Welcome to the Modivcare Facility web site for Tennessee. Currently this site hosts information and forms that medical facilities and medical groups can use to schedule transportation for our various Medicare clients including:
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/.
See the chart below for the counties covered by each plan.
|Level of Service||Coverage||Reservation Number||Counties|
|Ambulatory Wheelchair||Medicare||866-420-6187||Anderson, Bedford, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Cheatham, Chester, Claiborne, Cocke, Coffee, Crockett, Davidson, Decatur, DeKalb, Dyer, Fayette, Franklin, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardin, Hawkins, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Knox, Lake, Lauderdale, Lawrence, Lewis, Loudon, Macon, Madison, Marshall, Maury, McMinn, McNairy, Meigs, Montgomery, Moore, Obion, Overton, Pickett, Polk, Rhea, Roane, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Wayne, Weakley, Williamson|
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 as described below:
Ambulatory – This is a member who is able to walk on their own or with the assistance of a walker or cane and is able to be picked up and dropped off at the curb. This is curb to curb transportation.
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.
A copy of the Single Trip Request 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.
Modivcare maintains a Facility Department dedicated to handling the needs of nursing homes, hospitals, dialysis, mental health and substance abuse clinics. Dedicated staff and phone numbers are available to allow facilities to easily arrange transportation to and from covered services for eligible members.
The facility phone number is 866-386-8334 and the fax number is 866-386-0051.
However, Modivcare suggests that you fax your trip requests in to save time on the phone and make the most efficient use of your time. You will find instructions and forms for arranging a standing order or single trips in the answers found below.
Hospitals can arrange discharges by calling the Facility phone number at 866-386-8334 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 member.
Modivcare requires three business days notice prior to the date of the scheduled appointment. All requests, including those for trips to Dialysis, must be received by 12:00 noon or they will be processed the next day.
For example, the cutoff time to schedule a trip for Wednesday would be noon on Monday. The earliest a trip could be scheduled if notice is received after noon on Monday would be Thursday.
Examples of emergent trips include 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 urgent trips include doctor appointments deemed urgent by the physician, Dialysis, Wound Care, Chemotherapy, and Radiation.
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 “Where’s My Ride”.
Below are the Where’s My Ride numbers for each plan:
|Health Plan||Toll Free “Where’s My Ride Number”|
|Windsor Medicare Extra||866-420-6188|
Below are the reservation numbers for each plan:
|Health Plan||Toll Free Reservation Number|
|Windsor Medicare Extra||866-420-6187|
Yes, and the mileage limits vary by health plan. Please refer to the table below.
|Health Plan||Mileage Limit|
|Windsor Medicare Extra||Trips in excess of 50 miles one way require prior authorization by the health plan.|
Note: Mileage is defined as the number of miles between the member’s pick-up address and the member’s drop-off address.
The member will use the same “Where’s My Ride” phone number for their plan. These numbers are provided above. Once their appointment is finished, they or someone at the facility they visited will call the “Where’s My Ride” phone number and request that transportation be sent to pick-up the member. The transportation provider will be dispatched and will have sixty (60) minutes to pick-up the member.
Emergency ambulance trips are not arranged through Modivcare. If an emergency ambulance trip is needed, the facility should call 911.
Urgent/same day trips can be booked through Modivcare. Such trips 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 trips will be verified with the physician’s office for medical necessity. On the other hand, if the trip was simply not called in timely, the appointment should be rescheduled so that transportation can be booked providing the three business day notice.
The facility can fill out Single Trip Request Forms for the various members for trips up to 30 days in advance and fax them to the Modivcare Facility Department at 866-386-0051.
Again, three business days notice is required for routine trips.
Modivcare will update this FAQ with a process for how to submit multiple trips for a single member or multiple trips for multiple members within the next few days. In the meantime continue to fax Single Trip Request Forms.
To eliminate the need to arrange trips for members who have three or more trips to the same facility each week, Modivcare has created a standing order form and process. By using the standing order form, a facility can arrange trips in advance for a member 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 member is good for three months and will be recertified by the Modivcare staff to make sure the trip continues to be necessary. At the end of the three-month period, the facility will be asked to confirm that the standing order is still needed. The facility will not have to submit a new standing order if the standing order will remain in effect.
The Standing Order Request Form should be faxed to 866-386-0051.
The Standing Order Request Form must come from a Facility representative. Example: Dialysis Clinics, Mental Health and Substance Abuse Clinics.
Nursing Homes may book the first three trips for a member in need of Dialysis. The V Facility Department will then contact the Dialysis Clinic to secure a Standing Order for the member for future trips.