Ambulance

First Transit's fax number is (630) 873-1450.

Effective with dates of service beginning January 1, 2022, non-emergency ground ambulance services have been carved out from the HCI managed care plans' contracts. Providers must obtain a prior approval number for managed care customers for non-emergency ground ambulance services through First Transit, the prior approval vendor with which the Department contracts to provide prior authorization review for most non-emergency transportation. Providers can request prior approval via First Transit's PassPORT system or by phone at 866-503-9040.

• Detailed Billing Instructions for Changes to Non-Emergency Ground Ambulance Services for Managed Care Customers Effective January 1, 2022 (Provider Notice Issued 12/14/2021)
• FAQs Non-Emergency Ground Ambulance Transition from MCOs to FFS Document - this is a working document draft
• MCO Customer Requesting Ambulance Transport Flow Chart
• Information letter for MCO customers - this is a working document draft

Hospital discharges in an ambulance:

• The ambulance provider enters a single trip request through PassPORT
• The medical provider submits a PCS form to First Transit and gives a copy to the ambulance provider
• The ambulance provider faxes a Run Report to First Transit

Forms and documentation:

• 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). This change goes into effect on 6/1/22 (see provider notice dated 4/29/22). 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 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