Provider Notice issued 02/21/14

PassPORT Requirements for Non Emergency Ambulance Hospital Discharges

To:​ ​Enrolled Ambulance Providers
​Date: ​February 21, 2014
​Re: ​PassPORT Requirements for Non Emergency Ambulance Hospital Discharges

This notice supersedes the January 24, 2014 Informational Notice, PassPORT Requirements for Non Emergency Ambulance Hospital Discharges. The purpose of this notice is to advise ambulance providers of a new requirement related to ambulance services provided to patients being discharged from a hospital. Ambulance providers must enter ambulance transports for patients discharged from a hospital into First Transit's PassPORT system within 20 business days from the date of service, regardless of whether the ambulance provider has received the Illinois Medicaid Medical Certification for Non Emergency Ambulance (MCA) form from the hospital provider. More information about the MCA form and requirements can be found on the Non-Emergency Transportation Services Prior Approval Program's website and below.

Below is a summary of the procedures involving hospital discharges and MCA forms:

  1. Hospital Requirement to Complete the MCA Form Prior to Transport. The department requires that a hospital transmit a completed MCA form to First Transit and the ambulance provider prior to ordering an ambulance transport and prior to the transport service being provided. Hospitals were reminded of this requirement in a November 22, 2013 Informational Notice, Prior Approval for Non Emergency Ambulance Services. In accordance with 89 IL Admin Code 140.491(c)(4), hospitals must develop procedures to ensure compliance with the MCA form requirements.
  2. Ambulance Provider Inquiry to Hospital at Dispatch. Ambulance providers should ask hospitals if a MCA form has been completed and submitted to First Transit when the hospital calls to order the transport. Ambulance providers should not dispatch an ambulance for a patient being discharged from a hospital unless they have received a completed MCA form or have assurances that a MCA has been completed. Ambulance providers who offer to transport patients without a completed MCA form may be in violation of state law.
  3. Copy of MCA to Ambulance Provider. Hospitals must give the ambulance provider a copy of the completed MCA at the time of transport.
  4. PassPORT. All non-emergency ambulance transports involving a hospital discharge must be entered into PassPORT by the ambulance provider within 20 business days from the date of service, regardless if an MCA form was completed or not. By entering the trip into PassPORT, the department is notified that a non-emergency ambulance transport has occurred and the department's prior approval agent, currently First Transit, will link the completed MCA form with the transport. When an ambulance provider enters a hospital discharge ambulance transport into PassPORT, and First Transit has not received an MCA form (or has received an incomplete form) from the hospital for the ambulance service, the department will contact the hospital to request the completion of the form. Ambulance providers who do not receive a completed MCA at time of transport, shall contact the hospital immediately to request completion of the MCA form and submission to both the ambulance provider and First Transit. The trip will be listed as 'pending' in PassPORT until a completed MCA form is submitted. In those rare instances when the ambulance provider does not receive a completed MCA form at the time of transport, a completed MCA form can be submitted within 90 calendar days of transport. This should be the exception and not routine practice.

The department is committed to assisting both ambulance and hospital providers in complying with this requirement. The department holds weekly conference calls on Thursdays at 9:30, and will continue to do so throughout implementation. The conference call number is 888-494-4032, passcode 7212487979#. In addition, a separate e-mail address has been established which is dedicated to questions relating to this requirement. The e-mail address is hfs.mcaform@illinois.gov. Questions regarding this notice may be directed to First Transit at

1-877-725-0569.

Theresa A. Eagleson, Administrator

Division of Medical Programs