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Provider Notice Issued 11/21/2018

Date:  November 21, 2018
To:     Enrolled Transportation Providers; Hospitals; and Nursing Facilities
Re:     Physician Certification Statement for All Non-Emergency Transportation
This notice informs providers that effective with dates of service on and after November 1, 2018, providers may start to use the new standardized medical necessity form, HFS 2270 Physician Certification Statement (PCS), for all non-emergency transportation, including Ambulance, Medicar/Wheelchair Van and Service Car transports.
The HFS 2270 Physician Certification Statement replaces the current Medicaid Medical Certification for Non-Emergency Ambulance (MCA) and Certification of Transportation Services (CTS) forms. The new PCS form is an important document to certify that the appropriate level of transportation is being requested and is necessary for payment and/or verification of the level of service by Medicaid. This applies to participants covered under fee-for-service Medicaid, as well as HealthChoice Illinois Managed Care Organization plans.
Pursuant to Public Act 100-0646, the Hospital Licensing Act, the Nursing Home Care Act and the Illinois Public Aid Code have been amended to require completion of this form each time non-emergency transportation is ordered. This form must be completed prior to transport and a copy provided to the transportation provider at the time of transport.
Nursing facilities and hospitals are required to:
  • Develop a policy requiring a physician or their designee to complete the PCS;
  • Maintain a copy of the PCS in the patient’s medical record (hospitals only); and
  • At the request of the transportation provider, assist in completing the PCS if it is incomplete.

In cases when a PCS is not completed prior to or at the time of transport, the PCS must be provided at no charge within 10 calendar days of the request of the transportation provider.
Hospitals and nursing facilities will have until February 1, 2019 to implement usage of the PCS form.
Beginning October 1, 2018, HFS will begin collecting data regarding transportation claim denials as a result of a missing or incomplete PCS. This data will be reported quarterly on the Department’s website.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service Medicaid participants, or to the applicable HealthChoice Illinois Managed Care plan.
Teresa T. Hursey
Medicaid Director


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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director