Ambulance

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

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, save the file to your computer, then open the saved file.
• For residential transports - Certificate of Transportation Services (CTS)
• 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