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Possible online services disruption due to Internet related outage

A worldwide technology outage is causing disruption to some State of Illinois online systems.  We are aware of this issue and are diligently working on restoration.

Elizabeth M. Whitehorn, Director

HFS Transportation Provider Portal

Physician Certification Statement Form Issues Notification Portal

 

Pursuant to Public Act 100-0646, the Hospital Licensing Act, the Nursing Home Care Act and the Illinois Public Aid Code have been amended to require completion of the HFS 2270, Physician Certification Statement (PCS) for all non-emergency transportation originating at a hospital or LTC facility, via ground ambulance, medicar/wheelchair van or service car transport. This form must be completed prior to transport with a copy provided to the transportation provider at the time of transport. This requirement is mandatory for both fee-for-service and managed care clients.  

HFS recognizes the importance of providers having an outlet for reporting issues they may have with hospitals or LTC facilities’ completion of the PCS form. The provider portal has been created to allow transportation providers to submit PCS issues you are experiencing with Hospitals and Long-Term Care facilities in an electronic and secure format.  These issues include the facility not submitting a PCS form, not submitting the PCS form timely or submitting an incomplete PCS form. n to HFS.   The portal may be used to report issues for Medicaid fee-for-service participants as well as participants covered under an Illinois managed care plan.  

Our goal is to respond to these issues promptly.  Please allow HFS seven (7) business days to reply to your issue.    

This form should be completed by Transportation providers with issues involving hospitals or LTC Facilities and the completion of the PCS Form. You may upload private health information securely on this portal; to do so you must have specific member detail, including the member’s name, HFS 9-digit recipient identification number, and date of service. 

If you have any issues completing the for or questions regarding your submission, please email HFS.Transportation@illinois.gov.

* indicates required field

Transportation Provider Details/Follow-up Information

Failure to provide adequate information may prevent us from investigating this complaint.

Medicaid ID or NPI

Individual for HFS to follow-up with at Provider's Office

Facility/Complaint Information

Please provide as much detailed information about the complaint as possible.

Please select the Hospital or Long Term Care Facility not being compliant.

Please provide as much detailed information about the issue as possible.

Please provide examples of the PCS Form issues.

    Multiple files can be uploaded by holding down Shift or Ctrl while selecting.