Georgia Facility Resources

Yes, Facility may utilize the Modivcare Complaint Form which can be downloaded from this website. This form can be faxed to Modivcare Quality Assurance Department at 866-913-5801 for resolution.

Yes, Modivcare has created a Facility Services Web portal to request a standing order to replace faxing in a request. Your facility will need to complete a Medical Provider EDI Form located on the forms section of this website.

A copy of the Medical Necessity Form is located on this website and can be downloaded for your convenience.

A copy of the Standing order Request Form is located on this website and can be downloaded for your convenience.

Hospitals discharges are scheduled by hospital staff only and can be arranged 24/7 by contacting your regional facility line at:

• East Region – 866.570.6143
• Central Region – 866.570.6128
• Southwest Region – 866.652.3126

A Medical Necessity Form is not needed for hospital discharges. Dedicated call takers are assigned to handle discharges. Once the discharge is arranged, the transportation provider has between thirty (30) minutes to three (3) hours to pick up the Member.

Members call the Reservation for:

• East Region – 1-888-224-7988
• Central Region – 1-888-224-7981
• Southwest Region – 1-888-224-7985

The Medical Necessity Form is requested each time the Member is in need of transportation. If a Medical Necessity Form is signed by a Physician the form is active for 90 days. Permanent condition requests for stretcher transports are considered on a case by case basis.

The Facility may call the Facility Assistance line to file a complaint. The regional facility numbers are:

• East Region – 877-457-3341
• Central Region – 877-601-0610
• Southwest Region – 877-601-9795

Modivcare maintains a Facility Department dedicated to handling the needs of nursing homes, hospitals, dialysis, mental health and substance abuse clinics. Modivcare has dedicated staff and phone numbers available to schedule transportation needs from facilities. The phone numbers are:

• East Region – 866.570.6143
• Central Region – 866.570.6128
• Southwest Region – 866.652.3126

Transportation could be arranged for members, who need to see a doctor, go to other medical appointments, or to the drug stores during transport that does not have means to get to these appointments. The member’s medical condition should not be an emergency. For EMERGENCIES, DIAL 911.

Modivcare is responsible for the East, Central and Southwest regions on Georgia, a map of the counties in these regions may be downloaded in the forms section of this website.

Urgent/same day trips can be scheduled through Modivcare. Such rides should be for true 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 short notice trip requests may need to have the appointment rescheduled.

If the Member’s ride is more than 15 minutes late, a call should be made to the Ride Assistance line (also called the “Where’s My Ride” line). The phone number for the “Where’s My Ride” line at:

• East Region – 866.213.6853
• Central Region – 866.429.4061
• Southwest Region – 877.972.5461

The member’s Medicaid ID number, residential address and phone number, the doctor’s name, medical facility address and phone number.

Medical Necessity Form is needed for any Member who requires stretcher level of service. An Attending Physician, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist or RN can complete the Medical Necessity Form. The Medical Necessity Form should be faxed to:

• East Region – 877.457.3341
• Central Region – 877.601.0610
• Southwest Region – 877.601.9795

A standing order allows a medical facility to send in a one time request for a Member to attend their program 3 or more days per week for at least 3 months. The Standing Order Form serves as a time saver by not requiring a facility to call in multiple trips three days in advance for Members who receive repeat service. 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 the Modivcare staff to make sure the trip continues to be necessary. The Facility will not have to submit a new standing order.

Urgent care transport is not transportation initiated by dialing 911. It is also not transportation that requires an immediate response to take a member to the emergency room for evaluation of a new 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 the 3 days’ notice and failed to schedule their ride.

Modivcare will ask the caller can the member walk, or if they require the use of a wheelchair or stretcher, and then provide the best type of transportation for their needs.

It is best to call for a ride at least 3 days before the appointment. Urgent trips such as hospital discharges, wound care appointment, dialysis appointment and etc. may be accepted with less than 3 day notice.

The Standing Order Form should be faxed to Modivcare at:

• East Region – 877.457.3341
• Central Region – 877.601.0610
• Southwest Region – 877.601.9795

Complaints or issues may be reported (either verbally or written) by 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.

Standing Order must be completed by the Member’s treating facility. Examples: Dialysis Clinics, Mental Health or Adult Day Care. Members or their representative may schedule the first three trips for a Member in need of Dialysis. The Facility Department will then contact the treating facility to secure a Standing Order for the Member’s for future trips.