Provider Notice issued 12/23/03

Non-Emergency Transportation Services Prior Approval Program (NETSPAP)

The Illinois Department of Public Aid has contracted with First Transit, Inc. to administer the NETSPAP in the counties listed above. Effective with trips on or after February 1, 2004, participants residing in any of the counties listed above must obtain prior approval for all non-emergency medical transportation from First Transit. The Department of Human Services' local offices in these counties will no longer handle prior approval requests for non-emergency medical transportation services.

The participant, medical provider or transportation provider may call to receive approval for single trips. Requests for standing orders must be made in writing to First Transit and can only be made by the medical provider. Medical providers may fax the standing order requests to First Transit.

In order to be considered for reimbursement by the department, non-emergency transportation must be:

• For department approved medically necessary care;

• Provided by an enrolled transportation provider;

• Prior approved by First Transit, Inc.;

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

• Provided in the least expensive mode that meets the participant's medical needs on the date of transport.

Attached, for your reference, is an explanation of the prior approval under First Transit. The Department and First Transit will hold training sessions for transportation providers in the near future. As more information becomes available, it will be distributed to all Medicaid enrolled transportation providers in the above counties.

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.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs

Attachment to Non-Emergency Transportation Services Prior Approval Program (NETSPAP)

Prior Approval Process for First Transit

1. The request for transportation must be made by calling First Transit toll-free at:

1-877-725-0569
TTY 1-800-526-0844
8 a.m. to 5 p.m. Monday - Friday (closed on state holidays)

2. The request must be made to First Transit at least two business days (excluding weekends and holidays) prior to the trip.

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

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

Note- A participant may request services from a specific transportation 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. First Transit will review the request and take one of the following actions:

1. If the request is approved, First Transit will immediately post the approval in the department's prior approval system and will give the transportation provider the referral number. Transportation for the participant my then be arranged. The department will mail a Notice of Approval letter that contains information necessary to bill the department for the service. To ensure accurate billing, the transportation provider must wait for the approval notice before submitting a bill to the department. The transportation provider should bring errors on the Notice of Approval to the attention of First Transit.
   
2. If the request is denied, First Transit will post the denial in the department's prior approval system along with the reason for the denial. The department will mail a denial letter to the participant and the transportation provider.

5. Transportation providers must bill actual mileage.

6. 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.

7. Upon receipt of the bill (claim) by the department, prior approval of the transportation will be verified. If the transportation claim is not identical to the transportation approved on the Notice of Approval, the claim will be rejected.

8. 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 First Transit. All criteria for prior approval must be met for post approvals.

9. On behalf of the department, First Transit randomly samples trips to verify the validity of transportation requests and claims.

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

1. Residents of Long Term Care Facilities. Transportation for a participant who resides in a long-term care facility does NOT need prior approval by First Transit. 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 central office at 1-800-228-6533.