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Healthy Blue Medicaid Managed CareTransportation Request Form (Nonemergent ambulance transportation onlyPlease complete and fax to Healthy Blue. Facility fax: 18888225658 Facility telephone: 18774404065Date:Urgent

How to fill out nonemergent ambulance transportation only

How to fill out nonemergent ambulance transportation only

1. Collect all necessary medical information about the patient such as name, address, age, medical history, and any special medical conditions.
2. Contact the nonemergent ambulance transportation service provider to inquire about their specific requirements and procedures.
3. Provide the service provider with the patient's medical information and request a quote for the transportation cost.
4. Ensure that the transportation service is covered by the patient's insurance or arrange for alternative payment methods if necessary.
5. Schedule the transportation service according to the patient's needs and availability.
6. On the day of the transportation, ensure that the patient is ready and prepared for the journey.
7. Accompany the patient or arrange for someone to accompany them during the transportation if required.
8. Follow any specific instructions provided by the transportation service provider for a smooth and safe transfer.
9. Upon arrival at the destination, ensure that the patient is received by the appropriate medical personnel or caretaker.
10. Keep a record of the transportation details and any receipts or documents related to the service for future reference.

Who needs nonemergent ambulance transportation only?

1. Individuals who require specialized medical care or treatment in a nonemergent situation but are unable to travel by other means due to their medical condition or limitations.
2. Patients who do not have access to or are unable to use public transportation or private vehicles for medical appointments or treatments.
3. Elderly individuals who need assistance and medical supervision during transportation to and from medical facilities.
4. Patients with chronic illnesses or disabilities who need regular medical transportation for check-ups or follow-up appointments.
5. Individuals recovering from surgeries or medical procedures who are not yet fit to travel independently.

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What is nonemergent ambulance transportation only?

Nonemergent ambulance transportation only refers to transportation services provided by an ambulance for patients who do not require immediate medical attention or emergency care.

Who is required to file nonemergent ambulance transportation only?

Healthcare providers, facilities, or ambulance companies that provide nonemergent ambulance transportation services are required to file for this type of transportation.

How to fill out nonemergent ambulance transportation only?

To fill out nonemergent ambulance transportation only, providers need to submit detailed information about the patient, the reason for transportation, the destination, and the level of care required.

What is the purpose of nonemergent ambulance transportation only?

The purpose of nonemergent ambulance transportation only is to ensure that patients who do not require emergency care are safely and comfortably transported to their destination for medical appointments or other healthcare needs.

What information must be reported on nonemergent ambulance transportation only?

Information that must be reported on nonemergent ambulance transportation includes patient demographics, medical necessity, transportation provider information, pickup and drop-off locations, and the level of care provided during transportation.