Welcome to the Modivcare Facility web site for Delaware. 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/.
Standing Order Form to Modivcare via the Facilities Website or by faxing it to 877-813-5599. The form must be received in our office at least 3 days in advance. The Standing Order Form must be completed by the client’s nurse, social worker, caseworker or case manager or other healthcare professional directly involved in the client’s care. The Standing Order Form can be found here. Additionally, you can book your client’s standing order online at https://tripcare.logisticare.com/. You will need a user name and password to access this site. If you would like one, please contact our Facility Department at 866-469-2824.
All changes to standing orders must be requested by either contacting the Modivcare Facilities Department at 866-469-2824 or completing a new standing order form for the client that includes the changes and either submitting via the Facilities Website or faxing it to 877-813-5599.
Any concern you might have regarding transportation can be conveyed by using the WeCare for Facilities Website
Call the Modivcare Facilities Department at least 7 days before your client’s medical appointment and request tickets for the client. This allows for adequate time for delivery of bus tickets to the client via certified mail.
You can download a copy of the Mileage Reimbursement Trip Log here.
Mileage Reimbursement is a program to reimburse a member’s friend, neighbor or relative at a rate of $0.30 per mile from the member’s residence to the Medicaid paid service and the return trip home.
Prior to the appointment for the Medicaid covered service, you will need to call Modivcare to schedule the transportation. When scheduling mileage reimbursement trips, you will need the name of the person who will be transporting the member as well as their telephone number, mailing address, and social security number.
The member can call our Reservations line at 866-412-3778.
Reservations are taken may be made up to 4PM 3-business days before the medical appointment unless greater urgency can be verified with the physician or facility.
In order to be reimbursed, a Mileage Reimbursement TripLog will need to be completed. The physician’s office must sign the trip log. The payee will mail the completed signed trip log to Modivcare’s Claims Department for processing. Either you or the client will still need to call Modivcare before the trip(s) is made to get a trip number for the trip log. If you fail to call in ahead of time the driver will not receive reimbursement. The driver will be issued a check 3-4 weeks after Modivcare’s Claims Department receives the Mileage Reimbursement Trip Log.
Hospital-to-hospital transportation can be provided to an eligible Medicaid member if the member is going to a different hospital for a higher level of care otherwise not available at the hospital where they are currently admitted.
Standing Orders are reoccurring trips for treatment that are scheduled at least three days per week for a period of three months or more to programs such as Dialysis, Substance Abuse Counseling and Treatment, Chemotherapy, Radiation, and Medical Adult Day Care.
Facilities and Medicaid members do not have the freedom of choice to choose the transportation provider. A request can be made and will be noted by Modivcare; however, Modivcare reserves the right to utilize a different transportation provider consistent with the transportation needs of the member.
Discharges will be accepted 24 hours a day 7 days a week. Our goal is to provide transportation for hospital discharges within 3 hours of the request.
Tips for Hospital Discharges Arrangements
Modivcare offers a facility staff that is dedicated to handling the reoccurring non-emergency medical transportation (NEMT) needs of eligible Medicaid members with regular appointments at healthcare facilities as well as assisting hospitals with transportation for eligible members being discharged.
Trips for routine appointments as well as recurring services such as dialysis, chemo, etc. presently require a 3-business day notice. In some cases, with verification, Modivcare can provide same-day, next day, trips. These trips are considered urgent, but non-emergent and include such things as hospital discharges. Transportation reservations may be taken with less than the usually required 3-business day notice if they are of an urgent nature but still non-emergent nature such as hospital discharges.
Yes. The form can be accessed here.
Yes. The form can be accessed here.
Medical Necessity Forms are needed for any member who requires stretcher or wheelchair level of service. An Attending Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or RN can complete the Medical Necessity Form. A copy of the Medical Necessity Form can be found here. Once completed, it should be faxed to the Modivcare Facilities Department at 866-813-5599.
If an ambulatory member lives within ½ mile of a bus stop and their destination is also within ½ miles of a bus stop, they will be assigned to mass transit. In the event the member is unable to use the bus, a Medical Restriction Form is required. This must be completed by their primary care physician and be faxed to the Modivcare Utilization Review Department at 866-832-9680, ideally at the time the standing order is requested if possible. The form can be downloaded here.
Minors 13 to 17 may travel alone; however, a Consent and Release of Liability Form must be on file. The Consent and Release of Liability Form can be found here. This form must be returned to Modivcare signed by the minor’s parent or legal guardian. Please fax the form to 866-813-5599.
Modivcare in Delaware has an extensive transportation provider network that can supply transportation for clients who are ambulatory, clients who require a wheelchair and clients who must be transported by stretcher. The NEMT Provider Network includes both private and public transportation providers (DART Fixed Route and Paratransit). For clients who have a friend or family member available to transport them, Modivcare can supply Mileage Reimbursement.
Please call Modivcare’s Ride Assist Line at 866-896-7211.
Only active Medicaid members who do not have alternate means of transportation available to them qualify for non-emergent medical transportation provided through Modivcare in Delaware. Additionally, transportation services are limited to trips going either to or from a Medicaid covered service.
Riders who have a vehicle available and can drive themselves are not eligible to receive transportation services through Modivcare in Delaware.