MedicaidPrior AuthHigh impact
Prior Approval for Non-Emergency Ambulance Services
Illinois Medicaid - HFS·IL · Emergency Medicine·Provider Notice
Effective date
Nov 22, 2013
We identified it
Jun 20, 2026
Summary
Illinois hospitals must complete a Medical Certification for Ambulance Services (MCA) form prior to discharging Medicaid patients via non-emergency ambulance, certifying that lower-level transportation is medically contraindicated. The form must be submitted to First Transit and the ambulance provider before transport occurs.
Action Required
Immediately: Hospital discharge staff must complete MCA form prior to any Medicaid patient discharge requiring non-emergency ambulance transport. Submit completed form to First Transit (1-877-725-0569) and ambulance provider before transport. Provide copy to ambulance crew at pickup. Use online encrypted version at NETSPAP.com to avoid incomplete/illegible forms. Non-compliance may result in overpayment recovery from discharging physician and facility.