How to Bill Medicaid for NEMT in Illinois: Complete Guide for Transportation Providers

If you own or operate a non-emergency medical transportation (NEMT) company in Illinois, billing Medicaid directly can significantly increase your revenue per trip. This guide walks you through every step of the process, from IMPACT enrollment and HCPCS billing codes to claim submission, reimbursement rates, prior authorization, and vehicle licensing requirements. Whether you are launching a new NEMT business or transitioning from broker-only work, this is the definitive resource for billing Illinois Medicaid for transportation services.

Why Bill Medicaid Directly?

Most NEMT companies in Illinois start by subcontracting through transportation brokers or managed care organizations (MCOs). The broker secures the Medicaid contract, dispatches rides to you, and pays you a negotiated rate that is typically 30% to 50% less than what Medicaid actually reimburses. The broker keeps the difference.

When you enroll as a direct Medicaid provider and bill the state yourself, you capture the full reimbursement rate. No middleman. No revenue sharing. The math is straightforward: if Medicaid pays $45 for an ambulatory encounter and a broker pays you $25 for that same trip, direct billing means an additional $20 per ride going directly to your company.

This became even more compelling in FY2024 when Illinois increased NEMT reimbursement rates by approximately 40%. That rate increase made direct billing significantly more profitable for providers who were already enrolled and created a strong incentive for new providers to enroll.

Benefits of Direct Medicaid Billing

✓Full reimbursement — Receive 100% of the Medicaid fee schedule rate instead of a discounted broker rate
✓Higher per-trip revenue — Typical increase of $15 to $25 per trip compared to broker rates
✓Direct relationship with HFS — You control your claims, corrections, and payment timeline
✓FY2024 rate increase — Illinois boosted NEMT rates ~40%, making direct billing more profitable than ever
✓Business credibility — Being a Medicaid-enrolled provider enhances your reputation with facilities and MCOs

Important Consideration

Direct billing requires administrative investment. You will need to manage enrollment, claims submission, prior authorization tracking, and denial management. For some companies, the administrative overhead is worth the revenue increase. For others, partnering with an organization like Dream Care Rides that handles these functions can be the better path.

Step-by-Step IMPACT Enrollment

IMPACT (Illinois Medicaid Program Advanced Cloud Technology) is the state's provider enrollment portal. Every NEMT company that wants to bill Illinois Medicaid directly must complete enrollment through IMPACT. The process is detailed and documentation-heavy, but following these steps will help you navigate it efficiently.

Before You Begin: Gather Your Documents

Before creating your IMPACT account, assemble all of the following documents. Missing even one item will stall your application.

Required Documents Checklist

✓W-9 form — Must be on file with the Illinois State Comptroller's office before you enroll
✓Vehicle VINs and license plate numbers — For every vehicle in your fleet that will be used for Medicaid trips
✓PT or MC plates — Public Transportation or Motor Carrier plates are required on all NEMT vehicles
✓Insurance certificates — Minimum $250,000 bodily injury and $50,000 property damage per vehicle
✓Owner SSN and home address — Required for the criminal background check component
✓Business EIN — Your Employer Identification Number from the IRS
✓NPI number — National Provider Identifier (apply at nppes.cms.hhs.gov if you do not have one)

Enrollment Steps

File Your W-9 With the State Comptroller

Before touching IMPACT, submit your W-9 to the Illinois Comptroller's office. This step is often overlooked and will block your enrollment if not completed first. The Comptroller needs your W-9 on file to process any future Medicaid payments to your company.

Create Your IMPACT Account

Go to IMPACT.illinois.gov and create a new provider account. You will need your business email, EIN, and basic company information. The portal will generate a username and temporary password.

Select “Atypical Agency” Provider Type

When the enrollment application asks for your provider type, select “Atypical Agency”. This is the designated category for NEMT transportation providers in the Illinois Medicaid system. Do not select other provider types such as ambulance or home health, as these have different requirements and billing structures.

Enter Vehicle and Fleet Information

Enter the VIN, license plate number, and plate type (PT or MC) for every vehicle in your fleet. Each vehicle must have valid PT or MC plates and insurance meeting the minimum coverage thresholds. You can add vehicles later, but you need at least one active vehicle to complete enrollment.

Complete the Owner Disclosure Section

Provide the owner's Social Security Number, home address, date of birth, and any ownership interest in other healthcare entities. This information is used for the criminal background check and exclusion screening. All individuals with 5% or greater ownership interest must be disclosed.

Upload Insurance Documentation

Upload your certificate of insurance showing at minimum $250,000 bodily injury liability and $50,000 property damage liability per vehicle. The policy must name the enrolled entity as the insured. Ensure your insurance does not lapse during the enrollment review period.

Submit and Wait for Approval

After submitting your application, HFS reviews your documentation, runs the background check, and verifies your information. This review typically takes 30 to 90 days. Monitor your IMPACT portal for status updates and respond promptly to any requests for additional information.

Pro Tip: Follow Up Regularly

Do not submit your IMPACT application and wait passively. Check your portal weekly for status changes and contact the HFS provider enrollment unit if your application has been pending for more than 45 days without an update. Having a complete, error-free application is the single most important factor in reducing your enrollment timeline.

Need Help With Enrollment?

The IMPACT enrollment process can be complex. Dream Care Rides has helped multiple NEMT companies navigate provider enrollment. Contact us to learn about our partnership options.

Explore Partnership (708) 505-6994

HCPCS Billing Codes Explained

Illinois Medicaid uses Healthcare Common Procedure Coding System (HCPCS) codes to identify and reimburse NEMT services. Using the correct code for each trip is critical. An incorrect code will result in a claim denial, delayed payment, or underpayment.

Primary Service Codes

T2003 — Non-Emergency Transportation: Encounter/Trip

This is the most commonly used code for NEMT in Illinois. T2003 covers ambulatory transportation (service car, medicar) on a per-encounter basis. Use this code for sedan, SUV, or standard vehicle trips where the patient is ambulatory. Each one-way trip is one encounter.

T2005 — Non-Emergency Transportation: Stretcher Van

Used for stretcher van (non-ambulance) transportation. This code applies when the patient must be transported in a reclined or supine position on a stretcher but does not require ambulance-level care. The reimbursement rate for T2005 is higher than T2003, reflecting the specialized vehicle and crew requirements.

A0130 — Non-Emergency Transportation: Mileage (Per Loaded Mile)

Billed per loaded mile (the distance traveled with the patient in the vehicle). In many Illinois counties, mileage is bundled into the base encounter rate for standard Medicaid trips. However, for longer-distance or specific service scenarios, A0130 may be billed separately. Check your county's fee schedule for mileage billing rules.

A0120 — Non-Emergency Transportation: Additional Mileage

Used for additional mileage beyond what is included in the base encounter rate, when applicable. The specific thresholds and rules for when A0120 applies vary. Consult the HFS fee schedule and provider handbook for your service area.

T2001 — Non-Emergency Transportation: Attendant

Billed when a transportation attendant (aide) accompanies the patient during the trip and provides hands-on assistance. This is separate from the driver. The attendant must be trained and qualified per HFS requirements. T2001 is billed in addition to the base encounter code.

Modifiers

Modifiers are two-character codes appended to the primary HCPCS code to provide additional information about the service. Using the correct modifiers is essential for proper claim adjudication.

Modifier	Description	When to Use
GY	Item or service statutorily excluded	When the service is not a covered Medicare benefit but is billed to Medicaid
QL	Patient pronounced dead after transport	Rare; used only in specific circumstances documented in the provider handbook
TQ	Basic life support, urban	Indicates urban area service; impacts rate in some counties
UJ	Services provided at night	When the trip occurs during designated nighttime hours
TK	Extra patient or passenger	When an additional passenger (such as a parent or guardian) accompanies the patient
QM	Ambulance service provided under arrangement	Used in specific arrangement scenarios; verify applicability with HFS
QN	Ambulance service furnished directly by a provider	Used when the enrolled entity directly provides the transportation service

Coding Best Practice

Always match your billing code to the Prior Certification Statement (PCS) on file for the trip. If the PCS authorizes a medicar (ambulatory) trip and you bill T2005 (stretcher van), the claim will be denied. When in doubt, call the HFS billing support line at 877-782-5565 (options 1, 2, 4, 4) to verify the correct code before submitting.

How to Submit Claims

Once you are an enrolled provider with an active IMPACT account, you can submit claims for completed NEMT trips. Illinois Medicaid strongly encourages electronic claim submission for faster processing and fewer errors.

Electronic Claim Submission

Electronic claims are submitted through the IMPACT portal or through an approved clearinghouse. Electronic submission is the preferred method because it reduces processing time, provides immediate acknowledgment of receipt, and allows you to track claim status in real time.

Log Into IMPACT

Access the IMPACT portal at IMPACT.illinois.gov using your provider credentials. Navigate to the claims submission section.

Enter Trip Details

For each claim, enter the patient's Medicaid ID, date of service, pickup and drop-off locations, HCPCS code with applicable modifiers, loaded mileage, and the prior authorization number. Ensure all fields match the information on the PCS form.

Verify and Submit

Review all claim details before submitting. The portal performs basic validation checks and will flag obvious errors (missing fields, invalid codes). Correct any errors before final submission. Save your confirmation number for tracking.

Monitor Claim Status

After submission, track your claims through the IMPACT portal. Claims typically process within 30 days for clean electronic submissions. Claims that require manual review or have issues may take longer.

Key Contact: HFS Billing Support

Phone: 877-782-5565

Menu path: Options 1, 2, 4, 4

Use for: Billing questions, code verification, claim status inquiries

Hours: Business hours, Monday through Friday

Timely Filing Requirements

Illinois Medicaid has strict timely filing deadlines. For fee-for-service (FFS) claims, you must submit within 180 days from the date of service. For MCO claims, the deadline varies by plan but is typically 90 to 180 days. Claims submitted after the filing deadline will be automatically denied with no appeal option for late submission.

Do Not Miss Filing Deadlines

Establish a billing workflow that submits claims weekly or bi-weekly. Waiting until the end of the month or quarter increases your risk of timely filing denials and creates cash flow gaps. Many successful NEMT billing operations submit claims within 48 to 72 hours of completing the trip.

Illinois NEMT Reimbursement Rates

Illinois Medicaid NEMT reimbursement rates are published by the Department of Healthcare and Family Services (HFS) and vary by county and service type. Understanding the rate structure is essential for pricing your services and projecting revenue.

FY2024 Rate Increase

In FY2024, Illinois increased NEMT reimbursement rates by approximately 40%. This was one of the most significant rate increases in the program's history and was designed to attract more providers to the Medicaid NEMT network and improve service availability for beneficiaries. For NEMT company owners, this rate increase made direct billing substantially more financially attractive.

County-Specific Rates

Rates differ by county. Cook County (Chicago metro) typically has different rates than Will County, DuPage County, Lake County, and downstate counties. The rate variation reflects differences in operating costs, demand, and provider availability across regions.

How to Find Your County's Rates

1Visit the HFS Transportation Fee Schedule page
2Select your county and service code (T2003, T2005, etc.)
3Note both the base encounter rate and any mileage components
4Check for updates periodically, as rates may change with new fiscal years

Fee Schedule Resource

The official Illinois Medicaid NEMT fee schedule is published at:

hfs.illinois.gov/medicalproviders/medicaidreimbursement/transportation.html

Mileage Billing

For standard Medicaid fee-for-service NEMT trips, mileage is typically bundled into the base encounter rate. This means the flat per-trip reimbursement covers both the encounter and a standard mileage range. For trips that exceed the bundled mileage threshold, you may bill additional mileage using A0130 or A0120 codes. The specifics depend on your county and the trip parameters.

Revenue Impact: At current post-FY2024 rates, an NEMT company completing 40 Medicaid trips per day can see a revenue difference of $600 to $1,000+ per day by billing directly versus accepting broker rates. Over a month, that translates to $12,000 to $20,000 or more in additional gross revenue.

Prior Authorization Requirements

Most Medicaid NEMT trips in Illinois require prior authorization (PA) before the ride is provided. Without a valid PA, your claim will be denied. Understanding the PA process and managing it efficiently is one of the most critical operational components of direct Medicaid billing.

Who Manages Prior Authorization?

For fee-for-service (FFS) Medicaid members in Illinois, Transdev manages the Non-Emergency Transportation Services Prior Authorization Program (NETSPAP). Transdev is the contracted entity that receives and processes PA requests on behalf of HFS.

Transdev NETSPAP Contact Information

Provider phone: 866-503-9040

Member phone: 877-725-0569

Fax: 630-873-1450

PassPORT portal: Available 24/7 for electronic PA submissions

The HFS 2270 PCS Form

The Prior Certification Statement (PCS) is documented on the HFS 2270 form. This form must be completed by the patient's physician or authorized healthcare provider and certifies that the transportation is medically necessary. The PCS specifies the type of vehicle required (ambulatory, wheelchair, or stretcher), the level of assistance needed, and the duration of the authorization.

PCS Validity Periods

180

Medicar / Wheelchair

PCS is valid for 180 days (approximately 6 months) for ambulatory (medicar) and wheelchair transportation. This covers patients with stable, recurring transportation needs such as dialysis or physical therapy.

Ambulance

PCS is valid for 60 days for ambulance-level transportation. The shorter validity period reflects the higher acuity and the expectation that the patient's condition may change more rapidly.

Standing Orders for Recurring Rides

For patients with recurring medical appointments (such as 3x weekly dialysis), you can request standing orders through the PA process. A standing order authorizes a set schedule of rides over the PCS validity period, eliminating the need to request individual PAs for each trip. Standing orders are the most efficient way to manage high-frequency Medicaid NEMT patients.

PassPORT Portal

The PassPORT portal is Transdev's online system for submitting and managing PA requests electronically. It is available 24 hours a day, 7 days a week, and provides real-time status updates on your PA submissions. Using PassPORT instead of phone or fax is faster, creates a documented trail, and reduces errors.

Struggling With Prior Authorization?

PA management is one of the most time-consuming aspects of direct Medicaid billing. Dream Care Rides handles the entire PA workflow for our partner providers, from PCS tracking to standing order management.

Learn About Our PA Services (708) 505-6994

Vehicle & Provider Licensing

Beyond Medicaid enrollment, Illinois has specific vehicle and provider licensing requirements that NEMT companies must satisfy. Non-compliance can result in loss of your Medicaid provider status, fines, or both.

Stretcher Van Licensing (IDPH)

If your fleet includes stretcher vans, those vehicles must be licensed by the Illinois Department of Public Health (IDPH) under the Emergency Medical Services (EMS) Systems Act. The relevant regulations are:

•77 Ill. Admin. Code 515.835 — Stretcher van vehicle requirements including equipment standards, safety features, and inspection schedules
•77 Ill. Admin. Code 515.840 — Stretcher van personnel requirements including training and certification standards
•210 ILCS 50/3.86 — The statutory definition of a stretcher van and the legal framework for stretcher van operations in Illinois

Driver and Staff Requirements

Safety Training

Under Public Act 95-501, all NEMT drivers and attendants must complete approved safety training every 3 years. This training covers patient handling, wheelchair securement, stretcher operation (if applicable), emergency procedures, and infection control. Maintain training records for each employee as HFS may request documentation during audits or revalidation.

Background Checks

Per 89 Ill. Admin. Code 140.498, fingerprint-based criminal background checks are required for all individuals involved in providing Medicaid NEMT services. This includes owners, drivers, and attendants. Background checks must be completed through an approved vendor and results must clear before the individual begins providing Medicaid-funded transportation.

Provider Revalidation

Illinois requires Medicaid provider revalidation every 5 years. During revalidation, you must confirm that all business information, vehicle records, insurance policies, and personnel credentials remain current and compliant. Mark your revalidation date on your calendar immediately after initial enrollment.

Compliance Is Non-Negotiable

Failure to maintain vehicle licensing, insurance, training records, or background check documentation can result in immediate suspension of your Medicaid provider agreement. HFS conducts periodic audits, and any gaps in compliance put your entire billing relationship at risk. Build a compliance calendar and assign someone in your organization to own it.

Common Claim Denials & How to Avoid Them

Claim denials are the single biggest operational headache for NEMT companies billing Medicaid directly. Every denied claim represents a trip you provided but will not be paid for (unless you successfully appeal or correct the issue). Here are the most common denial reasons and how to prevent them.

1. Missing Prior Authorization

The most common denial. You provided the ride but did not have a valid PA on file at the time of service.

Prevention: Never dispatch a Medicaid trip without confirming that a valid PA exists. Build PA verification into your dispatch workflow. Check the PassPORT portal before every ride.

2. Incorrect HCPCS Code

The billing code on your claim does not match the service authorized on the PCS form. For example, billing T2005 (stretcher) when the PCS authorizes T2003 (ambulatory).

Prevention: Cross-reference every claim against the corresponding PCS before submission. Create a checklist that your billing staff follows for every claim.

3. Expired PCS

The PCS on file has expired (past the 180-day or 60-day validity period) and was not renewed before the trip occurred.

Prevention: Track PCS expiration dates for all recurring patients. Set up automated reminders 30 days before expiration so you have time to request a new PCS from the patient's physician.

4. Wrong Provider Information

The provider NPI, tax ID, or other identifying information on the claim does not match what is on file in IMPACT.

Prevention: Verify that your IMPACT profile information is current and matches exactly what you enter on claims. Update IMPACT immediately when any business information changes (address, NPI, EIN).

5. Timely Filing Violation

The claim was submitted after the 180-day (FFS) or plan-specific filing deadline. Late claims are automatically denied with no appeal for late submission.

Prevention: Submit claims within 48 to 72 hours of completing the trip. Establish a weekly billing cycle at minimum. Never let claims accumulate for weeks or months.

6. Member Eligibility Issues

The patient was not eligible for Medicaid on the date of service. This can happen when a patient's Medicaid enrollment lapses, they switch MCOs, or their eligibility status changes.

Prevention: Verify member eligibility before every trip through the IMPACT portal or by calling the eligibility verification line. Do not rely solely on the PA as proof of current eligibility.

Key Metric: Successful NEMT billing operations maintain a clean claim rate of 90% or higher. That means 9 out of every 10 claims are paid on first submission. If your denial rate exceeds 15%, your billing process likely has systematic issues that need to be identified and corrected.

Alternative: Partner With Dream Care Rides

Direct Medicaid billing is profitable, but it requires significant administrative infrastructure: dedicated billing staff, PA management systems, compliance tracking, denial management, and ongoing relationship management with HFS and Transdev. For many NEMT companies, especially those with fewer than 10 vehicles, the overhead can be challenging.

Dream Care Rides offers a partnership model that gives you the financial benefits of Medicaid billing without the administrative burden. We handle billing, prior authorization, client acquisition, and compliance management. You focus on what you do best: providing safe, reliable transportation.

What We Handle for Partner Providers

Medicaid Billing

We submit claims, track payments, manage denials, and handle appeals on your behalf. Our billing team maintains a clean claim rate above 95%.

Prior Authorization

We manage the entire PA workflow, from initial PCS requests to standing order renewals. No trips dispatched without confirmed authorization.

Client Acquisition

We bring Medicaid patients to you through our facility relationships, MCO contracts, and marketing. More rides for your fleet without sales overhead.

Compliance Support

We help you maintain compliance with HFS requirements, including revalidation tracking, insurance monitoring, and training documentation.

Who Is This Partnership For?

✓NEMT companies that want Medicaid revenue without building a billing department
✓Providers currently working under brokers who want higher per-trip earnings
✓New NEMT companies entering the Illinois market who need guidance and infrastructure
✓Established providers with high denial rates who need billing expertise

Partner With Dream Care Rides

We handle the billing complexity so you can focus on transportation. Higher per-trip revenue, zero billing overhead, and a dedicated partner invested in your success. Learn how our partnership model works.

Explore Partnership Options (708) 505-6994

Frequently Asked Questions

The IMPACT enrollment process typically takes 30 to 90 days from initial application to approval, depending on the completeness of your documentation and any background check delays. Having all required documents ready before you begin, including your W9, vehicle VINs, insurance certificates, and owner identification, can significantly reduce the timeline. Some providers report faster turnaround when they follow up with the HFS provider enrollment unit regularly.

PT (Public Transportation) plates are issued by the Illinois Commerce Commission for vehicles providing non-emergency transportation for hire. MC (Motor Carrier) plates serve a similar regulatory function. Both plate types satisfy the Illinois Medicaid requirement for NEMT provider vehicles. The specific plate type you need depends on your operating authority and the type of service you provide. Contact the Illinois Commerce Commission or the Secretary of State for current requirements.

Illinois Medicaid requires a minimum of $250,000 in bodily injury liability insurance and $50,000 in property damage liability insurance per vehicle. These are minimum thresholds, and many NEMT companies carry higher limits for additional protection. Your insurance certificates must be current and on file with HFS. Lapsed insurance can result in immediate suspension of your billing privileges.

The HCPCS code depends on the vehicle type and service provided. T2003 is used for ambulatory, service car, and medicar encounters. T2005 is for stretcher van transport. A0130 covers mileage per loaded mile, and A0120 is for additional mileage in certain scenarios. T2001 is for attendant services when an aide accompanies the patient. Always verify the correct code against the HFS fee schedule and match it to the Prior Certification Statement (PCS) authorization on file for the trip.

A claim denied for missing prior authorization (PA) can sometimes be corrected by obtaining a retroactive PA if the trip was medically necessary and the patient was eligible at the time of service. Contact Transdev at 866-503-9040 to inquire about retroactive authorization. However, retroactive approvals are not guaranteed, and the best practice is to always secure PA before providing the ride. If retroactive PA is denied, you may need to write off the trip cost.

No. Illinois Medicaid NEMT reimbursement rates are county-specific. Cook County rates differ from Will County, DuPage County, and downstate counties. The fee schedule published by HFS lists rates by county and service code. Always check the current fee schedule for your operating area before quoting or estimating reimbursement. Illinois increased NEMT rates approximately 40% in FY2024, making direct billing significantly more attractive than it was in prior years.

Illinois requires Medicaid provider revalidation every 5 years. During revalidation, you must confirm that your business information, vehicle fleet, insurance, and owner credentials are current. Failure to complete revalidation by the deadline results in termination of your provider agreement and loss of billing privileges. HFS sends revalidation notices, but it is your responsibility to track your revalidation date and initiate the process on time.

Illinois Medicaid does not reimburse NEMT providers for patient no-shows or extended wait times at facilities. You can only bill for completed, loaded trips with a valid prior authorization. This is one of the financial risks of direct billing that providers must account for in their business planning. Establishing clear communication with facilities and patients about pickup times can help reduce no-show rates.

Illinois Medicaid requires claims to be submitted within 180 days from the date of service for fee-for-service claims. For managed care organization (MCO) claims, the timely filing deadline varies by plan but is typically 90 to 180 days. Claims submitted after the filing deadline will be denied and cannot be appealed on the basis of late submission. Establish a billing workflow that submits claims weekly or bi-weekly to avoid timely filing issues.

For Illinois Medicaid fee-for-service NEMT claims, mileage is typically bundled into the base encounter rate for standard trips. However, for longer-distance trips or specific service types, additional mileage may be billed using code A0130 (per loaded mile) or A0120 (additional mileage). The specific billing rules depend on the trip type and county. Always consult the current HFS fee schedule and your provider manual for the correct mileage billing procedure in your area.