well as HealthChoice plans.
You may begin using the new PCS form effective immediately to replace the current MCA and CTS forms. The transition period will and become mandatory on February 1, 2019, when the MCA and CTS forms will be phased out.
- Online MCA Form (it will generate a one-page PDF copy for your records after you click Send)
- MCA Form (pdf) (please use only if you are not able to submit via Online MCA Form)
- Retaining a Copy of the Medical Certification for Non Emergency Ambulance (MCA) Form, Notice to hospitals and ambulance providers issued 05/13/2014
- PassPORT Requirements for Non Emergency Ambulance Hospital Discharges, Notice to ambulance providers issued 02/21/2014
- New Law Impacting Hospital Discharges of Illinois Medicaid Participants by Ambulance, Notice to providers of transportation and hospital services issued 10/07/2013
- Prior Approval for Non-Emergency Ambulance Services, Notice to participating medical assistance providers issued 07/01/2013
- 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
- Certificate of Transportation Services (CTS)