Servicing patients across all of New York
Effective January 1, 2016 Modivcare will provide NEMT services for the Elderplan New York - Medicaid Advantage/ Medicaid Advantage Plus and Homefirst MLTC and Senior Whole Health Managed Long Term Care (Medicaid Advantage and Advantage Plus).
Welcome to the Modivcare Facility website for information regarding the following NY Plans and Programs:
- Affinity Health Plan Medicare
- Empire BCBS HealthPlus FHP (19 and 20 year olds), CHIP Managed Long Term Care and Medicaid Advantage
- Anthem Empire BCBS Medicare Advantage
- Elderplan New York - Medicaid Advantage/ Medicaid Advantage Plus and Homefirst MLTC
- Nassau County Department of Social Services Medicaid plan members and recipients
- Senior Whole Health Managed Long Term Care (Medicaid Advantage and Advantage Plus)
- United Community Plan New York Medicaid/Medicare Advantage Plans
If you have general questions, please review the New York Facility Brochure and Frequently Asked Questions (FAQ). Also, please be aware that Modivcare is only responsible for certain types of non-emergency medical transportation in the state. Please refer to the document titled “What Modivcare is Responsible For in New York” for more information. The remaining documents on this site include forms used to request transportation services as well as informational brochures you can provide to your plan members.
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/.
At what levels of service will members travel?
The level of service describes the type of service needed to transport a member/recipient. A member/recipient can travel by one of several levels of service based on their physical needs as described below:
Gas Reimbursement - Modivcare provides mileage reimbursement to members or non-commercial drivers (i.e., not a qualified transportation provider 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.
Note: Gas Reimbursement is not a covered level of service for any Medicare members, Amerigroup Medicaid, or Nassau Medicaid recipients. Nassau County Medicaid recipients should contact the Department's Medical Services Unit at 516-227-8070 for approval of reimbursement.
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 ¾ of a mile (or within 10 blocks within NYC) from a transit stop and can walk that distance unescorted.
Note: For WellCare NY-Managed Long Term Care (Advocate and Advocate Complete), Amerigroup Managed Long Term Care, Senior Whole Health MLTC, MA and MAP, Elderplan Medicaid Advantage/Medicaid Advantage Plus and Homefirst MLTC, the use of Mass Transit is optional.
Mass transit is not a covered level of service for Affinity Medicare, Access Medicare and Amerigroup Medicare. Nassau Medicaid recipients may be eligible for reimbursement of mass transit expenses and should contact the Medical Services unit at 516-227-8070.
Livery - This is a member/recipient 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 of at the curb. This is curb to curb transportation.
Note: For WellCare NY-Managed Long Term Care (Advocate and Advocate Complete),Senior Whole Health MLTC, MA and MAP, and Elderplan Medicaid Advantage/Medicaid Advantage Plus and Homefirst MLTC plan members door to door service will be provided if necessary.
Ambulette - These will be members/recipients confined to a wheelchair that due to either physical weakness or mental impairment must travel with their own wheelchair and may be accompanied by a family member, caretaker, companion, or aide.
*NOTE: Stretcher Van for Senior Whole Health and Elderplan, and Homefirst MLTC New York is ONLY for wheelchair members who must be moved up or down four or more stairs.
How are out-of-state trips arranged?
Trips for member 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 that require travel beyond the county or in a neighboring state will be approved pending an authorization from the member’s health plan or the recipient’s local district Medicaid office.
(Out of State transportation is not covered for any WellCare New York, Inc., Senior Whole Health, Elderplan/Homefirst MLTC New York, or Amerigroup of New York plan)
(The Nassau County Department of Social Services will require the recipient’s physician to provide a “Closer Provider Certification” and the department must approve the travel)
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 has a dedicated facility department to handle the transportation needs of nursing homes, hospitals, dialysis, and mental health and substance abuse clinics. A dedicated staff and phone number is available to book transportation reservations from these facilities. The phone number is 866-428-2351. It is suggested that you fax your trip request to save time on the telephone and make the most efficient use of your time. The fax number is 877-457-3334. You will find instructions and forms for arranging a standing order or single trip reservation included in the answers found below.
How do hospitals arrange discharges?
Hospitals contact the Facility Line at 1-866-428-2351. No Physician's Transportation Restriction Form is needed for hospital discharges. Dedicated call takers are assigned to handle discharges. Once the discharge is arranged, the transportation provider has four (4) hours to respond and pick-up the patient.
How much notice is needed to book a reservation prior to a scheduled appointment?
See table below:
Three business days (72 hours) Two business days (48 hours) Access Medicare Amerigroup Medicare and MLTC Affinity Medicaid and Medicare WellCare Advocate and Advocate Complete Amerigroup Medicaid, FHP (19 and 20 year olds), CHP United Healthcare Community Plan Elderplan - Medicaid Advantage/Medicaid Advantage Plus Homefirst MLTC Nassau County Medicaid Senior Whole Health MLTC, Medicaid Advantage and Advantage Plus WellCare Medicaid (Healthy Choice), FHP (19 and 20 year olds), Medicaid Advantage (Liberty), Medicare
All trips must be received by 3:00p.m. or it will be processed the next day.
For example, for a Thursday appointment, the cutoff is 3:00p.m. on Monday; a request received after 3:00p.m. on Monday would be for an appointment on Friday.
The advance notice requirement does not apply for urgent requests or hospital discharges.
Member's transportation can be arranged with Modivcare for the following counties:
Health Plan (Chart 1) County Access Medicare Affinity Medicaid Affinity MediCare Amerigroup New York Medicare Advantage Amerigroup New York Managed Long Term Care Amerigroup New York Medicaid Elderplan New York Homefirst Nassau County DSS Medicaid/Human Services Senior Whole Health New York MLTC, Medicaid Advantage and Medicaid Advantage Plus Albany Bronx X X X X X X X X X Cayuga Duchess Erie Greene Herkimer Kings X X X X X X X X X Madison Manhattan X X X Monroe Nassau X X X X New York X X X X X X Oneida Onondaga Orange Orange Putnam X Queens X X X X X X X X X Rensselaer Richmond X X X X X X X Rockland Suffolk X Ulster Wayne Westchester X X Health Plan (Chart 2) County UnitedHealthcare Community Plan Medicaid United HealthCare Community Plan Advantage Medicare and Advantage Medicaid United HealthCare Community Plan (FHP 19 and 20) WellCare Medicaid (Healthy Choice) WellCare Medicaid Advantage (Liberty) WellCare (FHP 19 and 20) WellCare Managed Long Term Care (Advocate and Advocate Complete) WellCare Medicare Albany X Bronx X X X X X X X Cayuga X Duchess X Erie X X Greene Herkimer X Kings X X X X X X X Madison X Manhattan X Monroe X Nassau X X X X X X X New York X X X X X X X Niagara X Oneida X Onondaga X X X X Orange X Oswego X Putnam Queens X X X X X X X Rensselaer X X Richmond X X Rockland X Schenectady X Suffolk X X Ulster X X Wayne X Westchester X
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 happens if a trip is booked and a transportation provider does not arrive to take plan member/recipient to the appointment?
Modivcare has a dedicated 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 numbers to call for each plan are below:
"Where's My Ride" Access Medicare 866-435-9358 Affinity Medicaid 866-418-9810 Affinity Medicare 866-712-1055 Amerigroup Medicaid, FHP (Age 19 and 20), CHP 866-481-9489 Amerigroup Medicare 866-481-3133 Elderplan New York 877-714-6881 Homefirst MLTC 877-779-8612 Amerigroup MLTC 866-481-9685 Nassau Medicaid 877-813-5603 Senior Whole Health MLTC, Medicaid Advantage and Advantage Plus 877-564-0574 United Healthcare Community Plan 866-913-2498 WellCare MLTC (Advocate and Advocate Complete) 866-417-0302 WellCare Medicaid (Healthy Choice), FHP (Age 19 & 20), and Medicaid Advantage (Liberty) 866-417-0294 WellCare Medicare 866-430-0570
What happens if we don't know what time the plan member's appointment will be over and a time was not arranged in advance for the return ride?
The plan member/recipient will use the same “Where’s My Ride” phone number:
Plan Name "Where's My Ride" Access Medicare 866-435-9358 Affinity Medicaid 866-418-9810 Affinity Medicare 866-712-1055 Amerigroup Medicaid, FHP (Age 19 and 20), CHP 866-481-9489 Amerigroup Medicare 866-481-3133 Elderplan New York 877-714-6881 Homefirst MLTC 877-779-8612 Amerigroup MLTC 866-481-9685 Nassau Medicaid 877-813-5603 Senior Whole Health MLTC, Medicaid Advantage and Advantage Plus 877-564-0574 United Healthcare Community Plan 866-913-2498 WellCare MLTC (Advocate and Advocate Complete) 866-417-0302 WellCare Medicaid (Healthy Choice), FHP (Age 19 & 20), and Medicaid Advantage (Liberty) 866-417-0294 WellCare Medicare 866-430-0570
Once their appointment is finished, the plan member/recipient or someone at the medical office they visited will call the "Where's My Ride" phone number and request transportation to be sent to pick up the plan member/recipient. The transportation provider will be dispatched and will have 90 minutes to pick-up the plan member/recipient.
Nassau County Department of Social Services Medicaid once "Where's My Ride" has been called the transportation provider will have 60 minutes to pick-up the recipient.
What are examples of Urgent Trips?
Examples of such trips are doctor appointments deemed urgent by physician, Dialysis, Wound Care, Chemotherapy, Radiation, and Failure to Thrive (0-3 y.o.).
What if a Facility has an emergency trip?
Emergency ambulance trips are not arranged through Modivcare. If an 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/recipient to be seen the same day or the next day. All urgent/same day trips will be verified with the physician's office for medical necessity. If this is a case where the trip was just not called in timely, the appointment should be rescheduled so that the transportation can be booked providing the plan/Medicaid-specific required notice.
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/recipients for trips up to 30 days in advance and fax them to Modivcare at 877-457-3334. Again, three business days notice is required for routine trips for Affinity, Affinity Medicare, United Healthcare Community Plan, Senior Whole Health New York Managed Long Term Care, Medicaid Advantage and Medicaid Advantage Plus, Elderplan New York - Medicaid Advantage/Medicaid Advantage Plus and Homefirst MLTC, Nassau County Medicaid, WellCare of New York Inc.- Medicaid (Healthy Choice) and FHP (19 and 20 year olds), WellCare New York Medicare, Amerigroup Medicaid, and Access Medicare.
Two business days (48hrs) notice is required prior to the scheduled appointment for WellCare-Managed Long Term Care (MLTC) Advocate and Advocate Complete plans and Amerigroup Medicare and MLTC.
What is a Physician's Transportation Restriction Form and who completes it?
A Physician Transportation Restriction Form (PTR) is completed for any plan member/recipient who requires a level of service other than Mass Transit or Gas Reimbursement. A physician completes the PTR and determines the Level of Service by which the plan member/recipient will travel. The PTR should accompany any Standing Order Form or a Single Trip Request form and should be faxed to Modivcare's Facility Department at 877-457-3334.
For Nassau County DSS, the PTR should accompany any Standing Order Form or a Single Trip Request form and should be faxed to Modivcare's Facility Department at 877-272-3768.
Not applicable for any Medicare members, WellCare Managed Long Term Care (Advocate and Advocate Complete), Elderplan New York - Medicaid Advantage/Advantage Plus, and Homefirst MLTC, Amerigroup MLTC, Senior Whole Health Managed Long Term Care, Medicaid Advantage and Advantage Plus.
What is a Standing Order?
To eliminate the need to arrange trips for members/recipients who have three or more trips to the same facility each week, a standing order form and process have been created. This allows a facility to arrange trips in advance for a member/recipient scheduled for trips three days or more each week to the same location. Examples are: Mental Health or Substance Abuse. 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.
Note: For WellCare NY-Managed Long Term Care (Advocate and Advocate Complete), standing orders can be setup for members travelling to Adult or Social Day Health Services at least two days each week.
Where do I send the Standing Order Request Form?
The Standing Order Request Form should be faxed to Modivcare at 877-457-3334.
For Nassau County DSS, the Standing Order Request Form should be faxed to Modivcare Facility Department at 877-272-3768.
Who fills out the Standing Order Request Form?
Standing orders must come from the Facility representatives. Example: Mental Health or Substance Abuse Clinics. Nursing Homes may book the first three trips for a member in need of Chemotherapy. The Facility Department will then contact the Clinic to secure a Standing Order for the member/recipient for future trips.
Will transports to Veteran’s Hospitals be covered?
Yes. Trips to Veteran's Hospitals will be covered for Affinity Health Plan, United Healthcare Community Plan, WellCare of New York, Access Medicare, Elderplan/Homefirst MLTC and Amerigroup of New York eligible members.