Wisconsin Facility Resources

Hospitals contact the Reservation Line at (866) 907-1493 and select the discharge prompt. Dedicated call takers are assigned to handle discharges. For members who are ambulatory or require a wheelchair inform the reservationist of any special needs. Once the discharge is arranged, the transportation provider has three (3) hours to respond and pick-up the member.

Non-emergency medical transportation by Stretcher Van or BLS/ALS ambulance falls into two categories based on whether life support services are required during transport:

1. Non-emergency medical transportation without life support services (for a member who requires transportation in a supine position). This category of transportation is provided by SMV Stretcher Van or in an ambulance (optional). NEMT without medical care during transport require:
   • The NEMT provider is required to be contracted with Modivcare.
   • The transportation will not require a prescription for medical need.
   • The referring hospital, clinic, or other originating facility will be required to coordinate the transportation through Modivcare.
2. Non-emergency medical transportation requiring medical care during transport either by BLS or ALS are always provided by ambulance. The follow procedure is required:
   • The ambulance provider will be required to be contracted with Modivcare.
   • The transportation must be prescribed by a physician, physician assistant, or nurse practitioner. The prescription must:
     • Be in writing.
     • Be maintained and stored in the patient’s record at the referring hospital, clinic, or other originating facility.
     • State what medical care is necessitated by the member’s condition that requires transport with life support services.
   • The referring hospital, clinic, or other originating facility will have two options for coordinating transportation:
     • Coordinating through Modivcare. With this option, the referring hospital, clinic, or originating facility will contact Modivcare directly to arrange the transport. The hospital, clinic, or facility will be required to fax a copy of the prescription to Modivcare.
     • Coordinating directly with the ambulance provider. With this option, the ambulance provider is required to contact Modivcare within 24 hours after dispatching the trip to obtain a prior approval trip identification number (trip ID). The ambulance provider is required to obtain the prescription for medical need and submit to Modivcare.

Yes. The hospital or originating facility must provide an order of prescription from a physician, physician assistant, or nurse practitioner verifying medical necessity for the transport.

No, although Modivcare may call the medical provider to confirm that need.

The level of service describes the type of transportation service needed to transport the member. A member can travel by one of several levels of service based on their medical needs and mobility.

• BusPass/Mass Transit
  • The member lives within ¼ mile of a bus stop
  • The medical facility is within ¼ mile of a bus stop
  • The member can walk ¼ mile
  • The member understands common signs and directions
  • Bus passes can be obtained by calling LGTC
• Ambulatory
  • The member can walk unassisted from doorway of residence to the curb
  • The member can walk unassisted from the vehicle to the medical facility
• Wheelchair can transfer
  • The member can transfer from the wheelchair to the seat of an ambulatory vehicle
  • The member’s wheelchair folds and can be placed in the rear of the vehicle
• Wheelchair
  • The member is permanently confined to wheelchair
  • The member cannot transfer from the wheelchair to the seat of an ambulatory vehicle
  • The member requires a lift-equipped wheelchair van
• Stretcher
  • The member is confined to bed
  • The member cannot sit up or sit in a wheelchair
  • Non-emergency BLS or ALS transport may be requested if the member requires medical monitoring/services during transport

Modivcare provides NEMT for most of the Medicaid and BadgerCare Plus members enrolled in the following programs: WI Medicaid, Family-Planning Only Services, BadgerCare Plus Standard Plan, BadgerCare Plus Benchmark Plan, Tuberculosis-Only Services, Express Enrollment for Pregnant Woman, and for members enrolled in state-contracted managed care organizations (MCOs) who receive NEMT services on a fee-for-service basis (e.g., Children Come First). Medicaid and BadgerCare Plus members enrolled in an HMO will also receive NEMT services through Modivcare. That includes WI Medicaid or BadgerCare Plus members who are enrolled in an HMO in Milwaukee, Waukesha, Washington, Ozaukee, Kenosha, & Racine counties.

Modivcare cannot provide NEMT for members who reside in a nursing home or are enrolled in the BadgerCare Plus Core Plan, the BadgerCare Plus Basic Plan, SeniorCare or FamilyCare. However, Core and Basic Plan members enrolled in Family-Planning Only Services may receive NEMT to covered family planning services.

Trips for member to travel out of state require prior authorization of DHS’ Division of Health Care Access & Accountability. After the Prior Approval has been granted services are booked with Modivcare using the same process that other trips are booked as long as they are to a Medicaid reimbursable service. Trips to “border states” do not require prior authorization of DHS’ Division of Health Care Access & Accountability. Trips to non-border states do.

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

Modivcare maintains a Healthcare Facility Department dedicated to handling the needs of those healthcare facilities that serve Medicaid and BadgerCare Plus members who have no other way to get a ride, and who require regularly reoccurring non-emergency medical transport (NEMT). For example, transport three (3) days each week to and from dialysis treatment. A dedicated staff and phone number is available to reserve transportation needs requested from these facilities on behalf of the members they serve. The phone number is (866) 907-1497. It is suggested that you fax your trip requests in to save time on the phone and make most efficient use of your time. The fax number is (877) 352-5629. You will find instructions and forms for arranging a Standing Order trip or a Demand Response trip included in the answers below.

Except for hospital discharges and urgent trips, all reservation requests must be pre-arranged at least two (2) business day’s prior appointment day. The two business days includes the day of the call but not the day of the appointment. For example, call on Monday by noon for an appointment on Wednesday. Urgent/Same day and discharge trips may be called in 24 by 7.

If the referring Facility has a problem or concern with service, call Modivcare at 1-866-907-1494 or write to Modivcare at the following address with your complaints:

Modivcare Solutions, LLC
2335 City View Drive
Suite 200
Madison WI 53718
Modivcare will get back to you with an initial response in 10 business days. A final response will be sent to you in writing within 30 business days of receiving a complaint.

No.

No.

No.

Wisconsin standards require that if a request for NEMT falls under one or more of the denial criteria listed below, then Modivcare must deny the request:

• The Member is not eligible for NEMT Services on the date of service.
• The Member 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 member has access to available transportation.
• Transportation to the medical service for which NEMT service is requested is covered under another program.
• The medical appointment is not scheduled or was not kept.
• The trip was not requested timely and the request cannot be accommodated because of this.
• Additional documentation was requested and was not received timely.
• The Member refuses the appropriate mode of transportation.
• The Member refuses the NEMT provider assigned to the trip and another appropriate NEMT provider is not available.
• The Member refuses to cooperate in determining status of Medicaid eligibility.
• The Member is found to be ineligible for NEMT services based on the documented information that cannot be otherwise confirmed.
• The Member exhibits uncooperative behavior or misuses/abuses NEMT services.
• The Member is 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 arrive at the scheduled time. A dedicated phone line is available to call to find out the status of the ride. The line is called the “Where’s My Ride” line and the phone number to call is (866) 907-1494.

Once their appointment is finished, the member or someone at the medical provider’s office they visited must call the “Where’s My Ride” phone number at (866) 907-1494 and request that transportation be sent to pick-up the member. A transportation provider will be dispatched and will have 60 minutes to pick-up the member.

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

Urgent/Same Day trips can be booked through Modivcare 24 by 7. These trips must be for urgent conditions where a physician is requiring the member to be seen the same day or the next day. All Urgent/Same Day trips will be verified with the physician’s office for medical urgency. If it is a case where the trip was just not called in timely, then in those cases, the appointment should be rescheduled so that transportation can be booked providing the two-business day notice. Urgent and Same Day trips are required to be reserved through Modivcare’s Call Reservation Center at (866) 907-1493. Urgent and Same Day Reservations may not be ordered using the Facility “on-line” order entry service.

It is regularly reoccurring transportation for those members who need transport two (2) or more days per week for up to three (3) month’s duration (e.g., a Monday, Wednesday and Friday dialysis patient). To eliminate the need to call the reservation line to schedule every one of those trips, a standing order process and has been created. This allows a facility to arrange three (3) months’ worth of trips simply by filling out and faxing in the standing order form. At the end of those three (3) months, our Facility Department will call the healthcare facility and ask if the trip continues to be necessary. The facility will not have to submit a new standing order at that time unless the member’s mobility has changed.

The Standing Order Request Form should be faxed to the Modivcare Facility Dept. at (877) 352-5629.

Social workers, case managers or other licensed/certified medical professionals. If a member requests regularly reoccurring transportation for 3 or more days per week and 3 or more month’s duration, then the Facility Department will then contact the social worker or case manager to secure a Standing Order for the member.