Serving patients across all of Virginia
Welcome to the Modivcare Facility Website for the Commonwealth of Virginia and Washington, D.C.
The Virginia Operation offers this site to provide you with additional resources, as well as assist in arranging Medicaid transportation for eligible members. Qualified members have transportation benefits through:
- Virginia Medicaid
- AMERIGROUP Virginia
- Anthem HealthKeepers Plus
- Chartered Family Health
- Optima Family Care
- Southern Health/Care Net
- United HealthCare Community Plan
- Virginia Humana Gold Plus HMO (Medicare Advantage Plan)
All forms on this site are stored in PDF format. Your computer must have Adobe Acrobat Reader installed to be able to read and print the forms. If you do not have Adobe Acrobat, 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 required to transport a member. A member can travel by one of several levels of service based on the medical necessity and plan coverage.
Ambulatory (Taxi or Van)
Wheelchair Ambulance Stretcher-Van AMERIGROUP – Virginia AMERIGROUP – Virginia AMERIGROUP – Virginia FAMIS Plus only (under 18) Anthem HealthKeepers Plus Anthem HealthKeepers Plus Chartered Family Health Chartered Family Health Humana Gold Plus HMO (Medicare Advantage Plan) Humana Gold Plus HMO (Medicare Advantage Plan) Humana Gold Plus HMO (Medicare Advantage Plan) Humana Gold Plus HMO (Medicare Advantage Plan) Optima Family Care Optima Family Care Southern Health/Care Net Southern Health/Care Net United HealthCare Community Plan United HealthCare Community Plan Virginia Medicaid Virginia Medicaid Virginia Medicaid Virginia Medicaid
Can a facility ask for a preferred transportation provider?
Facilities and Medicaid members do not have the freedom of choice to choose the transportation provider. A request can be made and will be noted by Modivcare; however, Modivcare reserves the right to utilize a different transportation provider consistent with the transportation needs of the member.
Can an attendant stay with a Medicaid member for Medicaid paid service such as a doctor appointment?
No, attendants are for the safety of members while riding the vehicle only. However, the member can have an escort ride for free. Please see definition of escort listed above. When the transportation reservation is called in make sure and tell the customer service representative you have an escort riding as well.
Ambulance, as defined by Code of Virginia §32.1-111.1, means any vehicle, vessel or craft that holds a valid permit issued by the Virginia Department of Health, Office of Emergency Medical Services (OEMS) and that is specially constructed, equipped, maintained and operated, and intended to be used for emergency medical care and the transportation of patients who are sick, injured, wounded, or otherwise incapacitated or helpless. The word “ambulance” may not appear on any vehicle, vessel or aircraft that does not hold a valid EMS vehicle permit. Modivcare only facilitates non-emergency ambulance transportation.
An escort is a family member, friend or facility employee who accompanies a member for the entire trip and stays with the member at the destination. Modivcare is not responsible for providing escorts.
Stretcher-van services means transportation is provided to an individual who cannot be transported in a taxi/sedan (ambulatory) or wheelchair van, but does not need the medical services of an ambulance. Stretcher-van service does not provide emergency medical transport and does not include any medical monitoring, medical aid, medical care or medical treatment during transport.
Define Wheelchair Van?
A wheelchair van is a motorized vehicle equipped specifically with certified wheelchair lifts or other equipment designed to carry persons in wheelchairs, or other mobility devices. Wheelchair van services can only be used in non-emergency situations and are limited to use by members who can sit upright, to members without acute medical problems that require them to remain in a horizontal position and by members who use a mobility device.
Does Modivcare have the right to contact doctors, facilities, or agencies to verify appointments?
Yes, all Medicaid paid services are subject to verification or service authorization prior to transport.
How are out-of-state transports arranged?
Out-of-state transportation is allowed to the extent that it is general practice for the member in a particular locality to use services in a bordering state. Examples are travel from Scott County, Virginia to Kingsport, Tennessee or travel from Tazewell County, Virginia to Bluefield, West Virginia, Duffield, Virginia to Durham, NC, from Fairfax County to the District of Columbia or other similar near-by locations in bordering states. All other out-of-state transports are arranged by the Department of Medical Assistance Services (DMAS).
How can I tell if a member qualifies for an attendant?
Please refer to the Attendant Pre-Assessment Checklist (APAC) found on this website on the download navigator.
How can the Utilization Review/Facility Department help?
Facilities who would like to arrange a standing order appointment for Medicaid members should contact a Utilization Review/Facility Representative, or submit by fax a Transportation Request Form at least five (5) days in advance. The phone number is 866-679-6330 and fax number is 866-907-1491. Depending on the situation the five (5) days notice may be waived to two (2) days.
The Utilization Review/Facility Department is available 8:00 AM - 5:00 PM, Monday - Friday.
How do hospitals arrange transportation for members being discharged?
Hospitals contact the Facility Line at 866-679-6330 and select the appropriate prompt. Modivcare has three hours to assign the trip to a provider and pick up the member. The three hour time frame starts with the call to Modivcare. All hospital discharges should be arranged by hospital staff. The patient/member should not make the transportation request for the discharge. Modivcare will need to verify the discharge with hospital staff.
How do I arrange Public Transportation?
Call the Modivcare reservations line at 866-386-8331 at least seven (7) days before the scheduled medical appointment. This allows for proper delivery of the bus tokens, tickets, swipe cards or passes. Please tell the customer service representative the member will be using public transportation.
How do I get a copy of the Gas Reimbursement Trip Log?
You will find the Gas Reimbursement Trip Log on this website on the download navigator. Please make sure and contact Modivcare BEFORE transporting to receive prior approval and trip number for reimbursement. The trip number is required for reimbursement.
How do I schedule someone to receive gas reimbursement?
Prior to the Medicaid covered service, you will need to call Modivcare to schedule the transportation. When scheduling gas reimbursement trips, you will need the name of the person who will be transporting the member as well as their telephone number and mailing address.
How much notice is needed to schedule transportation?
Transportation should be scheduled five (5) business days in advance of the appointment. The day of the appointment is not being included in this calculation. Please have the member's name, Medicaid number, name and address to the pick-up facility, or residence, as well as the destination facility, available when making a reservation. Transportation reservations may be taken with less than a 5-day notice if they are of an urgent nature, which will be verified with the physician's office.
How will the gas reimbursement driver be paid?
In order to be reimbursed, a Gas Reimbursement Trip Log will need to be completed. The physician's office must sign the trip log. The payee will mail the completed signed trip log to Modivcare's Claims Department for processing. You still need to call Modivcare before the trip(s) is made to get a trip number for the trip log. If you fail to call in ahead of time you will not receive reimbursement.
- If I have scheduled transportation for a member and the appointment has been canceled or the member has decided not to attend, what should I do?
If my facility is next to a bus line (Public Transportation), can members take the bus?
Is it possible for a Medicaid member to be enrolled in both regular and managed care Medicaid?
Yes, waivered services would be covered by regular Medicaid and medical benefits would be covered by a managed care program. When you call Modivcare for transportation arrangements, transportation will be set up accordingly.
- Is there a Regular Medicaid User's Guide for Medicaid Transportation?
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 treatment is necessary.
What are examples of Urgent trips?
Examples of such trips are dialysis, wound care, chemotherapy, radiation, and doctor appointments deemed "urgent" by the physician. Modivcare will verify the urgency with the physician's office.
What are the benefits of a Volunteer Driver?
Reimbursed at a rate of $0.50 per traveled mile, personal satisfaction of helping others, FREE Emergency Kit, Modivcare driver training, etc.
What are the requirements to be a Volunteer Driver?
The requirements are:
- At least 18 years of age
- Current and valid driver's license
- Good driving record
- Criminal background check and drug screen
- Liability automobile insurance coverage
- Modivcare inspected automobile which is safe and in roadworthy condition (vehicle will have a Modivcare sticker on the passenger side back window)
- PASS Training
Note: Volunteer Drivers have the same requirements as regular transportation provider's drivers.
What does Ambulatory mean?
Ambulatory is defined as capable of walking, not bedridden and has the ability to transfer from a wheelchair to a vehicle without assistance, must be able to stand and pivot without assistance.
What does medically necessary transportation mean?
Medically necessary transportation is defined as the mode of transportation available that is most appropriate to the needs of the member. Covered non-emergency Medicaid transportation services include non-emergency ambulance, stretcher van, wheelchair van, fixed-route public transportation, gas reimbursement and taxi (including sedans and mini-vans).
Modivcare manages different levels of service in all of Virginia Medicaid’s Managed Care and regular Medicaid programs. Please see level of service table listed below for levels of service provided to each program. All transports must be prearranged and confirmed by Modivcare.
What happens if we don't know what time the member's appointment will be over and no time is arranged in advance for the return ride?
The member will use the same "Ride Assist" phone number listed above. Once their appointment is finished, the member or someone at the medical facility will call the "Ride Assist" phone number and request transportation to be sent to pick up the member. The transportation provider will be dispatched and will have up to 60 minutes to pick up the member.
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 is a standing order?
Standing Orders are reoccurring trips for treatment that are scheduled at least three days per week for a period of three months or more to programs such as Supported Employment, Psychosocial Rehabilitation, Adult Daycare, and Dialysis.
What is a transportation attendant?
An attendant accompanies a member or a group of members during transport only. The attendant is on the vehicle to ensure the safe operation of the vehicle and the safety of the members. An attendant is an employee of the company that provides transportation services for a member. A transportation attendant is not a personal assistant, an escort, a parent, caretaker, relative or friend. An attendant is not a medical professional, and does not offer professional medical services. A transportation attendant shall be provided for a member or a group of members when it is necessary for the safety of the member(s), to ensure timeliness of the trip and to reduce behavioral problems en route.
What is a Volunteer Driver?
Modivcare coordinates volunteer drivers to transport Medicaid members to and from their Medicaid covered service anywhere in Virginia. A Volunteer Driver is someone who is willing to share their time and vehicle to help meet the transportation needs of their community. The Volunteer Driver provides non-emergency Medicaid transportation for local and long distance trips.
What is an Urgent reservation?
Urgent reservations are defined as a reservation for an unscheduled episodic situation in which there is no threat to life or limb, but the member must be seen with less than a five (5)-day notice. Urgent care reservations are not for routine appointments or appointments where the caller failed to notify Modivcare to arrange transportation.
What is Non-Emergency Transportation (NET)?
Non-emergency Medicaid transportation is any transportation that is not initiated by dialing 911 and does not require immediate response to take a member to the emergency department for evaluation for a new or suddenly worsening condition that threatens life or limb. Transportation reservations may be taken with less than a 5-day notice if they are of an urgent nature, which will be verified with the physician's office.
What is the "Ride Assist" phone number?
The "Ride Assist" phone numbers are listed below:
Region Area Phone Number Region 1 Norton 866-246-9979 Region 2 Forest 886-586-0255 Region 3 Richmond 800-742-9758 Region 4 Norfolk 866-966-3326 Region 5/6 Charlottesville 866-973-3310 Region 7 Herndon 866-707-3761
Optima Family Care
Region Area Phone Number Region 1 Norton 877-892-3986 Region 2 Forest 866-417-0297 Region 3 Richmond 866-660-4371 Region 4 Norfolk 866-886-4018 Region 5/6 Charlottesville 866-907-5191 Region 7 Herndon 866-216-7858
Healthcare Phone Number AMERIGROUP VA 800-894-8396 ANTHEM HEALTHKEEPERS PLUS 877-892-3988 Southern Health/Care Net 800-734-0430 Chartered Family Health 800-315-4095 United HealthCare Community Plan 866-216-7867
What is the definition of VA Medicaid Transportation services?
Medicaid Transportation services are identified as non-emergency, medically necessary, transportation provided to eligible members to ensure reasonable access to and from Medicaid and FAMIS covered services.
What is the Gas Reimbursement program?
Gas Reimbursement is a program to reimburse a member's friend, neighbor or relative at a rate of $0.40 per mile from the member's residence to the Medicaid paid service and the return trip home.
What is the requirement for minors traveling alone?
Minors 13 to 17 may travel alone; however, a Consent and Acknowledgement of Responsibility Form must be on file. For transporting minors under the age of 13 please contact the Utilization Department for policy.
What should you do when transportation has been scheduled and no transportation provider arrives to transport the member to the medical appointment?
If a member's transportation is more than 15 minutes late, call the appropriate "Ride Assist" line.
When will a Gas Reimbursement trip be paid?
The check will be issued three (3) to four (4) weeks after Modivcare’s receipt of the Gas Reimbursement Trip Log.
Where do I get the Attendant Care Eligibility Assessment form?
You will find the Attendant Care Eligibility Assessment Form on this website on the download navigator.
Where do I get the Consent and Acknowledgement of Responsibility Form?
Please refer to the Consent and Acknowledgement of Responsibility Form found on this website on the download navigator.
Where do I get the Transportation Request Form?
Instructions and the Transportation Request Form that can be used for standing orders or a single trip are located on the Download navigation section of this website.
Who can request a change to a current standing order?
All changes to a standing order must be made by a facility representative. Changes must be made with Modivcare who will then contact the assigned transportation provider. Do not make changes with the transportation provider or driver directly. The new Transportation Request Form should be faxed to 866- 907-1491.
Who can request an attendant for a member?
Requests for an attendant will be accepted from a qualified assessor, such as the member, member's parent or guardian, the member's case manager or social worker.
At the time of the request, an Attendant Care Eligibility Assessment form must be completed and faxed to Modivcare's Utilization Review/Facility Department at 866-907-1491.
Who can sign the Consent and Acknowledgement of Responsibility Form?
The Consent and Acknowledgement Form must be signed by the parent or legal guardian of the minor.
- Who do I call if the member has not received the bus tickets?
- Who do I contact to be a Volunteer Driver?
Who fills out the Transportation Request Form?
The Transportation Request Form must be completed by a Facility representative. Example: dialysis clinician, social worker, case manager or other healthcare professional.