TITLE 89: SOCIAL SERVICES
CHAPTER I: DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES
SUBCHAPTER d: MEDICAL PROGRAMS
PART 140 MEDICAL PAYMENT
SECTION 140.494 RECORD REQUIREMENTS FOR MEDICAL TRANSPORTATION SERVICES
Section 140.494 Record Requirements for Medical Transportation Services
a) The record must, at a minimum, contain a dispatcher's log and individual trip tickets that document:
1) Identification of the client (name, address and client number);
2) Name and address or facility name of person or entity requesting service;
3) A copy of the Transportation Invoice;
4) Identification of the type of vehicle used (for example, ambulance, medicar, service car) and the vehicle's license plate number; and
5) The name of the driver and attendant, if applicable.
b) The trip ticket must document medical necessity for the following:
1) Non-emergency transportation that does not require an approval request;
2) Use of an ambulance;
3) Administration of oxygen;
4) Use of an attendant by a medicar, service car or a taxicab company; and
5) Use of a stretcher by a medicar.
c) Advanced Life Support transportation services must also maintain a copy of the Emergency Medical Services Run Sheets or other forms as required by the Illinois Department of Public Health.
d) In absence of proper and complete records, including, but not limited to, failure to provide documentation of safety training certification as required in Section 140.490(f), payments previously made shall be recouped.
(Source: Amended at 41 Ill. Reg. 999, effective January 19, 2017)