MedicaidPrior AuthHigh impact
New Requirements Related to Prior Approval for Non-Emergency Ambulance Services
Illinois Medicaid - HFS·IL · Emergency Medicine, General Practice·Provider Notice
Effective date
Jul 1, 2013
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now requires prior approval for non-emergency ambulance services for hospital discharges, with a Medical Certification for Non-Emergency Ambulance (MCA) form that must be completed by hospitals. The policy has a phased implementation with education period through September 30, 2013, followed by full enforcement requiring pre-transport approval starting October 1, 2013.
Action Required
By October 1, 2013: Billing team must ensure all non-emergency ambulance transports for Medicaid hospital discharge patients have completed MCA forms submitted by hospitals prior to transport. Update billing system to verify MCA form completion before processing ambulance claims. Claims without proper MCA forms will be denied for payment.