Date: September 17, 2021
To: All Medical Assistance Program Providers
Re: Billing Change for Non-Emergency Ground Ambulance Services for Managed Care Members Effective January 1, 2022
This notice informs providers of a change in billing non-emergency ground ambulance services for persons covered under the Department's HealthChoice Illinois (HCI) managed care health plans. For the Medicare-Medicaid Alignment Initiative (MMAI) plans, this billing change is only applicable for non-emergency ground ambulance services not covered by Medicare.
As a result of PA 102-0661, non-emergency ground ambulance services will be carved out of the managed care health plans' contracts effective with dates of service on and after January 1, 2022. HCI managed care health plans will cease paying non-emergency ground ambulance Category of Service 051 claims with dates of service on and after January 1, 2022.
For services beginning January 1, 2022, providers will submit claims for non-emergency ambulance services directly to the Department. Providers must obtain prior approval for non-emergency ground ambulance services through First Transit, the Department's non-emergency transportation prior approval contractor.
MMAI managed care plans will continue to cover and pay for Medicare-covered non-emergency ground ambulance services. Only non-emergency ambulance services not covered by Medicare will be carved out of the managed care contracts.
The Department will release additional guidance regarding this transition and expects full cooperation from providers during the transition time to minimize the disruption of service.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for fee-for-service issues, or to the applicable HealthChoice Illinois or MMAI managed care plan.
Kelly Cunningham, Administrator
Division of Medical Programs