July 7, 2022
In April 2022, the Illinois Department of Healthcare and Family Services (HFS) issued this provider notice to announce the new date for reinstatement of the HFS 2271 Certification of Transportation Services (CTS) form.
As specified in the notice, the HFS 2271 form is to be used for all non-emergency transports originating at a patient’s private residence for dates of service on or after June 1, 2022.
The HFS 2271 form will be used for prior and post approval purposes to determine the appropriate level of medically necessary transport for participants covered under the Medicaid fee-for-service (FFS) plan, HealthChoice Illinois (HCI) managed care plans, and Medicare-Medicaid Alignment Initiative (MMAI) plans. For Blue Cross and Blue Shield of Illinois (BCBSIL), this includes our Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM.
We encourage you to view the HFS notice for details. The reminders below are intended to give you a brief summary of key points:
The form should be completed by a qualified medical professional on behalf of the patient prior to non-emergency transports originating from the patient’s private residence.
A copy of the CTS should be given to the transportation provider at the time of transport.
One CTS may be valid for recurring non-emergency ground ambulance transports for up to 60 days and recurring medicar/wheelchair van and service car transports for up to 180 days.
If medical necessity or the level of transportation changes, a new CTS will be requested.
The requestor or recipient of transportation services should keep a copy of the CTS and, upon request, help the transportation provider complete the form if it’s incomplete.
For non-emergency ambulance, medicar/wheelchair van or service car transport originating from a long-term care facility or hospital, an HFS 2270 Physician Certification Statement (PCS) should be completed instead of the HFS 2271 CTS. Both of these forms are available on the Medical Forms Numeric Listing page on the HFS site.
If you have questions on transportation coverage for Blue Cross and Blue Shield of Illinois (BCBSIL) members, call the customer service number on the member’s BCBSIL ID card.