Welcome to the Modivcare Facility web site for Michigan. This site hosts information and forms that medical facilities in MI can use to schedule non-emergency Medicaid transportation for people living in Wayne, Oakland and Macomb counties who are on Medicaid and dually enrolled Medicaid/Children’s Special Health Care Services (CSHCS) and who have no other way to get a ride. Rides to dental, substance abuse and mental health services are also available for Medicaid HMO members living in those counties who have no other way to get a ride.
All trips must be pre-arranged and confirmed by Modivcare.
If you have general questions, please review the MI Facility Brochure and Frequently Asked Questions (FAQ). Also, please be aware that Modivcare is only responsible for managing non-emergency Medicaid transportation for beneficiaries living in Wayne, Oakland and Macomb counties. Please refer to the document titled “What Modivcare is responsible for in Michigan” for more information.
The remaining documents on this site include forms used to request non-emergency transportation services as well as informational brochures you can provide to your Medicaid beneficiaries who live in the three counties and who have no other way to get a ride.
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/.
The level of service describes the type of service needed to transport. A beneficiary can travel by one of several levels of service based on their physical needs as described below:
Ambulatory – This is a beneficiary 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 considered curb to curb transportation.
Wheelchair – These will be beneficiaries confined to a wheelchair at all times and require additional assistance.
Medivan – This is a beneficiary who is unable to walk from the residence to the curb without assistance. This is often referred to as door-to-door transport.
Modivcare covers people living in Wayne, Oakland and Macomb counties who are on Medicaid and dually enrolled Medicaid/Children’s Special Health Care Services (CSHCS) and who have no other way to get a ride. Rides to dental, substance abuse and mental health services are also available for Medicaid HMO members living in those counties who have no other way to get a ride.
Trips for beneficiary travel out of state are booked with Modivcare, using the same process that other trips are booked as long as they are to a Medicaid reimbursable service. Any out of state trips will be approved pending authorization from Medicaid.
A copy of the Medical Necessity Form is located at this web site and can be downloaded for your convenience. The Modivcare Healthcare Facility Department staff can also fax you the Medical Necessity Form and/or the Standing Order Form.
A copy of the Standing Order Request Form is located at this web site and can be downloaded for your convenience. Alternately, the Modivcare Healthcare Facility Dept. staff can fax the form to you.
Modivcare maintains a Healthcare Facility Department dedicated to handling the needs of those healthcare facilities whose Medicaid beneficiaries have no other means of transportation and who require regularly reoccurring non-emergency transport. For example, transport three days each week to and from dialysis. A dedicated staff and phone number is available to book transportation needs from these facilities. The phone number is (866) 569-1908. It is suggested that you fax your trip requests in to save time on the phone and make most efficient use of your time. The fax number is (866) 569-1910. You will find instructions and forms for arranging a standing order or included in the answers found below.
Hospitals contact the Reservation Line at (866) 569-1902 and select the discharge prompt. No Medical Necessity Form is needed for hospital discharges. Dedicated call takers are assigned to handle discharges. Once the discharge is arranged, the transportation provider has three (3) hours to respond and pick-up the patient.
The Medical Necessity Form only needs to be completed once unless (1) the level of service changes or (2) the physician or PA or RN noted a limitation in the MNF. In those cases an updated form should be submitted. For example, sometimes a beneficiary has a condition that requires them to have a higher level of service because they may be recovering from surgery or an injury. In that case a Medical Necessity Form should be submitted detailing the condition that requires the higher level of service. Once the beneficiary recovers and they will be returned to their regular level of service.
Two business days notice prior to the date of the scheduled appointment is necessary. For an example, call Monday for a Wednesday appointment.
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, and hospital discharges.
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 “Where’s My Ride” and the phone number to call is (866) 569-1903.
Once their appointment is finished, they or someone at the medical provider’s office they visited will call the “Where’s My Ride” phone number at (866) 569-1903 and request that transportation be sent to pick-up the beneficiary. The transportation provider will be dispatched and will have sixty (60) minutes to pick-up the beneficiary.
Emergency ambulance trips are not arranged through Modivcare. If an emergency ambulance trip is needed, 911 should be called.
Urgent/same day trips can be booked through Modivcare 24 by 7. Such trips should be for true urgent conditions where a physician is requiring the beneficiary be seen the same day or next day. All urgent/same day trips will be verified with the physician’s office for medical necessity. If it is a case where the trip was just not called in timely, then in those cases, the appointment should be rescheduled so that transportation can be booked providing the two business day notice.
Medical Necessity Forms are completed for any beneficiary who requires a level of service above ambulatory. The Medical Needs Form must be signed by a physician, physician assistant (PA), or a nurse practitioner. The information that the physician, PA or nurse practitioner provides on the Medical Necessity Form must justify the Level of Service requested on the Standing Order Form. Those levels of service are Ambulatory or Wheelchair/Medivan. The Medical Necessity Form should accompany a Standing Order Request Form and is faxed to the Facility Department at 866-569-1910.
To eliminate the need to arrange trips for beneficiaries 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 beneficiary scheduled for trips three days or more a week to the same location. Examples are: Dialysis, Mental Health, and Substance Abuse. A Standing Order for a beneficiary 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.
The Standing Order Request Form should be faxed to Modivcare at (866) 569-1910.
Standing orders must come from the healthcare facility representatives. For example, from a dialysis clinic social worker or a mental health or substance abuse program case manager. The Modivcare Facility Department will then contact the social worker or case manager to secure a Standing Order for the beneficiary for future trips.
Yes, trips to Veteran’s Hospitals will be covered for Medicaid eligible beneficiaries who have no other way to get a ride.