Welcome to the Modivcare Facility web site for Arizona. Currently this site hosts information and forms that medical facilities and medical groups can use to schedule transportation for our clients.
The forms on this site are stored in PDF format. Your computer must have Adobe Acrobat Reader installed for you to be able to read and print the forms. If you do not have a copy of Adobe Acrobat, you can download it for free at www.get.adobe.com/reader/.
Modivcare maintains a Facility Department dedicated to handling the needs of nursing homes, hospitals, dialysis centers, mental health facilities, and substance abuse clinics. We have dedicated staff and phone numbers available to book transportation for facilities.
The phone number is 888-589-6163.
To minimize your time on the phone, we suggest that you use the single trip request form. Complete the fax request form and send it to 888-589-6164.
Upon receipt of the form, a facility coordinator will complete the reservation and contact the ordering party with confirmation of the reservation.
*The website contains instructions and forms for arranging a standing order or single trip reservation.
Hospitals contact the Facility Line at 1-888-589-6163. Physician’s Transportation Restriction Forms are not needed for hospital discharges. Dedicated Facility Coordinators are assigned to handle discharges. Once the discharge is arranged, the transportation provider has up to four (4) hours to respond and pick-up the patient.
Three business days (72hrs) notice prior to the scheduled appointment is necessary.
Sudden life threatening medical situations, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose and any situation where immediate medical relief or treatment is necessary.
Examples of such trips are doctor appointments deemed urgent by physician, dialysis, wound care, chemotherapy and radiation.
In the event that a transportation provider is late, Modivcare maintains a staff trained to resolve late arrivals. A dedicated phone line is available to inquire about the status of their ride.
The line is called the “Ride Assist” line and the phone number to call is 866-252-3865.
Once their appointment is finished, the member or facility will call the “Ride Assist” phone number and request transportation be sent to return the member. The transportation provider will be dispatched and will have up to one (1) hour to arrive for the member’s return ride. The member/facility will use the same “Ride Assist” phone number 866-252-3865.
Emergency ambulance trips are not arranged through Modivcare. If a medical emergency ambulance trip is needed, 911 should be called.
Urgent/same day trips can be booked through Modivcare. Such trips should be true urgent conditions where a physician is requiring the member be seen the same day or the next day.
Arizona Evercare Select Facility Reservation line 888-589-6163.
Yes, if a facility has a transportation provider they prefer, please mention this when scheduling transportation. Modivcare will note the request on the trip and will do everything they can to honor the facility’s request, depending on availability of the transportation provider and/or if the preferred provider is a participant in the Modivcare network. Even though the request will be documented, trip assignment will be based on routing criteria that includes provider compliance. Modivcare does not guarantee that a preferred provider will be assigned based on a request.
For Arizona Evercare Select Medicaid, member’s transportation can be arranged with Modivcare for the following counties:
Standing order forms can be obtained through the website or by contacting the Facility Department at 888-589-6163.
The facility can fill out Single Trip Request Forms for the various members for trips up to 30 days in advance and fax them into Modivcare at 888-589-6164. Again, three business days notice is required for routine trips.
To eliminate the need to arrange trips for members who have three or more trips to the same facility each week, a standing order form and process has been created. This allows a facility to arrange trips in advance for a member scheduled for treatment three days or more a week to the same location. Example: dialysis, wound care, mental health, adult day care, and medication management.
A Standing Order will be create and inserted in our system. Our system will propagate the information based on the schedule furnished by the treating facility. Every standing order must be recertified by Modivcare on a quarterly basis. The treating facility will be asked to verify that the member’s information has not changed since the original standing order was created.
The level of service describes the type of service needed to transport a member. A member can travel by one of several levels of service based on their physical needs. See below:
The Standing Order Request Form should be faxed to Modivcare at 888-589-6164.
Standing order forms must be completed by a representative of the facility.
Modivcare must be notified of any temporary or permanent changes to a standing order. Our system will continue to propagate the original information unless we are notified of a change. Our network providers schedule their transports based on the information we send out in their daily manifest. If a facility or member only instructs the transportation provider of changes and not Modivcare, the member runs the risk of missing their appointment if the transport is assigned to a different provider. By informing Modivcare about changes to a standing order, it allows us to adjust any changes and ensures that our members are getting the best service available.