California Facility Resources

For certain health plans, members can be provided access to a member web-portal where they or their designated care giver may book their trips on-line. You should contact the California Operations Office at 1-877-917-8166 to determine eligibility and to arrange for a password and further instructions.

Yes for select facilities and clients.

Gas/Personnel Reimbursement: (available with select clients) The member is eligible for reimbursement for the cost of their transportation to and from covered medical services by friends or other individuals when transport is prior approved and the client has no other means of transportation or personal resources to use his or her own vehicle.

Public Transit: (available with select clients)The member lives within ½ mile (about 4-6 blocks) of a bus stop, the medical facility is within ½ mile (about 4-6 blocks) of the bus stop, the member can walk ½ mile (about 4-6 blocks) and understands common signs and directions.

Ambulatory: The member can walk to the vehicle and from the vehicle to their destination unassisted, but cannot utilize the bus.

Wheelchair: The member is a wheelchair user, requires lift-equipped or roll-up wheelchair vehicle and driver assistance. The member must have their own wheelchair or notify Modivcare of the need for one.

Gurney: Member can transfer to the stretcher with little or minimum assistance, cannot sit in a wheelchair, and does not require any medical attention/monitoring during transport. Patients on oxygen can be transported but the oxygen has to be self-administered/monitored by the patient or applied/dc’d by medical personal at the sending and receiving ends of the transport.>

BLS Ambulance*: The member is confined to bed, cannot sit in a wheelchair, and/or requires medical attention/monitoring during transport for reasons such as isolation precautions at the receiving end, oxygen not self-administered by patient, sedated patient.

SCT/ALS Ambulance*: The member is confined to bed, cannot sit in a wheelchair, and/or requires medical attention/monitoring during transport for reasons such as IV requiring monitoring, cardiac monitoring, and tracheotomy.

*Note – the type of an ambulance to be responded may vary by geographic location based on local EMS protocols.

A copy of the Physician Transportation Restriction Form can be obtained by contacting the appropriate reservation number for the member’s health plan. You may also request the appropriate form by calling the Modivcare California Utilization Department at 1-866-666-8645.

You should contact the California Operations Office at 1-877-917-8166 to determine eligibility and to arrange for a password and further instructions.

Hospital discharges are scheduled by hospital staff only and can be arranged 24/7 by contacting the Reservation phone number for the member’s insurance. Discharges should be arranged at least 2 hours in advance when possible to prevent unnecessary delays.

If a PCS Form is signed by a Physician the form can be active up to 30, 60, 90 or 180 days. For some clients, the form can be active for up to 1 year.

Complaints will be accepted on any Reservation or Where’s My Ride phone line. Complaints can also be registered on our main web site (www.modivcare.com) under “We Care”.

When you book the reservation on behalf of the member by phone Modivcare will tell you what time the member should be ready to be transported. If you book the reservation on behalf of the member On Line, you will indicate what time the member should be picked up. If the pick-up time changes or you have to cancel the trip request on behalf of the member, please contact us immediately at the appropriate reservation phone number for the member’s insurance – these numbers are listed on this web site in the DOWNLOADs section.

If you are calling for a discharge, urgent or other same day appointment, Modivcare will take the necessary information to create the reservation and you will receive a call back when a transportation provider has been arranged and a pick-up time is confirmed with the transportation provider.

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 the Physician. Examples would include Dialysis; wound care, Chemotherapy and radiation treatments.

If an emergency ambulance trip is needed, 911 should be called immediately. Emergency ambulance trips are not arranged through Modivcare.

Urgent/same day rides can be scheduled through Modivcare. Such rides should be for urgent conditions where a physician is requiring the Member be seen the same day or next day. All urgent/same day rides will be verified with the physician’s office for medical necessity. In some cases same day trip requests may need to have the appointment rescheduled.

As a registered user you will be able to manage your patient/clients’ standing orders or single trips online without having to make a phone call or access a fax machine, 24 hours a day, seven days a week. You will be able to request new trips, submit changes and best of all, review the status on all your requests. You will have the ability to add any facility staff as a user so that they can also access the FSW. Our Facility Services Website is a secure website and compliant with all HIPAA and PHI rules and regulations.

If the ride is 15 minutes past pick up time, please call the appropriate “Where’s My Ride” line or Reservation line for that member’s insurance. These are available on this web site.

The Member’s Health Plan ID number, Pick-up address and phone number Appointment date and time, Destination address and phone number, nature of the appointment, level of service and member’s requirements during transportation.

A complaint is defined as an expression of dissatisfaction about any matter. Possible subjects for complaints include, but are not limited to, provider arriving late, provider does not show for pick-up, rider does not show for pick-up, rudeness of a provider staff member or a Modivcare employee, or failure to respect the Member’s rights.

Physician Certification Forms are required for select clients for any Member who requires a level of service higher than public transportation. An Attending Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or RN can complete the PCS Form. The form will cover any future transports for the date range indicated on the form. The PCS Form can be faxed to the Modivcare California Utilization Department at 1-877-457-3352. For questions concerning the PCS form, you may contact us at 1-866-666-8645.

A standing order allows a Facility to send in a one-time request for a Member to attend their program 2 or more days per week for at least 3 months. A Standing Order serves as a time saver by not requiring a Facility to call in multiple trips three days in advance for Members who receive repeated services. Examples are: Dialysis, Mental Health, and Adult Day Care. A Standing Order for a Member is valid for three months and will be recertified by Modivcare’s staff to make sure the trip continues to be necessary. The Facility will be asked to provide information at that time, but the Facility will not have to submit a new standing order. It is important to note that a Standing Order will be cancelled if the member becomes hospitalized and will need to be re-initiated when the member is discharged in order for transportation to resume.

A Standing Order can be arranged by: (1) calling the reservation line for that particular health plan; (2) booked on line for select facilities and members; (3) by fax by completing a Standing Order Form.

Urgent care transport is not transportation initiated by dialing 911. It is also not transport that requires an immediate response to take a member to the emergency room for evaluation of a new or suddenly worsening condition that threatens life or limb (e.g., any sudden life threatening medical situation, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose or any situation where immediate medical relief or treatment is necessary). Urgent care transport does not include routine doctor’s appointments when a patient could have provided adequate notice and failed to schedule their ride.

• Door-to-door: means transportation service whereby the driver parks the vehicle and meets the Member at the threshold of the primary entrance of the pick-up address; assists the Member to and into the vehicle, and delivers the Member to the threshold of the primary entrance of the drop-off address.
• Curb-to-curb: means transportation service whereby the Member meets and boards the vehicle at the curb of the pick-up address and disembarks at the curb of the drop-off address

The Facility Resources page is our Modivcare web-based tool which allows facilities with registered users to be able to set up Standing Orders as well as single trip reservations online from the convenience of their computer. The Facility Resources page can be found at modivcare.com/facility-resources. Please contact a facility representative at 1-866-529-2128 for more information. An Electronic Data Interchange (EDI) Form must be filled out and faxed to 1-877-601-0535 to receive login credentials to begin using the FSW. EDI form can be downloaded from the Downloads link above.

Modivcare manages and arranges for non-emergent transportation only. If you have a member that is experiencing a potential life or limb threatening emergency and needs to go to the emergency room, you should call 911.

A list of specific phone numbers for each of our clients to arrange for non-emergency transportation is listed in a document on the DOWNLOADS page.

Modivcare will ask the call a variety of questions to determine the needs of the member during the transport in order to recommend the best type of transportation for the member needs. Modivcare will honor higher requests being required by medical personnel should a higher level of service be required over what is recommended during the call. Below are generic examples to help understand the different kinds of transportation that maybe available to the member. Financial coverage of a specific kind of transportation is dependent on (1) ensuring the member meets the necessity for that kind of transportation and (2) the member’s transportation benefit with their health plan. Modivcare will help in identifying when a specific request requires an authorization from the member’s health plan or may not be covered by the member’s health plan.

Standing Order Requests are to be called in by facility reps only at

866-529-2128

If you have more than 5 members to set up on standing order you can send the request via email to our LAS Admins email at [email protected]

Complaints or issues may be reported (either verbally or written) by Modivcare, Facilities, Members, Transportation Providers or any individuals or groups in contact with Modivcare.

The Member, a relative, caregiver, nurse, or doctor may request a ride.

Facility staff may schedule the first three trips for a member in need of dialysis. Our call takers will complete a Standing Order Form and forward to our Facility Department who is responsible for creating the standing order. Standing Orders must be completed or validated by the Member’s treating Facility. Example: Dialysis Clinics, Mental Health or Adult Day Care.

The Facility Department will contact the ordering party and confirm that the standing order was set-up within 5 business days from the date the completed Standing Order request or information was provided to Modivcare. If you have not heard from Modivcare by the 5th business day, you can contact the Facility Department at 866-529-2128 to determine the status of the order.

The Facility Department will contact the ordering party and confirm that the standing order was set-up within 5 business days from the date the completed Standing Order request or information was provided to Modivcare. If you have not heard from Modivcare by the 5th business day, you can contact the Facility Department at 866-529-2128 to determine the status of the order.