PM 20-22-02: Prior Approval

WAG 20-22-02.

Prior approval is given by DynTek for a person residing in Cook County.

For a person residing outside of Cook County, prior approval is given either by the Family Community Resource Center, the central All Kids Unit, or the Bureau of Comprehensive Health Services.

Prior approval is not needed for:

  • emergency ambulance;
  • ambulance transfers between hospitals;
  • clients in long term care facilities; and
  • ambulance services for Medicare eligible persons, when the trip is allowed by Medicare. If Medicare disallows the transportation, post approval must be requested.

Prior approval is needed for:

  • nonemergency ambulance within Illinois or border states;
  • nonemergency transportation to care in another state;
  • Medicar;
  • taxi;
  • service car;
  • private car;
  • plane;
  • intercity bus; or
  • train.

Prior approval is given for the least expensive type of transportation that meets the client's needs. If available, public transportation that meets the client's needs is approved, rather than a more expensive type of transportation.

An approved request does not require written notice to the client. The client is notified orally. The client receives a written notice if the request is denied.

Instruct a person enrolled in Managed Care to call their plan's Member Services for all medical transportation requests except transit cards, bus passes, or tokens.

NOTE: The Department of Children and Family Services (DCFS) medical liaison calls DynTek for transportation prior approval and to arrange medical transportation for a DCFS ward. Direct a call regarding transportation for a DCFS ward to the child's DCFS caseworker or to DCFS.