Serving patients across all of Ohio
Welcome to the Modivcare Facility web site for Ohio. 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.
Anthem Wellpoint:
Humana National Medicare (MCR):
Meridian Health Plan (MA):
UnitedHealthcare Ohio Medicaid:
UnitedHealthcare Medicare National:
UnitedHealthcare Group Retiree
HCSC Group Retiree
Group Retiree National Line Reservation/Ride Assist
Humana Group Retiree:
Forms
Please click on the title that corresponds to the document you would like to view.