South Carolina Facility Resources

Some examples of trip denials may include, but not be limited to:

• Residential moves
• Dual Eligible Members: Since Medicaid is a payer of last resort, Members who have alternate insurance coverage for their transportation would be denied by Modivcare.
• Emergency transport: Any transport where an emergency request is made. For instance a member who needs to be transported from one hospital for a higher level of care and is medically unable to wait the 3 hour window.
• Transport to non-Medicaid covered services

If the request is made to transport a child to or from school to their Medicaid covered service appointment, it may be covered. The transportation must still meet all other requirements for the NEMT program. All arrangements for signing the child out of school are the responsibility of the parent, guardian or other authorized people. The transportation provider is not responsible for providing an escort. An escort is required if the child is under the age of 15.

Yes! Members can register for an account by going to the member web site at mymodivcare.com

Once registered, the member or anyone assisting the member may request NEMT services by following the instructions available on the website. The member must have arranged at least one ride through the Reservation Line before booking online.

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

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

Hospital discharges are scheduled by hospital staff only and can be arranged 24/7 by contacting the facility line at 866-420-6231. A Medical Necessity Form is not needed for hospital discharges. Our dedicated Facility Assistance call takers are assigned to handle discharges. Once the discharge is arranged, the transportation provider has 30 minutes to three (3) hours to respond and pick up the Member.

Members call the Reservation number below for their region.

• 866-910-7688 SC Region 1 Reservations
• 866-445-6860 SC Region 2 Reservations
• 866-445-9954 SC Region 3 Reservations

The Medical Provider should schedule rides for the Member.

Transportation is covered anywhere within the South Carolina state lines. Additionally, trip requests to a Facility which is within 25 miles of the South Carolina border are booked through Modivcare using the same process as a standard trip request. For transportation requests that would require the member to travel more than 25 miles outside the state line, please call the Facility Assistance line at 866-420-6231 and a representative will be happy to answer any questions you may have.

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 up to 90 days. Permanent condition requests for stretcher transports are considered on a case by case basis.

The Facility may call the Facility Assistance line at 866-420-6231. Complaints will also be accepted on any Reservation or Where’s My Ride phone line. A Facility may utilize the Modivcare Complaint Form which can be downloaded from this website. This form can be faxed to Modivcare for resolution using the numbers below:

• SC Nursing Homes: 877-272-3486
• Region 1: 866-420-6253
• Region 2: 877-272-3939
• Region 3: 877-272-3990

Modivcare will tell the Caller what time the Member should be ready. If the pickup time changes the Member will receive a call with the new time.

Hospital-to-hospital transportation is covered by the NEMT program if the member is going to a hospital for a higher level of care that is not available at the hospital they are at. NEMT transportation is not covered for transfers between hospital buildings of the same hospital system.

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 number is 866-420-6231. Forms and instructions to arrange standing orders and single trips can be found on this site.

Yes. Under the South Carolina DHHS contract, service under Medicaid is arranged by Modivcare. In general, Medicare will cover Ambulance transportation and Medicaid will cover wheelchair and ambulatory (by van, car or bus) transportation.

Yes! Facility representatives may be authorized to book reservations on behalf of their Members. A user form and manual may be requested by calling our Facility Assistance Line at 866-420-6231 Monday thru Friday 8AM-5PM. Urgent care transports should still be requested through the Facility Assistance Line.

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. Examples would include Dialysis, wound care, Chemotherapy and radiation treatments.

Transportation is for Healthy Connections Medicaid Members, who need to see a doctor, go to other medical appointments, or to the drug store and who have no other way to get a ride. The Member's medical condition should not be an emergency. For EMERGENCIES, DIAL 911.

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

Urgent/same day rides 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.

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).

• 866-910-7689 SC Region 1 Ride Assist
• 866-445-9962 SC Region 2 Ride Assist
• 866-445-9964 SC Region 3 Ride Assist

The Member's Healthy Connections Medicaid ID Number, address and phone number, the doctor's name, address and phone number.

A complaint is defined as an expression of dissatisfaction about any matter. Possible subjects for complaints include, but are not limited to, provider arriving late, provider does not show for pick-up, rider does not show for pick-up, rudeness of a provider staff member or a Modivcare employee, or failure to respect the Member's rights.

Medical Necessity Forms are needed for any Member who requires stretcher, Basic Life Support, or Advanced Life Support 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 accompany a Single Trip Request form when faxed to the Modivcare Facility Department using the fax numbers below:

• SC Nursing Homes: 877-272-3486
• Region 1: 866-420-6253
• Region 2: 877-272-3939
• Region 3: 877-272-3990

A standing order allows a 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 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.

Urgent care transport is not transportation initiated by dialing 911. It is also not transport that requires an immediate response to take a member to the emergency room for evaluation of a new or 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 adequate notice and failed to schedule their ride.

Door-to-door means transportation service whereby the driver parks the vehicle and meets the Member at the threshold of the primary entrance of the pick-up address; assists the Member to and into the vehicle, and delivers the Member to the threshold of the primary entrance of the drop-off address.

Curb-to-curb means transportation service whereby the Member meets and boards the vehicle at the curb of the pick-up address and disembarks at the curb of the drop-off address.

Hand-to-hand means transportation service whereby the driver parks the vehicle and meets a responsible individual at the threshold of the primary entrance of the pick-up address who transfers a physically or mentally challenged Member to the care of the driver; assists the Member to and into the vehicle, and delivers and transfers the Member to the care of a responsible individual at the threshold of the primary entrance of the drop-off address.

Modivcare will ask if the Member can walk, or if they require the use of a wheelchair or stretcher, and then provide the best type of transportation for their needs.

It is best to call for a ride at least 3 days before the appointment. Urgent trips, like hospital discharges may be accepted with less than 3 days' notice.

The Standing Order Request Form should be faxed to Modivcare at:

• SC Nursing Homes: 877-272-3486
• Region 1: 866-420-6253
• Region 2: 877-272-3939
• Region 3: 877-272-3990

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

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

Standing Orders must be completed by the Member's treating Facility. Example: 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.