Provider Notice issued 07/17/02

Non-Emergency Transportation Services Prior Approval Program (NETSPAP)

The Illinois Department of Public Aid has contracted with DynTek Services, Inc. (DynTek) to administer the NETSPAP in the counties listed above.

Starting August 1, 2002, all non-emergency medical transportation for participants in the Department's Medical Assistance Programs residing in the counties listed above must receive prior approval from DynTek. The local Department of Human Services office in the above listed counties will no longer be responsible for any non-emergency medical transportation prior approval.

The participant, medical provider or transportation provider may call for the prior approval of single trips. Transportation providers CANNOT make arrangements for standing referrals. Only medical providers can make arrangements for standing referrals. 

Transportation providers CANNOT request approval by fax or by any other paper media. 

• Non-emergency transportation must be:

• for Department approved medically necessary care;

• provided by an enrolled transportation provider;

• prior approved by DynTek Services, Inc.;

• to the nearest medical provider that meets the participant's needs; and

• provided in the least expensive mode that meets the participant's current medical needs.

Prior Approval Process. The process for non-emergency prior approval through DynTek is outlined below.

1. The request for transportation must be made by telephone to DynTek at:

1-877-725-0569
TTY 1-800-526-0844
8 a.m. to 5 p.m. Monday - Friday.

2. The request must be made to DynTek:

• no fewer than two business days (excluding weekends and holidays) before the scheduled trip; and
• no more than seven business days before the scheduled trip.

3. When calling for a prior approval, the following information must be provided to DynTek:

• the participant's name, address, phone number and recipient identification number;
• the name and address of the medical provider;
• the date, time and reason for the appointment; and
• the name of the transportation provider.

Note- A participant may request services from a specific transporation provider; however, all of the criteria for approval of non-emergency transportation services that are itemized in this notice must be met, including the most appropriate mode of transport that meets the participant's current medical needs.

4. DynTek will review the request and either approve or deny it. DynTek will provide the transportation provider with the referral number and other pertinent information about the approval.

1. If the request is approved, DynTek will immediately post the approval in the IDPA data system, including the date of the scheduled trip and the appropriate procedure codes from the Handbook for Providers of Transportation Services. The Department will mail a Notice of Approval letter that provides all information for billing. To ensure accurate billing, the transportation provider must wait for the approval notice before submitting its bill to the Department.
2. If the request is denied, DynTek will post the denial and the denial reason. The Department will mail a denial letter to the participant and the transportation provider.

5. DynTek will calculate and approve mileage for each trip, using nationally recognized mapping software. Transportation providers should bill actual mileage. In no circumstances should billed mileage exceed the mileage approved by DynTek.

6. Transportation for the participant may then be arranged.

7. Once the transportation has been provided and the Notice of Approval has been received and reviewed, the transportation provider may bill the Department following established procedures.

8. Upon receipt of the claim by the Department, prior approval of the transportation billed will be verified. If the transportation claim is not identical to the transportation approved on the Notice of Approval, the claim will be rejected.

9. Post approvals will be made only in urgent situations, such as hospital discharges after hours or on a weekend, or medical appointments scheduled for the same day.  Requests for a post approval must be made by phone to DynTek. All criteria for prior approval must be met for post approvals.

Exceptions. There are two exceptions to the process described above:

1. Residents of Long Term Care Facilities. Transportation for a participant who resides in a long term care facility will NOT need prior approval by DynTek. The facility will arrange necessary transportation and the transportation provider will bill the Department directly.

 

2. DCFS Wards. Special procedures are used to approve non-emergency medical transportation for children who are in the care and custody of the Illinois Department of Children and Family Services (DCFS). Only DCFS Medical Liaisons may make non-emergency medical transportation arrangements for DCFS wards. Questions regarding non-emergency medical transportation for a DCFS ward should be directed to the child's DCFS caseworker or DCFS centrally at 1-800-228-6533.

On behalf of the Department, DynTek conducts a program
of random sampling of medical providers, participants and
transportation providers to verify the validity of transportation
requests and claims.

The Department and DynTek plan to hold training sessions for transportation providers in the immediate future to provide further information about the program.  As more information or detail becomes available, it will be distributed to all transportation providers.  Please be assured that all transportation providers will be kept informed of the changes and new procedures.

Questions regarding this notice should be directed to the Bureau of Contract Management at 1-217-524-7478.  Billing questions should be directed to 1-217-782-5565.

Matt Powers, Administrator
Division of Medical Programs