Illinois Medicaid NEMT Prior Authorization Process: Complete Provider Guide

What Is NETSPAP?

NETSPAP stands for the Non-Emergency Transportation Services Prior Authorization Program. It is the State of Illinois's mechanism for ensuring that Medicaid-funded non-emergency medical transportation is medically necessary before it is provided and billed. The program applies specifically to Fee-for-Service (FFS) Medicaid members — those who are not enrolled in a managed care organization.

The Illinois Department of Healthcare and Family Services (HFS) contracts with Transdev Inc. to administer NETSPAP. Transdev reviews prior authorization requests, verifies medical necessity, and issues Request Tracking Numbers (RTNs) that providers need in order to bill HFS for completed trips.

The legal authority for NETSPAP comes from 89 Ill. Admin. Code 140.491, which sets out the rules governing non-emergency transportation services under Illinois Medicaid. As an NEMT provider, you are expected to be familiar with this administrative code section, because it defines the documentation requirements, covered service types, and compliance obligations that affect your day-to-day operations.

Key Points About NETSPAP

• Applies to FFS members only — Managed care members follow their MCO's separate transportation authorization process
• Administered by Transdev Inc. — Transdev is the contracted vendor responsible for reviewing PA requests, issuing RTNs, and processing documentation
• Governed by 89 Ill. Admin. Code 140.491 — This is the regulatory foundation for all NEMT prior authorization requirements in Illinois
• Covers all NEMT service types — Medicar (sedan), wheelchair, stretcher van, and ambulance non-emergency transports all require prior authorization through NETSPAP for FFS members
• Requires a Request Tracking Number (RTN) — Every authorized trip is assigned an RTN, which you must include on your claim when billing HFS

Without a valid RTN from Transdev, your claim for an FFS member's transport will be denied by HFS. This makes the prior authorization step non-negotiable for your revenue cycle. Building a reliable, repeatable process for obtaining PAs is one of the most important operational investments an NEMT company can make.

Transdev Contact Information

Having the right contact information at your fingertips saves time and prevents missed authorizations. Below is the complete directory for reaching Transdev, the NETSPAP administrator. Keep these numbers and addresses posted in your dispatch office and accessible to every staff member who handles scheduling and billing.

Phone Numbers

• Member Services: (877) 725-0569 — For Medicaid members calling about their own transportation benefits and authorization status
• Provider Line: (866) 503-9040 — The dedicated line for NEMT providers submitting PA requests, checking RTN status, and resolving authorization issues
• TTY (Hearing Impaired): (630) 873-1449 — Telecommunications device for the deaf
• HFS Billing Inquiries: (877) 782-5565 then press options 1, 2, 4, 4 — For questions about claim status, remittance advices, and billing rejections after a trip has been completed

Fax Numbers

• Main Fax: (630) 873-1450 — Primary fax line for submitting PA requests, PCS forms, and supporting documentation
• Alternate eFax: (630) 596-8608 — Secondary electronic fax line; use this if the main fax is busy or unresponsive

Email

• Documentation Email: us.tru.efax@transdev.com — For emailing PA requests, PCS forms, CTS forms, and other supporting documents. Include the member's name and Medicaid RIN in the subject line for faster processing.

Business Hours

Transdev's phone and fax lines are staffed Monday through Friday, 8:00 AM to 5:00 PM Central Time. Requests submitted after hours via fax or email will be processed the next business day. For after-hours and weekend authorization needs, use the PassPORT online portal, which is available 24 hours a day, 7 days a week, 365 days a year.

FFS vs Managed Care: Which Authorization Process?

Before you submit a single PA request, you must determine which authorization pathway applies to the member. Illinois Medicaid has two fundamentally different tracks, and using the wrong one will result in a denied claim — even if the transport was legitimately needed and properly performed.

Fee-for-Service (FFS) Members

FFS members are those who receive their Medicaid benefits directly through the state rather than through a managed care plan. For these members, all NEMT prior authorization goes through Transdev / NETSPAP. You submit your PA request to Transdev, receive an RTN, perform the transport, and then bill HFS directly using the RTN on your claim.

FFS members typically include individuals who are newly eligible and not yet enrolled in managed care, those with certain disability categories, dual-eligible members in specific programs, and members in geographic areas or situations where managed care enrollment is not mandatory.

Managed Care Members

The majority of Illinois Medicaid recipients are enrolled in one of five managed care organizations (MCOs). For these members, transportation authorization is handled by the MCO, not by Transdev. Each MCO has its own process, and many contract with transportation management companies (brokers) to handle authorization and trip logistics.

The five Illinois Medicaid MCOs are:

• Meridian Health Plan (Centene subsidiary)
• Molina Healthcare of Illinois
• Blue Cross Blue Shield Community Health Plan
• Aetna Better Health of Illinois (CVS Health subsidiary)
• CountyCare Health Plan (Cook County Health)

How to Determine the Member's Plan

There are several ways to verify whether a member is FFS or enrolled in managed care:

1. Check the member's Medicaid card — Managed care members typically have a card from their MCO (e.g., a Meridian or Molina card) in addition to or instead of the standard Illinois Medicaid card
2. Use the Illinois MEDI system — The Medicaid Eligibility Database Inquiry system allows enrolled providers to verify a member's eligibility and plan enrollment in real time
3. Call the HFS Provider Assistance line — If you cannot access MEDI, call HFS at (877) 782-5565 to verify the member's enrollment status
4. Ask the member directly — Many members know which plan they are enrolled in, though you should always verify electronically before submitting a PA

FFS Prior Authorization: Step by Step

The Fee-for-Service prior authorization process through Transdev follows a structured workflow. Each step must be completed correctly for the PA to be approved and for you to receive a valid Request Tracking Number (RTN) for billing.

Step 1: Verify Member Eligibility

Before initiating any PA request, confirm that the member is currently active on Illinois Medicaid and enrolled in Fee-for-Service (not managed care). Use the MEDI system or call HFS at (877) 782-5565. Record the member's Medicaid Recipient Identification Number (RIN) and verify their date of birth.

Step 2: Gather Required Information

Transdev requires specific information for every PA request. Having this ready before you call, fax, or submit online significantly speeds up the process:

• Member's full legal name as it appears on their Medicaid card
• Date of birth
• Medicaid RIN (Recipient Identification Number)
• Member's phone number (or emergency contact number)
• Doctor or facility name and address for the medical appointment
• Service type requested — Medicar (sedan), wheelchair, stretcher van, or ambulance
• Pickup address — Full street address including apartment/unit number
• Drop-off address — Full street address of the medical facility
• Mobility needs and special requirements — Wheelchair type (manual vs. power), oxygen, bariatric needs, attendant required, behavioral considerations
• Appointment date and time
• Return trip requirements — Will-call, scheduled return time, or one-way only

Step 3: Submit the PA Request

You can submit your PA request through any of these four channels:

1. Phone: Call the provider line at (866) 503-9040 during business hours (Mon-Fri, 8 AM - 5 PM CT). Have all required information ready before calling.
2. Fax: Fax your completed PA request form and supporting documents (PCS, CTS) to (630) 873-1450 (main) or (630) 596-8608 (alternate eFax).
3. Email: Send your request and documentation to us.tru.efax@transdev.com. Include the member's name and RIN in the subject line.
4. PassPORT Portal: Submit electronically through the PassPORT online system, available 24/7/365. This is the fastest method and provides immediate confirmation.

Step 4: Receive the Request Tracking Number (RTN)

Once Transdev reviews and approves your request, you will receive a Request Tracking Number (RTN). This number is your proof of authorization and is required on every claim you submit to HFS for payment. Record the RTN immediately and associate it with the trip in your dispatch and billing systems.

Step 5: Perform the Transport and Bill HFS

After completing the authorized transport, submit your claim to HFS with the RTN included. Claims without a valid RTN will be denied. Ensure that the service date, service type, and pickup/dropoff locations on your claim match what was authorized in the PA.

Timing Requirements

Transdev recommends submitting PA requests 5 to 7 business days before the scheduled transport date. This gives Transdev adequate time to review the request, contact you if additional documentation is needed, and issue the RTN. While urgent and same-day requests can be made by phone, planning ahead dramatically increases your approval rate and reduces the administrative burden on your team.

Physician Certification Statement (HFS 2270) & Certification for Transportation Services (HFS 2271)

The Physician Certification Statement is the clinical documentation that establishes medical necessity for non-emergency medical transportation. Without a valid PCS, the PA request will be denied. Understanding which form to use, who can complete it, and how long it remains valid is essential for every NEMT provider.

HFS 2270: Physician Certification Statement (PCS)

Form HFS 2270 is the standard Physician Certification Statement used when the transport originates from a hospital, long-term care facility, clinic, or other medical setting. This is the form you will use most frequently for hospital discharges, facility-to-facility transfers, and transports from skilled nursing facilities to medical appointments.

HFS 2271: Certification for Transportation Services (CTS)

Form HFS 2271 is the Certification for Transportation Services form, which became effective in June 2022. This form is used when the transport originates from a residential address — typically the member's home. If the member lives at home and needs transportation to a doctor's appointment, dialysis center, or any other medical facility, the CTS form (HFS 2271) is the correct document.

Who Can Complete the PCS / CTS?

The following licensed professionals are authorized to complete the PCS (HFS 2270) or CTS (HFS 2271) form:

• MD — Doctor of Medicine
• DO — Doctor of Osteopathic Medicine
• PA — Physician Assistant
• CNS — Clinical Nurse Specialist
• RN — Registered Nurse
• NP — Nurse Practitioner
• Discharge Planners — Hospital discharge planning staff with appropriate credentials
• LCSW — Licensed Clinical Social Worker
• LPN — Licensed Practical Nurse

The certifying professional must have direct knowledge of the member's medical condition and be able to attest that the requested level of transportation (medicar, wheelchair, stretcher, or ambulance) is medically necessary based on the member's functional limitations.

Validity Periods

The validity period of a PCS depends on the type of transport and whether the trips are recurring:

• Medicar (sedan) recurring transports: PCS valid for 180 days from the date of certification
• Wheelchair recurring transports: PCS valid for 180 days from the date of certification
• Ambulance recurring transports: PCS valid for 60 days from the date of certification

For one-time (non-recurring) transports, the PCS must be dated no earlier than a reasonable period before the service date. The certifying provider should complete the PCS as close to the transport date as possible to ensure it reflects the member's current medical status.

When Is a PCS Required?

A PCS is required in the following situations:

• Hospital-originating transports — Any transport where the pickup location is a hospital
• LTC facility-originating transports — Any transport from a long-term care, skilled nursing, or rehabilitation facility
• Stretcher or ambulance-level transports — Regardless of origin location
• Recurring transport setups — Standing orders for dialysis, chemotherapy, physical therapy, and other ongoing treatment series

Standing Orders for Recurring Rides

Many Medicaid members require ongoing, recurring transportation to medical appointments — dialysis three times per week, weekly chemotherapy sessions, regular physical therapy visits, or monthly specialist appointments. Rather than submitting a separate PA request for every individual trip, you can set up a standing prior authorization that covers the entire series of recurring transports.

What Is a Standing Prior Authorization?

A standing PA is a single authorization that covers multiple trips over a defined time period. For example, a standing PA might authorize wheelchair transport for a dialysis patient from their home to a dialysis center every Monday, Wednesday, and Friday for the next 180 days.

How to Set Up a Standing Order

1. Obtain a PCS covering the recurring need: The certifying provider must document the medical condition, the type of treatment requiring recurring transport, the frequency (e.g., 3x/week), and the expected duration of the treatment series. One PCS can cover the entire recurring schedule.
2. Complete the Standing Prior Authorization (SPA) form: This form captures the recurring transport schedule, including the days of the week, pickup and dropoff times, addresses, and service type.
3. Submit both documents to Transdev: Send the PCS and SPA form together via fax, email, or the PassPORT portal. This ensures Transdev has all necessary documentation to authorize the entire series.
4. Receive the standing RTN: Once approved, Transdev issues an RTN that covers all trips within the authorized schedule. Use this RTN when billing for each individual trip in the series.

Renewing Standing Orders

Standing orders expire when the PCS validity period ends (180 days for medicar/wheelchair, 60 days for ambulance) or when the authorized treatment series concludes. To avoid gaps in coverage:

• Track expiration dates proactively: Set reminders in your system 30 days before each standing order's expiration date
• Request a new PCS from the certifying provider: Contact the facility or physician 2-3 weeks before expiration to allow time for them to complete the renewal PCS
• Submit the renewal before the current order expires: Aim to have the new standing PA approved and active before the old one lapses. Any trips performed without a valid PA will be denied
• Update your dispatch system: When the new RTN is issued, immediately update your scheduling and billing systems so that future trips use the correct authorization number

MCO-Specific Authorization Processes

Each of the five Illinois Medicaid managed care organizations has its own process for authorizing non-emergency medical transportation. Some MCOs handle transportation authorization internally, while others contract with transportation management companies (brokers). As an NEMT provider, you need to know the correct contact information and process for each MCO.

Meridian Health Plan

Meridian contracts with MTM (Medical Transportation Management) to handle transportation authorization and trip coordination.

• MTM Provider Line: (866) 606-3700
• Process: Call MTM to request authorization. MTM will verify the member's eligibility with Meridian, confirm medical necessity (PCS may be required for higher service levels), and issue a trip authorization number. You must be credentialed with MTM to accept trips.

Molina Healthcare of Illinois

Molina also contracts with MTM for transportation management, but uses a different provider line than Meridian.

• MTM Provider Line (Molina): (855) 687-7861
• Process: Similar to Meridian's process. Call the Molina-specific MTM number, verify eligibility, provide trip details, and receive authorization. Keep in mind that even though both Meridian and Molina use MTM, they are separate contracts with separate credentialing requirements.

Blue Cross Blue Shield Community Health Plan

BCBS Community handles transportation authorization through their own internal transportation department.

• Transportation Line: (877) 860-2837
• Process: Call the BCBS Community transportation line directly to request authorization. They handle verification and authorization internally. You will need to be in BCBS Community's provider network.

Aetna Better Health of Illinois

Aetna Better Health manages transportation through their member services and transportation coordination department.

• Transportation Line: (866) 329-4701
• Process: Contact Aetna Better Health to request transportation authorization. They will verify the member's eligibility and medical necessity, then issue authorization for the transport. Credentialing with Aetna Better Health's provider network is required.

CountyCare Health Plan

CountyCare, operated by Cook County Health, serves members primarily in Cook County and coordinates transportation through their member services department.

• Transportation Line: (312) 864-8200
• Process: Contact CountyCare directly to arrange and authorize transportation. Their service area is more geographically limited than the other MCOs. Ensure you are enrolled in CountyCare's provider network.

Using the PassPORT Online Portal

The PassPORT portal is Transdev's online system for submitting and managing NEMT prior authorization requests for FFS Medicaid members. It is the most efficient channel for PA submissions and offers significant advantages over phone, fax, and email.

Availability

PassPORT is available 24 hours a day, 7 days a week, 365 days a year. Unlike phone and fax, which are limited to Transdev's business hours (Mon-Fri, 8 AM - 5 PM CT), PassPORT allows you to submit PA requests, check authorization status, and manage standing orders at any time — including evenings, weekends, and holidays.

How to Register

To gain access to the PassPORT portal, you must be an enrolled Illinois Medicaid NEMT provider. The registration process typically involves:

1. Contact Transdev at (866) 503-9040 and request PassPORT portal access
2. Provide your provider enrollment information — Your Illinois Medicaid provider number, NPI, business name, and contact details
3. Receive your login credentials — Transdev will provide a username and temporary password for the portal
4. Complete initial login and setup — Log in, change your password, and familiarize yourself with the portal's interface and features

Benefits of Electronic Submission

Using PassPORT over phone, fax, or email provides several operational advantages:

• Immediate confirmation: Electronic submissions receive instant confirmation that Transdev has received your request, eliminating the uncertainty of fax transmissions
• Real-time status tracking: Check the status of any PA request at any time without calling the provider line and waiting on hold
• Audit trail: Every submission, status change, and communication is logged electronically, creating a complete documentation trail for compliance purposes
• Reduced errors: The portal's structured input fields help prevent common submission errors such as missing information, incorrect RIN formatting, or incomplete addresses
• 24/7 access: Submit requests outside of business hours, which is particularly valuable for Monday morning transports that need to be authorized over the weekend
• Batch management: View and manage all your active PAs, standing orders, and pending requests in one centralized location

Handling Denials & Appeals

Even well-run NEMT operations encounter PA denials. How you handle denials — quickly identifying the cause, correcting the issue, and resubmitting or appealing — directly impacts your revenue and operational efficiency. A systematic approach to denial management can recover a significant percentage of initially denied authorizations.

Common Denial Reasons

Understanding the most frequent denial reasons allows you to prevent them proactively and address them efficiently when they occur:

• Incomplete or missing PCS: The PA request was submitted without a Physician Certification Statement, or the PCS was incomplete (missing signature, missing diagnosis, or missing medical justification)
• Expired PCS: The PCS validity period had lapsed before the transport date. Remember: 180 days for medicar/wheelchair recurring, 60 days for ambulance recurring
• Wrong form used: HFS 2270 was submitted for a residential-originating transport (should have been HFS 2271), or vice versa
• Member not eligible: The member's Medicaid eligibility had lapsed or the member was enrolled in managed care (making Transdev the wrong authorization entity)
• Insufficient medical necessity: The PCS did not adequately document why the requested level of transport (e.g., stretcher vs. wheelchair) was medically necessary
• Duplicate request: A PA was already on file for the same member, same date, and same destination
• Missing or incorrect member information: Wrong RIN, incorrect date of birth, or misspelled name causing a system mismatch

The Appeal Process

If your PA request is denied, you have the right to appeal. The appeal process typically involves the following steps:

1. Review the denial notice carefully: The denial will include a specific reason code or explanation. Understand exactly why the request was denied before taking any action.
2. Gather additional documentation: Based on the denial reason, obtain the specific documentation needed to address the issue. This might be an updated PCS, additional medical records, a corrected form, or a letter of medical necessity from the treating physician.
3. Submit the appeal to Transdev: Send the appeal with all supporting documentation via fax to (630) 873-1450, email to us.tru.efax@transdev.com, or through the PassPORT portal. Clearly reference the original RTN or request number and state that this is an appeal.
4. Follow up within 5-7 business days: If you have not received a response, call the provider line at (866) 503-9040 to check the status of your appeal.

Resubmission Tips

In many cases, a denied PA can be corrected and resubmitted rather than formally appealed. This is often faster:

• Clerical errors: If the denial was due to a typo, wrong RIN, or missing field, correct the error and resubmit as a new PA request
• Missing PCS: Obtain the PCS, attach it, and resubmit. Make sure the PCS is signed and dated before the transport date
• Wrong form: Complete the correct form (HFS 2270 vs. HFS 2271) and resubmit with a note explaining the correction
• Insufficient medical necessity: Work with the certifying provider to add more specific clinical detail to the PCS, then resubmit with the enhanced documentation

Timeline for Appeals

Appeals should be submitted as soon as possible after receiving a denial notice. While there is no strict calendar deadline published for all denial types, best practice is to submit your appeal or corrected resubmission within 30 days of the denial date. The longer you wait, the more difficult it becomes to obtain the necessary documentation and the more likely you are to miss the window for retroactive authorization.

Tips for NEMT Providers

The following operational recommendations are drawn from real-world experience managing high volumes of Illinois Medicaid NEMT prior authorizations. Implementing these practices will reduce your denial rate, improve your cash flow, and make your authorization process more predictable and efficient.

1. Track PA Expiration Dates Religiously

Expired authorizations are one of the most common and most preventable causes of claim denials. Build an automated tracking system — whether a spreadsheet, a feature in your dispatch software, or a dedicated database — that alerts your team 30 days before any PA or standing order expires. Assign a specific staff member responsibility for renewal management.

2. Submit Clean, Complete Documentation Every Time

Incomplete submissions are the number one cause of PA delays and denials. Before submitting any PA request, run through a checklist:

• Is the correct form being used (HFS 2270 vs. HFS 2271)?
• Is the PCS signed and dated by an authorized provider?
• Does the PCS include a specific diagnosis and medical justification for the requested transport level?
• Is the member's name, DOB, and RIN correct and legible?
• Are the pickup and dropoff addresses complete, including any suite, floor, or apartment numbers?
• Is the appointment date and time included?
• Are mobility needs and special requirements documented?

3. Verify Eligibility Before Every Trip

Never assume that a member's eligibility status or plan enrollment is the same as it was last week or last month. Medicaid eligibility can change monthly, and members can be moved between FFS and managed care plans. Check eligibility through the MEDI system or by calling HFS before initiating every PA request. This five-minute step can save you from performing a transport that will never be paid.

4. Use Standing Orders Whenever Possible

If a member needs recurring transport — dialysis, chemo, physical therapy, wound care, or any regular medical appointment — set up a standing order rather than submitting individual PA requests for each trip. Standing orders reduce your administrative workload by 80-90% for recurring members and ensure continuous authorization coverage when managed properly.

5. Build Strong Relationships With Facilities

Your PCS forms come from healthcare providers at the facilities you serve. The stronger your relationship with discharge planners, case managers, social workers, and nursing staff, the faster and more accurately those forms get completed. Strategies for building facility relationships include:

• Provide reliable, on-time service — Nothing builds trust faster than consistently showing up on time with professional drivers and clean vehicles
• Make the PCS process easy — Pre-fill what you can on the PCS form (member name, RIN, appointment details, addresses) before sending it to the facility for clinical completion
• Communicate proactively — Notify facilities when a member's standing order is approaching expiration so they can prepare the renewal PCS in advance
• Assign a dedicated contact person — Give each facility a single point of contact at your company who they can reach directly for scheduling, authorization questions, and issue resolution

6. Invest in PassPORT Training

Every member of your team who touches scheduling or authorization should be proficient with the PassPORT portal. Electronic submission is faster, more accurate, and provides better tracking than phone or fax. The 24/7 availability alone makes it invaluable for weekend and evening authorization needs.

7. Create a Denial Management Process

Do not simply accept denials. Establish a structured process for reviewing every denial, categorizing the reason, correcting the issue, and resubmitting or appealing within 48 hours. Track your denial rate by reason code over time to identify patterns and systemic issues in your authorization workflow.

8. Stay Current on Regulatory Changes

Illinois Medicaid policies and procedures change. The introduction of the CTS form (HFS 2271) in June 2022 is a recent example. Subscribe to HFS provider bulletins, attend provider webinars, and monitor updates to 89 Ill. Admin. Code 140.491. Regulatory awareness prevents compliance issues that can lead to payment clawbacks and provider sanctions.

9. Document Everything

Maintain complete records of every PA request, every RTN received, every PCS form, every phone call to Transdev or an MCO, and every denial and appeal. In the event of an audit or payment dispute, your documentation is your defense. Electronic records through PassPORT provide an automatic audit trail, but supplement with your own internal documentation as well.

10. Consider Partnership Models

If managing the full prior authorization, billing, and credentialing process in-house is overwhelming your team, consider partnering with an established NEMT provider like Dream Care Rides. Partnership models can include shared authorization management, billing support, and operational consulting — allowing you to focus on driving while we handle the administrative complexity.

Frequently Asked Questions