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Provider Notice Issued 12/14/2021

Date:   December 14, 2021

To:       Enrolled Transportation Providers

Re:      Detailed Billing Instructions for Changes to Non-Emergency Ground Ambulance Services for Managed Care Customers Effective January 1, 2022

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This notice provides billing clarification to providers relating to the provider notice dated September 17, 2021, regarding the change in billing non-emergency ground ambulance services for customers covered under one of 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.

Effective with dates of service beginning January 1, 2022, non-emergency ground ambulance services have been carved out from the HCI managed care plans' contracts. MCOs will cease paying non-emergency ground ambulance Category of Service 051 claims with dates of service on or after January 1, 2022. Claims for non-emergency ground ambulance services must be billed directly to the Department for non-Medicare primary customers covered under one of the HCI managed care plans.

The service codes included in this HCI carve-out are as follows. Claims can have either an 'N' indicator code or be left blank for non-emergency Specialty Care Transport (A0434) codes billed.

CPT CodeDescription
A0426Advance Life Support Base Rate
A0428Basic Life Support Base Rate
A0433Advance Life Support Level 2 Base Rate
A0434Specialty Care/Critical Care Transport Base Rate
A0425Mileage associated with an above listed non-emergency transport
A0422Oxygen associated with an above listed non-emergency transport

 
Providers must obtain a prior approval number for managed care customers for non-emergency ground ambulance services through First Transit, the prior approval vendor with which the Department contracts to provide prior authorization review for most non-emergency transportation.

Providers can request prior approval via First Transit's Passport system or by phone at
866-503-9040.

Providers will then submit claims directly to the Department for dates of service beginning January 1, 2022.

MCOs will continue to schedule and process Category of Service 051 trip requests for all MMAI customers and will continue covering and paying for Medicare-covered non-emergency ground ambulance services for these customers. Only non-emergency ambulance services not covered by Medicare will be carved out of managed care for this population. 

MCOs will be responsible for payment of any initial Category of Service 051 trips which, upon review and notification to NET provider of denial, result in downgraded levels of transport.

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 managed care plan.

 

Kelly Cunningham, Administrator
Division of Medical Programs



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JB Pritzker, Governor • Theresa Eagleson, Director