Utah Facility Resources

Modivcare schedules but does not pay for trips. However, the state fee schedule for transportation provider permits payment of tolls.

Ambulatory:

• You can walk unassisted from your residence to the curb and board the vehicle.
• You can walk unassisted from the vehicle to the medical facility.
• You have no other form of transportation, don’t own a vehicle or have no access to bus/para-transit services

Wheelchair:

• You are confined to a wheelchair.
• You cannot transfer from the wheelchair to the seat of an ambulatory vehicle.
• You require a lift-equipped or roll-up wheelchair van and the assistance of trained personnel.

Stretcher:

• You cannot walk and are confined to bed.
• You cannot sit up or sit in a wheelchair.
• You do not require medical monitoring during transport.

No.

NEMT will be authorized for transporting a client to the closest, Utah Medicaid – enrolled medical or dental provider unless:

• Client just moved. In that case the client has one (1) month to locate a closer medical provider, or
• The trip is to a specialist who is the closest available, or
• No appointment is available at the closest medical provider within the next 30 days for a child or the next 45 days for an adult.

Their “preference” will be taken into consideration but cannot be guaranteed.

Yes, but minors 16 years of age or younger must be accompanied by the child’s parent, foster parent, caretaker or legal guardian, as appropriate.

Covered if the services are unavailable or cannot be performed in Utah. Less than 120 miles no prior approval needed. Meals and lodging must be coordinated through members case worker at UDOH and not Modivcare.

A copy of the Standing Order Request Form is located on this web site and can be downloaded for your convenience. Alternately, the Modivcare Facility Services Dept. staff can fax the form to you, or the standing order can be requested online at this web site.

Call the Facility Services Dept. at 855-563-4405 or do it online.

Modivcare maintains a Facility Services Department dedicated to handling the non-emergency medical transportation needs of medical providers that serve Utah Medicaid members who have no other way to get a ride, and who may need a single trip or regularly reoccurring (standing order trips) non-emergency medical transport (NEMT). For example, transport three days each week to and from dialysis. A dedicated Facility Services Department staff, phone and fax numbers are available to book transportation needs received from these medical providers by phone, fax or online on behalf of the members they serve. The phone number is 855-563-4405. The fax number for facility services is 877-637-9079. You will find instructions and forms for arranging non-emergency medical transportation included on this web site and/or in the answers below.

Hospitals contact the Facility Services Line at 855-563-4405 or the Reservation Line at 855-563-4403.

10 minutes from the scheduled pick-up time.

Cancellations should be called in 24 hours in advance and, in unforeseen circumstances, 2 or more hours before the scheduled pick-up time.

Requests for routine NEMT services must be pre-arranged at least 3 business days in advance during our reservation hours: Monday – Friday between 8:30 a.m. and 5:30 p.m. 3 business days prior notice includes the day of the call but not the day of the appointment. For example, call on Monday for an appointment on Thursday as shown in the chart below. Urgent care, hospital discharges, same day and next day trip requests can be requested with less than 3 business days’ notice during regular reservation hours. All trips requested with less than 3 business days prior notice will have to be confirmed with the medical provider that the client needs to come in today or tomorrow and that the treatment cannot be delayed to another day. Otherwise, the appointment will have to be rescheduled for another day.

Appointment on: Call Modivcare on:

Saturday Wednesday before Sunday Wednesday before Monday Wednesday before
Tuesday Thursday before
Wednesday Friday before
Thursday Monday before
Friday Tuesday before

No, you will need to contact the managed care program’s transportation line.

It would not be considered a non-covered service because for Diagnosis Related Group patients’ hospital-to-hospital transport is not covered unless the client is first discharged.

No.

No.

Non-emergency transportation is not covered for member residing in a Nursing Home or other long term care facilities.

Members who receive mental health services under a Prepaid Mental Health Plan (PMHP) would not qualify for transportation through Modivcare.

Modivcare will provide transport for the client to the closest, Medicaid-enrolled medical provider with specific exceptions.

Call Modivcare we will locate a provider with the correct equipment to transport your patient. Since this may require more time to locate a provider with the proper equipment, please call us with as much advance notice as possible. A member weighing over 600 pounds would contact their Utah Department of Health worker to arrange transportation.

If a request for NEMT falls under one or more of the denial criteria listed below, then Modivcare must deny the request:

• The Client is not eligible for NEMT services on the date of service.
• The Client does not have a medical need that requires NEMT services.
• The medical service for which NEMT service is requested is not a covered medical service.
• The client has access to available transportation.
• Transportation to the medical service for which NEMT service is requested is covered under another program.
• The trip was not requested timely and the request cannot be accommodated because of this reason.
• Additional documentation was requested and was not received timely.
• The Client refuses the appropriate mode of transportation.
• The Client refuses the NEMT provider assigned to the trip and another appropriate NEMT provider is not available.
• The Client refuses to cooperate in determining status of Medicaid eligibility.
• The Client exhibits uncooperative behavior or misuses/abuses NEMT services.
• The Client is consistently not ready to board NEMT transport ten (10) minutes after the scheduled pick up time.

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 Ride Assistance Line (referred to as the Where’s My Ride line) number, 855-563-4404 is available 24 by 7 to find out the status of the ride and resolve issues.

Once their appointment is finished, the client or someone at the medical provider’s office can call the Where’s My Ride number at 855-563-4404 and request that transportation be sent to pick-up the client. A transportation provider will be dispatched and will have 60-90 minutes to pick-up the client.

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

Urgent/same day trips are booked Monday through Friday between 8:30 a.m. and 5:30 p.m. All urgent or same day trips will be verified with the physician’s office for medical necessity. If it is a case where the trip request was simply not called in timely, then in those cases the appointment should be rescheduled so that transportation can be booked with 3 business days’ prior notice.

It is regularly reoccurring transportation for those members who need transport 3 or more days per week for 3 or more month’s duration, e.g., a Monday, Wednesday and Friday dialysis patient. To eliminate the need to request transport for every one of those appointment, a standing order process has been created. This allows a facility to arrange 3 months worth of trips simply by filling out and faxing in the standing order form, or by completing an online request. At the end of those 3 months, our Facility Services Department will call the medical provider and ask if the trip continues to be necessary. The facility will not have to submit new standing order or medical necessity forms at that time unless the client’s mobility has changed.

The Standing Order Request Form should be faxed to the Modivcare Facility Services Department at 877-637-9079.

Social workers, case managers or other licensed/certified medical professionals.

Yes, pharmacy trips would be covered when traveling directly from the doctor or dental appointment. Individual pharmacy trips would not be covered.

Modivcare schedules but does not pay for trips. However, that type of trip is not a covered service so the transportation provider would not be paid for performing the trip.