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Medical Certification for Non Emergency Ambulance (MCA) Form
Illinois Medicaid - HFS·IL · Emergency Medicine·Provider Notice
Effective date
Jan 1, 2015
We identified it
Jun 20, 2026
Summary
Illinois Medicaid requires Medical Certification for Non Emergency Ambulance (MCA) forms for all non-emergency ambulance transports from hospital discharges. After January 1, 2015, ambulance providers must have a completed MCA form before transport or risk non-payment, with only 20 business days to submit forms to First Transit.
Action Required
By January 1, 2015: Ambulance providers must obtain completed MCA forms before providing non-emergency hospital discharge transports. Submit MCA forms to First Transit within 20 business days of service date or claims will be denied and cannot be reimbursed by Illinois Medicaid. For August 1 - December 31, 2014 services: Submit MCA forms within 90 days if not completed at time of service.