NEMT billing in Illinois

Two lanes set by eligibility. A customer enrolled in Medicaid but not in a managed care organization gets non-emergency transportation through the state's centralized prior authorization process, which HFS contracts to Transdev; Transdev connects customers with enrolled providers in their area by random selection, and the provider bills HFS. A customer in a HealthChoice Illinois MCO gets transportation through the plan, and charges for covered non-emergency services for MCO members are billed to the MCO.² Non-emergency ground ambulance is the exception. Since January 1, 2022, non-emergency ambulance claims for HealthChoice Illinois members are billed to HFS, with prior approval from Transdev for services Medicare does not cover.

Medicaid provider enrollment in Illinois runs through IMPACT⁹. Fee-for-service customers who are not in an MCO contact Transdev's NETSPAP service, which prior approves non-emergency rides but does not schedule them, while HealthChoice Illinois members schedule rides through the number on their plan membership card¹.

Enroll in IMPACT, the HFS web-based provider enrollment system. Both MCO and fee-for-service transportation providers must be enrolled, with every vehicle listed and a Provider Type Specialty selected. Eligible providers own or lease and operate ambulances, medicars, taxis, service cars or private automobiles licensed by the Illinois Secretary of State, with IDPH licensing where a stretcher is billed. Medicar, taxi and service car providers certify that drivers and employee attendants completed a Department-approved safety program before transporting customers, recertified every three years. NEMT providers other than government-owned vendors and private autos submit to a fingerprint-based criminal background check and are subject to OIG on-site visits, and enrollment is conditional for one year.² Enrollment does not transfer. A change in ownership that requires a new federal tax ID ends the enrolled provider's participation; the buyer enrolls in IMPACT with its own NPI, requests new prior approvals, and cannot bill under the purchased company's number.

• A prior approval or post approval on file before the claim, carrying the Request Tracking Number Transdev issued; the claim must match the approval or it rejectsThe approval status shows in PassPORT the business morning after Transdev adjudicates it. The provider waits for the authorization notice before billing and verifies that the approved details are correct.
• HFS 2270 Physician Certification Statement for non-emergency trips that start at a hospital or long-term care facility, or HFS 2271 Certificate of Transportation Services for trips from a home residence, with a copy held by the transportation provider at the time of transportOne form can cover recurring medicar, wheelchair van or service car trips for up to 180 days and recurring ground ambulance trips for up to 60 days; a new form is needed when the level of transport changes. A PCS used for a hospital discharge is valid for that date only.
• Trip records kept under 89 Ill. Admin. Code 140.494 showing loaded miles only; mileage other than loaded miles and no-show trips are non-covered
• Driver and employee attendant safety training certifications for medicar, taxi and service car staff, produced on request; HFS recovers all payments for trips run by a non-certified driver or attendant
• The signed HFS 194-M-C Billing Certification Form from each remittance advice, retained for three years from the voucher date, because all services are billed electronically
• For ambulance trips, medical necessity documented on the patient care report, with the EMS Patient Care Report included for ALS and critical care transports

The HFS Non-Ambulance Transportation Fee Schedule effective January 1, 2026 lists A0090 for private auto mileage, A0100 for taxi, A0120 for the service car base rate, A0130 for the medicar (wheelchair van) base rate, A0425 for ground mileage, T2001 for a non-emergency transportation attendant, T2001 with modifier TK for an additional attendant, and T2005 for a stretcher van, with base rates set by county and a note that prior approval is required for all non-emergency transportation.³ HFS posts separate ground ambulance and air ambulance fee schedules with the same January 1, 2026 effective date. The non-ambulance schedule records that rates for A0120, A0130, T2001 and T2001 TK were increased January 1, 2023 and that T2001 with TK took effect October 1, 2013. The NEMT billing codes page walks through the transport codes and the origin and destination modifiers in plain language.

180 days from the date of service for initial and resubmitted non-institutional fee-for-service claims. Medicare crossover and Medicare-denied claims have two years from the date of service.⁵ Third-party liability claims are due within 180 days after the primary payer's final adjudication; a replacement claim has 12 months from the original paid voucher date and a void and rebill 90 days from the void DCN. A newly enrolled provider's 180 days start on the date the enrollment was recorded on the provider file. HealthChoice Illinois plans set their own windows by contract.