Serving patients across all of Maine

Welcome to the Modivcare Facility web site for Maine. 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/.

member using a computer

Forms

Please click on the title that corresponds to the document you would like to view.

Member FAQs

  • At what levels of service will members travel?

    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:

    Mileage Reimbursement -Modivcare provides mileage reimbursement to members or non-commercial drivers (i.e., not a qualified transportation provider but such as a relative or family member) who transport a member to his or her covered medical appointment. Mileage reimbursement will be paid at a specified rate per mile for each mile that the member is driven in the vehicle.

    Mass Transit - Where available and suitable for the physical condition of the member. This will be the mode of transportation for ambulatory members who reside less than 1/2 of a mile from a transit stop and can walk that distance unescorted.

    Ambulatory - This is a member who is able to walk on their own or with the assistance of a walker or cane and able to be picked up and dropped off at the curb. This is curb to curb transportation.

    Chair Car/Wheelchair - These will be members confined to a wheelchair that due to either physical weakness or mental impairment they must travel with their own wheelchair. If assistance is needed, please inform Modivcare at the time the reservation is called in. Transportation companies may dispatch a vehicle with just a driver, no attendant.

  • Can I schedule Standing Order and single trip request on line?

    Modivcare has a brand new Facility Service Website. With this web based tool you will be able to access key Modivcare trip management functions on line which includes:

    • Requesting new trips
    • Reviewing request status
    • Modifying existing trips
  • For MaineCare members, which counties can transportation be arranged with Modivcare?

    Modivcare is the designated transportation broker for members that are registered and reside in Region 8. This region includes all of York County and the following cities in Oxford County:

    • Brownfield
    • Denmark
    • Fryeburg
    • Hiram
    • Porter
    • Lovell
    • Stoneham
    • Stow
    • Sweden
  • How can I get a Standing Order Request Form?

    A copy of the Standing Order Request Form is located on this web site and can be downloaded for your convenience.

  • How can the Facility Department help?

    Modivcare maintains a facility department dedicated to handling the needs of nursing homes, hospitals, dialysis, and mental health and substance abuse clinics. A dedicated staff and phone number is available to book transportation needs from these facilities. The phone number is 877-659-1305. It is suggested that you fax your trip request to save time on the phone and make most efficient use of your time. The fax number is 877-637-9091. You will find instructions and forms for arranging a standing order or single trip reservation included.

  • How do hospitals arrange discharges?

    Hospitals contact the Facility Line at 877-659-1305. No Physician's Transportation Restriction Form needed for hospital discharges. Dedicated call takers are assigned to handle discharges. Once the discharge is arranged, the transportation provider has up to four (3) hours to respond and pick-up the member.

  • How do I get started with the on line service?

    Getting started is as simple as contacting your facility representative.

    Facility Phone: 877-659-1305

  • How much notice is needed to book a reservation?

    Two business days (48hrs) notice prior to the scheduled appointment is necessary for routine non-urgent requests.

  • What are examples of emergencies?

    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.

  • What are examples of Urgent Trips?

    Examples of such trips are doctor appointments deemed urgent by physician, dialysis, wound care, chemotherapy and radiation.

  • What happens if a trip is booked and no transportation provider arrives to take plan member to the appointment?

    Modivcare maintains a staff to resolve any issues when a transportation provider is late or fails to show at the scheduled time. A dedicated phone line is available to call to find out the status of the ride. The line is called the “Ride Assist Line” and the phone number to call is 877-659-1303.

  • What happens if we don’t know what time the plan member’s appointment will be over and no time is arranged in advance for the return ride?

    Once their appointment is finished, they or someone at the medical office they visited will call the "Ride Assist" phone number and request transportation to be sent to pick up the plan member. The transportation provider will be dispatched and will have up to 1 hour (60 minutes) to pick up the plan member.

    Ride Assist Phone: 877-659-1303

  • What if a Facility has an emergency trip?

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

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

    Urgent/same day trips can be booked through Modivcare. Such trips should be true urgent conditions where a physician is requiring the plan member to be seen the same day or the next day.

  • What if a facility has multiple trips to book for different members?

    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 877-637-9091. Again, two business days’ notice is required for routine trips.

  • What is a Standing Order?

    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 trips three days or more a week to the same location. Example: dialysis. A Standing Order for a member is good for three months and will be recertified by the Modivcare 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.

  • Where do I send the completed Standing Order Request Form?

    The Standing Order Request Form should be faxed to Modivcare at 877-637-9091.

  • Who fills out the Standing Order Request Form?

    Standing orders must come from the Facility representatives. Example: dialysis clinic, social worker. Nursing Homes may book the first three trips for a member in need of Chemotherapy. The Modivcare Facility Department will then contact the Clinic to secure a Standing Order for the member for future trips.