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Provider Notice issued 09/20/12
The interim appeals process is initiated by the ground ambulance provider filing a written, signed request for appeal with the Bureau of Comprehensive Health Services within 60 calendar days of the date of the decision rendered pursuant to Ill Admin. Code 140.491(h). The address for submitting a non-emergency ambulance appeal is:
The request for appeal shall include:
A brief statement of the issue on appeal; and
Documentation supporting the appeal request. Any documentation that was not previously submitted to the department, or its agent, prior to the decision rendered in Ill. Admin. Code 140.491(h) must be designated as such.
The Bureau of Comprehensive Health Services or its prior approval agent shall conduct an informal review of the request for appeal, including a review of all documentation submitted under (b) above, and within 60 calendar days issue the department’s written decision to reverse, modify, or affirm the department’s initial decision.
Interim Appeals Process for Non-emergency Ambulance Services
| To: | Participating Transportation Providers |
| Date: | September 20, 2012 |
| Re: | Interim Appeals Process for Non-emergency Ambulance Services |
Effective July 1, 2012, the Department implemented an interim appeals process for non-emergency ambulance services. The following interim appeals process shall be in effect until a final appeal process is adopted pursuant to administrative rules:
First Transit Inc.
799 Roosevelt Road, Building 4, Suite 200
Glen Ellyn, IL 60137-5908
Attention: Ambulance Appeals Section
Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator
Division of Medical Programs