Provider Notice issued 01/31/11

Chapter T-200, Handbook for Providers of Transportation Services Update​

The department has updated Chapter T-200, Handbook for Providers of Transportation Services, with a new fax number for the department's non-emergency transportation prior approval agent, First Transit, Inc.

In addition, the form HFS 3076F, Notice of Approval for Transportation Services is no longer being issued. The notice of approval is now generated by the prior approval agent First Transit, Inc.

These changes have been added to Chapter T-200 available on the HFS Web site. If you do not have access to the Internet, or need a paper copy, printed copies are available upon written request. You need to specify a physical street address to ensure delivery. Submit your written request or fax to:

Illinois Department of Healthcare and Family Services

Provider Participation Unit

Post Office Box 19114

Springfield, Illinois 62794-9114

Fax Number: 217-557-8800

E-mail the Provider Participation Unit

Instructions for Updating Handbook

T-211.1 Prior Approval for Non-Emergency Transportation

Remove pages HFS T-211 (1-4) and insert new pages HFS T-211 (1-4)

T-211 Approval for Non-Emergency Transportation

The department has contracted with a prior approval agent to operate a centralized transportation prior approval process.

Except as listed below, prior approval is required for all non-emergency transportation services to and from a source of medical care covered by the department's Medical Programs.

Prior approval is not required for ambulance service from one hospital for admission to a second hospital to receive inpatient services, which are not available at the sending hospital.

In situations when prior approval is not required, providers have the responsibility for verifying the appropriate mode of transportation, the participant's eligibility and the origin and destination prior to accepting the participant for transport.

T-211.1 Prior Approval for Non-Emergency Transportation

Healthcare and Family Services (HFS) contracts with First Transit Inc. to provide prior approvals of requests for non-emergency transportation services. To request a prior approval, medical providers should contact First Transit Inc. Requests for approvals must be made at least seven (7) business days prior to the date the transportation service is needed. "Business days"means Monday through Friday and does not include Saturdays, Sundays or holidays. Providers may also enroll with First Transit Inc. to submit prior approvals on line at the Non-Emergency Transportation Services Prior Approval Program (NETSPAP) Web site.

Prior approval requests must contain enough information for the prior approval administrator to make a well-informed decision on medical necessity, appropriateness and anticipated patient benefits of the service.

= Prior Approval Process for First Transit

Revised January 2011

Healthcare and Family Services (HFS) contracts with First Transit Inc. to provide prior approvals of requests for non-emergency transportation services. Each request, single or standing prior approval, must contain enough information for the department's prior approval administrator to make a well-informed decision on medical necessity, appropriateness and anticipated patient benefits of the service.

1. The request for transportation must be made by calling First Transit, toll-free, at: 1-866-503-9040 (TTY: 1-630-873-1449 for the hearing impaired) 8 a.m. to 5 p.m. - Monday through Friday (closed on State holidays)

2. The request must be made to First Transit at least seven (7) business days (excluding weekends and holidays) prior to the trip.

3. Trips may be requested as a single trip or a standing prior approval.

1. A standing prior approval with duration of up to six (6) months may be obtained when subsequent trips to the same medical source are required based on standing orders for specific medical services.

2. Standing prior approvals may be submitted by anyone for all services.

3. Standing prior approvals will not be accepted by telephone but are accepted by fax at 630-873-1450.

4. Standing prior approval requests should be submitted to First Transit at least seven (7) business days in advance of the begin date of the medical services. All medical documentation justifying the level of transportation required by the participant must be submitted with the standing prior approval request in order for validation to occur.

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

• The participant's name, address and telephone number;

• Recipient identification number;

• The name and address of the medical provider;

• The date, time and purpose for the appointment;

• Information to determine the level of transportation; and

• Transportation provider name and provider number

6. When requesting a standing prior approval, the following also applies:

• The patient's physician or other health professional will be contacted by First Transit to validate the following:

• Medical appointment(s)

• Medical need

• The necessity for ongoing visits

• Already established appointment dates

• The number and expected duration of the required ongoing visits.

7. First Transit will review the request and take one of the following actions:

• If the request is approved, First Transit will issue a Request Tracking Number, (a unique number assigned to each request for non-emergency transportation at the time the request is initially recorded in First Transit's system). First Transit will submit the approval to HFS' prior approval system for posting. A Notice of Approval letter that contains information necessary to bill HFS for the service will be mailed to the transportation provider. To ensure accurate billing, the transportation provider must wait for the approval notice before submitting a bill to HFS. The transportation provider should bring errors on the Notice of Approval to the attention of First Transit.

• If the request is denied, First Transit will issue a Request Tracking Number. First Transit will submit the denial, along with the reason for the denial, to HFS's prior approval system for posting. A denial letter will be sent to the participant and the transportation provider.

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

9. Upon receipt of the bill (claim) by HFS, 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.

An approval does not guarantee payment. The participant for whom transportation is approved must be eligible at the time each service is provided.

Approval will be given for the least expensive mode of transportation, which is adequate to meet the participants' medical needs. The department reserves the right for its authorized transportation approval agent to determine the appropriate mode of transportation and if necessary, provide the participant with a random selection of transportation providers in the participant's geographic area.

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

T- 211.2 Post Approval for Non-Emergency Transportation

In the event it is not possible to obtain prior approval for non-emergency transportation, post approval must be requested.

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.

Post Approval Requests Within 20 Business Days of the Date of Service

First Transit processes post approval requests made within 20 business days of the date of service, and must include the information required for a prior approval. All criteria for prior approval must be met for post approvals.

Requests for post approvals are subject to the same criteria as those for prior approvals as stated in Topic-211.1.

Post Approval Requests After 20 Business Days of the Date of Service

The department processes post approval requests submitted beyond 20 business days from the date of service. Providers must submit the post approval requests to the department on either the single trip or standing prior approval form available on First Transit's Non-Emergency Transportation Services Prior Approval Program (NETSPAP) Web site. Additionally, a letter from the provider must accompany the completed form, and must indicate which of the following exceptions (T-211.2(a) or T-211.2(b)), the post approval is being submitted under:

T-211.2(a) - The department or the DHS FCRC has received the patient's application for one of the department's Medical Programs, but approval of the application has not been issued as of the date of service. In such a case, the post approval request must be received by HFS no later than ninety (90) calendar days following the date of the Agency's Notice of Decision approving the application.

T-211.2(b) - The participant did not inform the provider of his or her eligibility for one of the department's Medical Programs. In such a case, the post approval request must be received by HFS no later than six (6) months following the date of service, but will be considered for payment only if there is attached to the request a copy of the provider's dated, private pay bill or collection correspondence, which was addressed and mailed to the participant each month following the date of service.

Requests for exceptions to the post approval deadline are to be submitted to HFS by fax at 217-524-7120, or may be mailed to the following address:

Bureau of Comprehensive Health Services

Transportation Billing Unit- Post

Approval Requests Exceptions

607 East Adams St.

Springfield, Illinois 62701

=T-211.3 Prior Approval Notification

Revised January 2011

If the requested transportation service is approved, the transportation provider will receive a Notice of Approval for Transportation Services, listing the approved service(s). The transportation provider must review the Notice of Approval for Transportation Services for accuracy. If there are errors on the Notice, First Transit must be contacted to correct the posted approval.

The transportation claim submitted must match the services that appear on the Notice of Approval for Transportation Services, or the claim will be rejected.