Agencies
Services
Provider Notice issued 09/18/2024
| To: |
Enrolled Transportation Providers |
| Date | September 18, 2024 |
| Re: |
Publicly Owned Transportation Providers – Ground Emergency Medical Transportation (GEMT) Supplemental Payments |
This notice informs providers enrolled in the Ground Emergency Medical Transportation (GEMT) program that payment for FY2024 (7/1/2023 – 6/30/2024), will be due by October 31st, 2024.
ACH Direct Debit is the preferred method of payment for Ground Emergency Medical Transportation (GEMT) payments. Providers should complete the ACH HFS3881G form and return it to HFS at HFS.GEMT@Illinois.gov
HFS 3881G ACH/Wire Transfers Form Completion Instructions
Agency Information |
|
|
|
Field |
Completion |
Federal Program Name |
Name of GEMT Provider |
Agency Identifier |
HFS |
Agency Location Code |
478 |
ACH Format |
CCD+ (ACH Credit) or CTX (Wire Transfer) |
Address |
GEMT Provider address |
Contact Person Name |
The person the Illinois Treasurer’s Office contacts to set up the ACH |
Telephone Number |
Telephone number of Contact |
Additional Information |
Email address of Contact |
|
|
Payee/Company Information |
|
|
|
Field |
Completion |
Name |
Illinois Department of Healthcare and Family Services |
SSN No. or Taxpayer ID No. |
371320188 |
Address |
201 South Grand Avenue East Springfield, IL 62763 |
Contact Person Name |
Donavon Patton |
Telephone Number |
217-785-9623 |
Financial Institution Information
This is completed by the Illinois Treasurer’s Office.
If you choose not to participate in the ACH process, then you may still remit payment via check noting “GEMT Payment” to the address noted below. Please include the invoice number on the check.
Illinois Department of Healthcare and Family Services
Bureau of Fiscal Operations - GEMT
PO Box 19491
Springfield, IL 62794-9491
Questions regarding the program should be sent to HFS.GEMT@illinois.gov or the Bureau of Professional and Ancillary Services at 877-782-5565.
Kelly Cunningham, Administrator
Division of Medical Programs