ET3 Integration

A walkthrough of AngelTrack's fully compliant ET3 system, which is perfectly integrated with its billing system

AngelTrack integrates with the CMS ET3 program, to automatically upload applicable trip data to them on your behalf.


To learn more about ET3, visit the following websites:


With admin, captain, or biller privileges, visit the "ET3 Configuration" item under Settings. You must already be enrolled in the ET3 program at CMS, and have an upload credential. To learn how to enroll and obtain your upload credential, refer to the ET3 Data Submission Guide, linked above.

To proceed, you must fill out all the fields in the "Uploader settings" section with the credential information issued to you by CMS. Make sure the ☑ Active checkbox is ticked. Once that's done, AngelTrack will know that ET3 is active, and so it will begin uploading trips that match the ET3 criteria.

From the ET3 Configuration page you can monitor the progress of ET3 validations and uploads, and if there are any errors, a link will appear to the ET3 Upload Queue where these can be reviewed and retried.


For a dispatch to be reportable to ET3, ET3 must be configured and active in AngelTrack, and the trip must meet these criteria:

  • The "Execution status" field is set to any of:
    • Completed, best effort, or
    • Completed, as ordered;
  • A patient record is attached to the dispatch; and
  • The service-level provided (or the service-level requested if no QA determination has been made yet) is at least BLS.

When those criteria are met, then AngelTrack will include the ET3 schematron whenever the trip is validated, and will upload the trip to CMS once it passes QA review.


The ET3 program has its own schematron, which applies whenever the ET3 criteria (above) are met.

On the PCR side, this means the ET3 schematron runs in addition to the national schematron and any state- and county-level schematrons, before the crew are allowed to submit their report to QA.

Likewise during QA review, where the ET3 schematron will run when applicable, in additional to the national, state, and any county schematrons.

Once an ET3-reportable call has graduated from (or skipped over) QA, AngelTrack will re-validate it one last time, using the national and ET3 schematrons. Any validation errors will be reported in the ET3 Upload Queue. All trips that pass validation will be uploaded to CMS in the next upload cycle -- which occur every ten minutes.


AngelTrack's ET3 uploader runs every ten minutes, and will send up all applicable trips that have graduated from (or skipped over) QA review, and have passed final validation against the ET3 and national schematrons.

If any error occurs during upload, the affected trips will appear in the ET3 Upload Queue. If the error is due to a schematron complaint issued by CMS, then the dispatch will wait in the failed-uploads queue until someone fixes it; once they save their changes, AngelTrack will automatically re-validate and re-upload the dispatch.

Initial upload of historical data

When you join ET3, you are required to submit your historical trip data for the period 2019-03-01 through 2020-02-29. AngelTrack will automatically do this for you, as soon as you enable the feature and provide your ET3 username and password.


When ET3 is enabled on your AngelTrack server, new choices appear in some of the PCR's dropdown lists:

  • The "Patient disposition" dropdown list in Followup will contain the new ET3 choices for non-transport situations:
    • Patient treated - transferred care to non-EMS [ET3]
    • Patient treated - transferred care to telehealth [ET3]
  • The "Type of destination" dropdown list in Followup will contain the new ET3 destinations:
    • Mental health facility
    • Drug and/or alcohol rehab
    • ET3 federally qualified health center
    • ET3 qualified health care partner
    • ET3 rural health clinic

There also will appear, again on the Followup page, a field to record whether an alternate disposition was offered to the patient, and if the patient accepted or refused it.

The above selections will cause AngelTrack's Coding page to automatically set certain ET3 values, discussed further below.


The ET3 program allows you to bill for transports to alternate (non-ER) destinations, and for treatment-in-place [T.I.P.] and telehealth services provided through your ambulances.

This is accomplished through the use of the ET3-only modifiers, which are used to indicate the alternate destination:

  • C: Community mental health center
  • F: Federally qualified health center
  • O: Physician's office
  • U: Urgent care
  • W: Treatment in-place or via telehealth, i.e. no transport

On AngelTrack's Coding page, when you mark the claim as an ET3 claim*, the above modifiers will be accepted. Note that they may only be used in reference to the destination, never to the origin; the origin modifier must be one of the traditional choices.

*AngelTrack will automatically mark a claim as ET3 if 1) ET3 is enabled on your AngelTrack server, 2) the primary insurance type is 'Medicare', and 3) the dispatch has not yet been coded such that a biller has already chosen whether to mark it as ET3.

Automatic modifier setting

As with non-ET3 claims, AngelTrack will attempt to automatically set the location modifier using its facility records, each of which has a type and modifier field that will be used for this purpose. Once you set or modify those fields, AngelTrack will auto-set them when it can.

To that end, new ET3-related choices in the aforementioned datafields (facility type / facility modifier) when you enable ET3 on your AngelTrack server.

ET3 refusal code G2022

If a patient refuses an alternate disposition, and instead demands transport to an ER in the usual manner, the ET3 billing model asks that this fact be communicated in the insurance claim. This communication is achieved by the inclusion of a service line for HCPCS code G2022 ("Transfer to Emergency Department") at a price of $0.01.

To include the G2022 service line, tick the ☑ Include patient refusal code (G2022) checkbox on the Coding form. The box will be enabled when all of the following are true:

  1. ET3 is enabled on your AngelTrack server, or was previously enabled and the dispatch in question was marked for ET3;
  2. Transport occurred;
  3. The type of destination is a hospital; and
  4. The crew indicated (on Followup) that the patient refused an alternative disposition.