Ambulance
Hospital discharges in an ambulance:
- The ambulance provider enters the single trip request through PassPORT
- The medical provider electronically submits the MCA form to First Transit
- The ambulance provider faxes the Run Report to First Transit
Forms and documentation:
- Online MCA Form (it will generate a one-page PDF copy for your records after you click Send)
- PDF MCA Form (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)
