Medicaid Transportation Justification Request
Every state must provide necessary transportation to and from the place of medical service to all beneficiaries. This benefit is regulated by state law. Generally, this transportation is the beneficiary’s usual vehicle. However, sometimes the condition of the beneficiary means that a special ambulette is required. In any case, the transportation must be medically appropriate and cost-effective.
The Medicaid Transportation Justification Request plays a very important role in this case as without this form a beneficiary will not have the chance to be provided with necessary transport.
What is the Medicaid Transportation Justification Request?
The Medicaid Transportation Justification Request is a form that filed when one wants to request transportation for a beneficiary. It is an official document that confirms the eligibility of the applicant to obtain a certain type of transportation.
There are two types: emergency and non-emergency. The first type refers to various injuries including burns and extreme trauma. Emergency transportation is dispatched after a 911 call. A non-emergency request is aimed at simply getting a beneficiary to a medical care institution.
When is the Medicaid Transportation Justification Request Due?
When filling out this form, an applicant must indicate if the requested transport is a long-term need of the beneficiary or a temporary one. The due date will be designated according to your choice.
Is the Medicaid Transportation Justification Request Accompanied by other Forms?
No, the Medicaid Transportation Justification Request may be submitted independently. However, sometimes you must provide more documents about the state of health of the beneficiary to confirm the necessity of getting an appropriate vehicle.
How do I fill in the Medicaid Transportation Justification Request?
First of all, the Medicaid Transportation Justification Request must include the name, date of birth, medical number, address, and telephone number of the patient. After that, you choose the mode of transportation needed: livery, ambulette ambulatory, ambulette wheelchair, stretcher van, BLS ambulance, or ALS ambulance.
The most important thing is to indicate the diagnosis of the patient which prompted the transportation justification request. Certification statement is also included so that the applicant can confirm that they understand and agree on possible results after the form is filed. The last part of the document consists of the following information: physician’s name, National Provider Identifier, date, telephone, hospital or clinic name, its address, the name of the person who completed the document, and a signature. The request can be rejected if it isn’t entirely complete.
Where do I send the Medicaid Transportation Justification Request?
The request must be signed by a medical doctor, nurse practitioner or physician’s assistant. The absence of a signature will mean the transportation request is rejected. After being signed, it must be sent to the New York Department of Health (Office of Health Insurance Programs) for consideration.