Handbook For Providers Of Transportation Services
Handbook for Providers ofTransportation ServicesChapter T-200Policy and Procedures forTransportation ServicesIllinois Department of Healthcare and Family Services
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresCHAPTER T-200Medical Transportation ServicesTABLE OF CONTENTSFOREWORDT-200 BASIC PROVISIONST-201 PROVIDER PARTICIPATION.1 Participation Requirements.2 Participation Approval.3 Participation Denial.4 Provider File MaintenanceT-202 TRANSPORTATION REIMBURSEMENT.1 Charges.2 Electronic Claim Submittal.3 Claim Preparation and Submittal.31 Submittal of Helicopter Services.4 Payment.5 Allowable Procedure CodesT-203 COVERED SERVICEST-204 NON-COVERED SERVICEST-205 RECORD REQUIREMENTST-210 GENERAL LIMITATIONS AND CONSIDERATIONS ON COVERED SERVICES.1 Additional Passenger.2 Residents of Long Term Care Facilities (LTC).3 Hospital-Based (Owned) Transportation Services.4 Participants Enrolled with a Managed Care Organization (MCO).5 Participants Receiving Screening, Support and Assessment Services (SASS)August 2008HFS T-200 (i)
Chapter T-200 – Policy and ProceduresHandbook for Transportation ServicesT-211 APPROVAL FOR NON-EMERGENCY TRANSPORTATION.1 Prior Approval for Non-Emergency Transportation.2 Post Approval for Non-Emergency Transportation.3 Prior Approval NotificationAPPENDICESAppendix T-1Technical Guidelines for Claim Preparation and MailingInstructions for Form HFS 2209, Provider InvoiceAppendix T-2Claim Preparation and Mailing Instructions – Form HFS 3797,Medicare Crossover FormAppendix T-3Explanation of Information on Provider Information SheetAppendix T-3aProvider Information SheetAppendix T-4Sample Uniform Trip TicketAugust 2008HFS T-200 (ii)
Chapter T-200 – Policy and ProceduresHandbook for Transportation ServicesFOREWORDPURPOSEThis handbook has been prepared for the information and guidance of transportationproviders who provide services to participants in the department’s MedicalPrograms. Contained in this handbook are both policy and procedures foremergency and non-emergency transportation services. This handbook providesinformation on how to access the department’s authorized agent for thetransportation prior approval process. This handbook provides information regardingspecific policies and procedures relating to transportation services.This handbook can be viewed on the department’s Web site dbooks/Pages/Chapter200.aspxIt is important that both the provider of service and the provider’s billing personnelread all materials prior to initiating services to ensure a thorough understanding ofthe department’s Medical Programs policy and billing procedures. Revisions in andsupplements to the handbook will be released from time to time as operatingexperience and state or federal regulations require policy and procedure changes inthe department’s Medical Programs. The updates will be posted to the department’sWeb site ices/Pages/default.aspxProviders will be held responsible for compliance with all policy and procedurescontained herein.Inquiries regarding coverage of a particular service or billing issues may bedirected to the Bureau of Comprehensive Health Services at 1-877-782-5565.August 2008HFS T-200 (iii)
Handbook for Transportation ServicesAugust 2008Chapter T-200 – Policy and ProceduresHFS T-200 (iv)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresCHAPTER T-200TRANSPORTATION SERVICEST-200BASIC PROVISIONSFor consideration for payment by the department for transportation services, aprovider enrolled for participation in the department’s Medical Programs mustprovide such services. Services provided must be in full compliance with both thegeneral provisions contained in the Chapter 100, Handbook for Providers of MedicalServices, General Policy and ders/Handbooks/Pages/Chapter100.aspx andthe policy and procedures contained in this handbook. Exclusions and limitationsare identified in specific topics contained herein.The billing instructions contained within this handbook are specific to thedepartment’s paper forms. Providers wishing to submit 837P electronic transactionsmust refer to Chapter 300, Handbook for Electronic Processing ooks/Pages/5010.aspx .Chapter 300 identifies information that is specific to conducting Electronic DataInterchange (EDI) with the Illinois Medical Assistance Program and other health careprograms funded or administered by the Illinois Department of Healthcare andFamily Services.An approved provider is responsible for the safety and wellbeing of patients duringthe transport.All non-emergency transportation requires approval except as specified in TopicT-211.August 2008HFS T-200 (1)
Handbook for Transportation ServicesAugust 2008Chapter T-200 – Policy and ProceduresHFS T-200 (2)
Handbook for Transportation ServicesT-201PROVIDER PARTICIPATIONT-201.1PARTICIPATION REQUIREMENTSChapter T-200 – Policy and ProceduresTransportation providers eligible to be considered for participation are those whoown or lease and operate any of the following: Ambulances licensed by the Illinois Secretary of State and inspectedannually by the Illinois Department of Public Health (Vehicle RegistrationType Ambulance).Helicopters possessing a special EMS license and an FAA Air CarrierCertificate issued by the United States Department of Transportation.Medicars licensed by the Illinois Secretary of State.Taxicabs licensed by the Illinois Secretary of State and, whereapplicable, by local regulatory agencies.Service cars licensed by the Illinois Secretary of State as livery or publictransportation.Private automobiles licensed by the Illinois Secretary of State.Other specialized modes of transportation, such as buses, trains andcommercial airplanes.Drivers and vehicles must meet the Illinois Secretary of State licensingrequirements.Ambulance providers who provide services within Illinois must be in compliance withthe EMS Systems Act (210 ILCS 50). Other transportation provider types basedoutside of Illinois must provide a valid license, permit or certification from the statewhere the business is headquartered.Safety Training Certification Requirement- As required under Public Act 0950501, all providers of non-emergency medi-car and service car transportation mustcertify that all drivers and employee attendants have completed a safety programapproved by the department, prior to transporting participants of the department’sMedical Programs.The safety training certification is required every three years. It is the provider’sresponsibility to re-certify. Medicar and service car providers must maintaindocumentation of their driver and employee attendant certifications. Failure toproduce the documentation upon request from the department shall result inrecovery of all payments made by the department for services rendered by a noncertified driver or attendant.August 2008HFS T-201 (1)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresMedicar and service car providers receiving federal funding under 49 U.S.C. 5307 or5311, are not subject to the safety training program certification requirement duringthe period of federal funding. Documentation of the federal funding period must bemade available to the department upon request.Providers of transportation services are classified as emergency or non-emergency.Emergency transportation includes ambulance and helicopter providers. Nonemergency transportation includes medicar, taxicab, service car, private automobile,bus, train, and commercial airplane providers.The provider must be enrolled for the specific category of service(s) (COS) for whichcharges are to be made. The categories of service for which a transportationprovider may enroll are:COSSERVICE DEFINITION50Emergency Ambulance- Transportation of a patient whose medicalcondition requires immediate treatment of an illness or injury.The destination of an emergency ambulance is a hospital or anothersource of medical care when a hospital is not immediately accessible.OrEmergency Helicopter- Transportation of a patient when the responsiblephysician determines such mode to be a medical necessity. Suchdetermination must be documented in writing by the physician.51Non-emergency Ambulance- Transportation of a patient whose medicalcondition requires transfer by stretcher and medical supervision. Thepatient’s condition may also require medical equipment or theadministration of drugs or oxygen, etc., during the transport.52Medicar- Transportation of a patient whose medical condition requires theuse of a hydraulic or electric lift or ramp, wheelchair lockdowns, ortransportation by stretcher when the patient’s condition does not requiremedical supervision, medical equipment, the administration of drugs or theadministration of oxygen, etc.53Taxicab- Transportation by passenger vehicle of a patient whose medicalcondition does not require a specialized mode.54Service Car- Transportation by passenger vehicle of a patient whosemedical condition does not require a specialized mode.55Private Automobile- Transportation by passenger vehicle of a patientwhose medical condition does not require a specialized mode.56Other Transportation- Transportation by common carrier, e.g., bus, trainor commercial airplane.August 2008HFS T-201 (2)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresTo participate, a transportation provider is required to enroll and file a provideragreement with the department.Procedure: The provider must complete and submit: Form HFS 2243 (Provider Enrollment/Application) Form HFS 1413T (Agreement for Participation) W9 (Request for Taxpayer Identification Number)The following documentation must be provided with the application, ifappropriate. Medicare Method of Payment- ambulance only Copy of Secretary of State Vehicle Identification card. Copy of approved rate of reimbursement as established by localgovernment authority. Copy of FAA Air Carrier Certificate.The above HFS forms and the W9 may be obtained from the Provider ParticipationUnit. E-mail requests for enrollment forms should be addressed to:HFS.PPU@illinois.govProviders may also call the unit at 217-782-0538 or mail a request to:Healthcare and Family ServicesProvider Participation UnitPost Office Box 19114Springfield, Illinois /default.aspxThe forms must be completed (printed in ink or typewritten), signed and dated in inkby the provider, and returned to the above address. The provider should retain acopy of the forms.Participation approval is not transferable - When there is a change in ownershipof an enrolled transportation company, or a change in the Federal Employer'sIdentification Number or the Social Security number of an enrolled transportationprovider, a new application for participation must be completed. Claims submittedby the new owner, using the prior owner's provider information, may result inrecoupment of payments and other sanctions.Fingerprint-Based Criminal Background Checks- As part of the enrollmentprocess, non-emergency transportation providers, excluding vendors owned oroperated by governmental agencies and private automobiles, must submit to afingerprint-based criminal background check as set forth in 89 Ill. Adm. Code140.498.August 2008HFS T-201 (3)
Handbook for Transportation ServicesT-201.2Chapter T-200 – Policy and ProceduresPARTICIPATION APPROVALWhen participation is approved, the provider will receive a computer-generatednotification, the Provider Information Sheet, listing all data on the department’scomputer files. The provider is to review this information for accuracy immediatelyupon receipt. For an explanation of the entries on the form, see Appendix T-3 andT-3a.If all information is correct, the provider is to retain the Provider Information Sheet forsubsequent use in completing claims to ensure that all identifying informationrequired is an exact match to that in the department files. If any of the information isincorrect, refer to Topic T-201.4.The Provider Participation Unit will assign the enrollment date.Non-emergency transportation providers are subject to a 180-day probationaryenrollment period as set out in 89 Ill Adm. Code 140.11.T-201.3PARTICIPATION DENIALWhen participation is denied, the provider will receive written notification of thereason for denial.Within ten calendar days after the date of this notice, the provider may request ahearing. The request must be in writing and must contain a brief statement of thebasis upon which the department's action is being challenged. If such a request isnot received within ten calendar days, or is received, but later withdrawn, thedepartment's decision shall be a final and binding administrative determination.Department rules concerning the basis for denial of participation are set out in 89 Ill.Adm. Code 140.14. Department rules concerning the administrative hearingprocess are set out in 89 Ill. Adm. Code 104 Subpart C.T-201.4PROVIDER FILE MAINTENANCEThe information carried in the department’s files for participating providers must bemaintained on a current basis. The provider and the department share responsibilityfor keeping the file updated.Provider ResponsibilityThe information contained on the Provider Information Sheet is the same as in thedepartment’s files. Each time the provider receives a Provider Information Sheet it isto be reviewed carefully for accuracy. The Provider Information Sheet containsinformation to be used by the provider in the preparation of claims; any inaccuraciesfound are to be corrected and the department notified immediately.Any time the provider effects a change that causes information on the ProviderInformation Sheet to become invalid the department is to be notified. Whenpossible, notification should be made in advance of a change.August 2008HFS T-201 (4)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresProcedure: The provider is to line out the incorrect or changed data, enter thecorrect data, sign and date the Provider Information Sheet with an original signatureon the line provided. Forward the corrected Provider Information Sheet to:Healthcare and Family ServicesProvider Participation UnitPost Office Box 19114Springfield, Illinois 62794-9114Failure of a provider to properly notify the department of corrections orchanges may cause an interruption in participation and payments. Inaddition, the prior approval process may be interrupted if the department’sprior approval agent does not have correct information.Department ResponsibilityWhen there is a change in a provider's enrollment status or the provider submits achange the department will generate an updated Provider Information Sheetreflecting the change and the effective date of the change. The updated sheet willbe sent to the provider and to all payees listed if the payee address is different fromthe provider address.August 2008HFS T-201 (5)
Handbook for Transportation ServicesAugust 2008Chapter T-200 – Policy and ProceduresHFS T-201 (6)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresT-202TRANSPORTATION REIMBURSEMENTT-202.1CHARGESCharges billed to the department must be the provider’s usual and customary chargebilled to the general public for the same service or item. Providers may only bill thedepartment after the service has been provided.T-202.2ELECTRONIC CLAIMS SUBMITTALAny services that do not require attachments or accompanying documentation maybe billed electronically. Further information concerning electronic claims submittalcan be found in Chapter 100, Topic 112.3.Providers billing electronically should take special note of the requirement thatForm HFS 194-M-C, Billing Certification Form, must be signed and retainedby the provider for a period of three years from the date of the voucher.Failure to do so may result in revocation of the provider’s right to billelectronically, recovery of monies or other adverse actions. Form HFS 194M-C can be found on the last page of each Remittance Advice that reportsthe disposition of any electronic claims. Refer to Chapter 100, Topic 130.5 forfurther details.Please note that the specifications for electronic claims billing are not the same asthose for paper claims. Please follow the instructions for the medium being used. Ifa problem occurs with electronic billing, providers should contact the department inthe same manner as would be applicable to a paper claim. It may be necessary forproviders to contact their software vendor if the department determines that theservice rejections are being caused by the submission of incorrect or invalid data.For information regarding electronic billing please refer to Chapter 300, Handbookfor Electronic Processing ooks/Pages/5010.aspx T-202.3CLAIM PREPARATION AND SUBMITTALRefer to Chapter 100, Topic 112, for general policy and procedures regarding claimsubmittal. For general information on billing for Medicare covered services andsubmittal of claims for participants eligible for Medicare Part B, refer to Chapter 100,Topics 112.5 and 120.1. For specific instructions for preparing claims for Medicarecovered services refer to Appendix T-2.Form HFS 2209, Transportation Invoice, is to be used to submit charges fortransportation services. All services for which charges are made must be coded withspecific procedure codes. Procedure codes and reimbursement rates for eachtransportation provider are listed on the Provider Information Sheet.August 2008HFS T-202 (1)
Handbook for Transportation ServicesChapter T-200 – Policy and ProceduresThe department uses a claim imaging system for scanning paper claims. Theimaging system allows more efficient processing of paper claims and also allowsattachments to be scanned. Refer to Appendix T-1 for technical guidelines to assistin preparing paper claims for processing. The department offers a claimscannability/imaging evaluation. Please send sample claims with a request forevaluation to the following address:Healthcare and Family Services201 South Grand Avenue EastSecond Floor - Data Preparation UnitSpringfield, Illinois 62763-0001Attention: Vendor/Scanner LiaisonAll routine paper claims are to be submitted in a pre-addressed mailing envelopeprovided by the department for this purpose, HFS 2244. Use of the pre-addressedenvelope should ensure that billing statements arrive in their original condition andare properly routed for processing.For a non-routine claim submittal, use HFS 2248, Special Approval Envelope. Anon-routine claim is:Any claim to which Form HFS 1411, Temporary MediPlan Card, is attached.Any claim to which any other document is attached.Should envelopes be unavailable, the HFS 2209, Transportation Invoice can bemailed to:Healthcare and Family ServicesPost Office Box 19105Springfield, IL 62794-9105For electronic claims submittal, refer to Topic T-202.2 above. Non-routine claimsmay not be electronically submitted.T-202.31 Submittal of Emergency Helicopter ServicesProviders of emergency helicopter services, including hospitals, should follow theinstructions for claim preparation and submittal set out in Section T-202.3. Inaddition, the provider’s record for each service must contain the air flight record anda physician’s written statement that indicates the patient’s diagnosis and medicalneed. A general statement such as “transport ordered by an M.D.” or “transport to ahigher level of care,” is not sufficient.August 2008HFS T-202 (2)
Handbook for Transportation ServicesT-202.4Chapter T-200 – Policy and ProceduresPAYMENTPayment made by the department for allowable medical transportation servicesprovided to patients who are not eligible for Medicare will be mad
T-202 TRANSPORTATION REIMBURSEMENT .1 Charges .2 Electronic Claim Submittal . Appendix T-1 Technical Guidelines for Claim Preparation and Mailing Instructions for Form HFS 2209, Provider Invoice . Appendix
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