Serving patients across all of Georgia

Welcome to the Modivcare Facility website for Georgia. Currently this site hosts information and forms that medical facilities and medical groups can use to schedule transportation for our various clients including:

  • Georgia Department of Community Health (DCH)

If you have general questions concerning transportation for DCH, please review the Frequently Asked Questions.

Happy young female

Forms

Please click on the title that corresponds to the document you would like to view.
Central Single Trip Log Form
Complaint Form

Used by facilities to file a complaint

East Single Trip
Facility Information Brochure

How to Access Non-Emergency Medical Transportation (NET) for Georgia Medicaid Members

GA Standing Order Central
Southwest Single Trip Request
Level of Service Form
Medical Provider EDI Form

Form is to request access to enter standing orders on-line

Mileage Reimbursement Instructions Form

Mileage Reimbursement Program information, payment schedule and instructions.

Mileage Reimbursement Trip Log

Blank Mileage Reimbursement Forms for download or printing.

NET Medical Necessity Form
Service Area Map

Indicates Counties Modivcare Serves in Georgia

Southwest Standing Order Form
UHC CIP Mileage Reimbursement Form

A letter that describes the required process for members participating in the mileage reimbursement program.

UHC CIP Mileage Reimbursement Trip Log

A form required for a rider who has someone to provide transportation to the appointment. The form is completed by the rider, signed by the physician and submitted to Modivcare for mileage/gas reimbursement. 

Member FAQs

  • Can I file a complaint by fax?

    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.

  • Can I request a standing order on-line?

    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.

  • How can a Medical Necessity Form be obtained?

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

  • How can a Standing Order Form be obtained?

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

  • How do hospitals arrange discharges?

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

    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.

  • How does a member request a ride?

    Members call the Reservation for:

  • How many times does the Medical Necessity Form need to be completed?

    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.

  • How to report a Complaint by phone?

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

  • Is there a phone line just for Facilities to use?

    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:

  • What are the requirements to receive non-emergency transportation (NET)?

    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.

  • What counties is Modivcare responsible for arranging NET transports ?

    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.

  • What if a Facility has an urgent/same day trip?

    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.

  • What if the ride is late or the Member has other problems with transportation?

    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:

  • What information is needed when calling for a ride?

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

  • What is a Medical Necessity Form and who completes it?

    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:

  • What is a Standing Order?

    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.

  • What is not considered an Urgent Care transport?

    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.

  • What kind of transportation will the Member get?

    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.

  • When should the request for a ride be called in?

    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.

  • Where do I send the Standing Order Form?

    The Standing Order Form should be faxed to Modivcare at:

  • Who can report Complaints to Modivcare?

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

  • Who can set up a reservation for transportation?

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

  • Who fills out the Standing Order Form?

    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.