IEHP Transportation Request Form (SNF & LTC) 2017-2024 free printable template

Transportation Request Form (SNF & LTC) TODAYS DATE:* IEP ID#:* NAME: Member Height:Member Weight: (Height & Weight needed only if Member is going by Wheelchair/ Gurney)Track to Ventilator; Suctioning:SPECIAL

How to fill out iehp transportation request form

How to fill out iehp transportation request:

1. Obtain the iehp transportation request form from the relevant healthcare provider or insurance company.
2. Fill in your personal information such as your name, address, phone number, and member ID.
3. Provide the details of the appointment or medical service that requires transportation, including the date, time, and location.
4. Indicate the type of transportation needed, such as wheelchair-accessible van or regular car.
5. If necessary, specify any special requirements or accommodations needed during the transportation, such as assistance or medical equipment.
6. Sign and date the form to indicate your consent and agreement with the provided information.
7. Submit the completed iehp transportation request form to the designated authority or transportation provider.

Who needs iehp transportation request:

1. Individuals who have a healthcare plan with iehp.
2. Patients who are unable to drive or arrange their own transportation to medical appointments or services.
3. People with mobility limitations or medical conditions that require specialized transportation assistance.

Video instructions and help with filling out and completing iehp transportation request

Instructions and Help about iehp transportation form snf

Holland a healthy welcome to you from IEP your Inland Empire Health Plan With all the health benefits and services we provide we believe you should know how they work And the best way to use them So in the next few minutes well Glover your benefits with IEP DualChoice Cal Disconnect Plan Medicare-Medicaid Plan that puts your benefits from both Medicare and Medical together Lets start with your core benefits They include doctor visits specialist care hospital care prescriptions labs Andorrans durable medical equipment and more There's also preventive warlike checkups And vaccinations You also get medicine at low or no-cost IEP DualChoice covers long-term services and supports benefits These help you liven your own in the community You may qualify for in-home supportive services multi-purposesenior services program community based adult services and skilled nursing facility On top of your core benefits you also get extra benefits for zero dollars me tell you about them Extra benefit one Dental Care by Delta Dental It covers dentures including partials crowns and root canals Plus up to two oral exams and cleanings each year And unto one dental x-ray each year Extra benefit two Vision care100 limit every two years for contact lenses and eyeglasses including frames and lenses Extra benefit three Transportation IEP DualChoice covers thirty one-way trips each year to a medical location approved by IEP DualChoice Simply put when you have medical appointment now you have a ride Free bonus a care manager This person guides you to the services you need Get the most out of your health coverage with IEP DualChoice Sign up for one of our much health education classes and programs Most are free And they can show you how to feel healthy Choose from Asthma Healthy Heart Diabetes Stop smoking Weight Loss and more To sign up call IEP DualChoice Member Services Get extra free benefits like the IEP 24-hour nurse advice line Call when you can't reach your doctor or need help after hours You'll get helpful advice for minor sprains aches pain colds or flu Another free benefitMember Services With IEP you get friendly service Call us if you have a question about your health benefits Were here to help There you have it A look at your benefits with IEP DualChoice Remember Your plan benefits help you feel healthy Use them now Look in your member handbook for more details about your health benefits go to wwwiehporg Of course you can always call IEP DualChoiceMember Services The number is on the back of your IEP Member ID Card Let IEP show you how to get the most out of your health benefits Watch the rest four how-to programs online with topics like how to get your medicine getting care after hour sand getting care from your doctor Thank you for watching

People Also Ask about iehp transportation request

What is the number for LA Care transportation?

L.A. Care will work with you and your Provider to find the transportation service that best fits your needs and to schedule a ride. Call L.A. Care Member Services at 1-888-839-9909 to learn more about your transportation options and how to schedule a ride.

Can you have Medi-Cal and IEHP at the same time?

IEHP DualChoice will cover many of the Medicare and Medi-Cal benefits you get now, including: All Medicare covered services, doctors, hospitals, labs, and x-rays. You will have access to a Provider network that includes many of the same Providers as your current plan. Prescription drugs covered by Medicare.

Does IEHP cover labor and delivery?

IEHP offers these types of services: Hospice and palliative care* Hospitalization* Maternity and newborn care.

Is IEHP the same as medi-cal?

IEHP is the health plan for Medi-Cal recipients in San Bernardino County. We are dedicated to providing our Members and local communities with optimal care and vibrant health.

Is IEHP Medicare or Medicaid?

IEHP is one of the top 10 largest Medicaid health plans and the largest not-for-profit Medicare-Medicaid plan in the country. It is the largest Local Initiative plan in the Inland Empire region, serving more than 90% of the Medi-Cal managed care market compared to its commercial counterpart, Molina Healthcare.

What are the two types of Medi-Cal?

You should keep this guide and use it when you have questions about Medi-Cal. California offers two ways to get health coverage. They are “Medi-Cal” and “Covered California.” Both programs use the same application.

Does IEHP help with housing?

Inland Empire Health Plan (IEHP) offers Community Supports, which are special care options. These may be offered (instead of state plan-covered services) to qualified Members at medium to high levels of risk. You may find that Community Supports with IEHP can help during a transition in housing or care.

For pdfFiller’s FAQs

Who is required to file iehp transportation request?

The individual who requires transportation services to access medical care must file the IEHP Transportation Request. This can be done either online or by fax.

What is the penalty for the late filing of iehp transportation request?

It is not possible to answer this question as the exact penalty for late filing of an IEHP Transportation Request will depend on the specific circumstances and the policies of the local IEHP office.

What is the purpose of iehp transportation request?

The purpose of an IEHP Transportation Request is to provide IEHP members with access to medically necessary transportation services to and from scheduled appointments. This includes services such as non-emergency medical transportation, taxis, bus passes, and wheelchair van services.

What is iehp transportation request?

IEHP Transportation Request refers to the process of requesting transportation services from Inland Empire Health Plan (IEHP). IEHP is a not-for-profit health plan that provides healthcare services to eligible individuals in Riverside and San Bernardino counties in California, USA. IEHP Transportation Request allows IEHP members who have enrolled in a specific transportation benefit to request transportation assistance for medical appointments, such as doctor visits, hospital visits, and other healthcare-related trips. The transportation services are usually provided through contracted transportation providers such as taxis, public transportation, ambulances, or non-emergency medical transportation companies. The member typically fills out a transportation request form, providing details of the appointment, their preferred mode of transportation, and any special needs or accommodations required. The request is then reviewed and approved by IEHP, and the member is informed about the transportation arrangement for their medical appointment. IEHP Transportation Request is aimed at ensuring that eligible members have access to necessary medical services, even if they face transportation barriers. It helps support their healthcare needs and promotes timely and efficient access to medical care.

How to fill out iehp transportation request?

To fill out an IEHP (Inland Empire Health Plan) transportation request, you need to follow these steps: 1. Download the transportation request form: Go to the IEHP website or contact their customer service to obtain a copy of the transportation request form. Ensure you have the latest version. 2. Fill out personal information: Start by providing your personal information, including your full name, address, phone number, IEHP member ID, and date of birth. Double-check the accuracy of the information. 3. Indicate appointment details: Specify the details about your appointment. Include the date, time, and location of the appointment. Also, mention the reason for the visit (e.g., doctor's appointment or therapy session). 4. Mention companion requirement: If you require assistance or a companion to accompany you, indicate that request on the form. 5. Choose the mode of transportation: Select the transportation mode that best suits your needs. Options may include van transport, non-emergency medical transportation, or public transportation. Tick the appropriate box based on your preference. 6. Provide supporting documentation: Depending on your request, you may need to attach supporting documentation. This might include a doctor's note or a prescription indicating the need for transportation assistance. 7. Get the healthcare provider's confirmation: Ask your healthcare provider to certify and sign the transportation request form. Their signature is required to ensure the validity and necessity of the requested transportation assistance. 8. Submit the form: Once you have completed the transportation request form, ensure it is filled out accurately and signed. Submit the form through the designated submission method mentioned on the form, such as mail or fax. Remember to keep a copy of the completed form for your records. Additionally, it's advisable to contact IEHP or review their website for any specific guidelines or requirements related to transportation requests.

What information must be reported on iehp transportation request?

The specific information required on an IEHP (Inland Empire Health Plan) transportation request may vary depending on the organization and specific requirements. However, some common information typically included in an IEHP transportation request may include: 1. Member Information: This includes the name, member ID, date of birth, and other relevant personal details of the individual needing transportation services. 2. Appointment Details: The date, time, and location of the medical appointment or service for which the transportation is required. 3. Medical Facility Information: The name, address, and contact details of the medical facility where the appointment is scheduled. 4. Medical Necessity: A brief explanation or documentation specifying why transportation assistance is required, such as the member's physical condition, mobility limitations, or medical treatments received. 5. Transportation Preferences: Any specific transportation preferences requested by the member, such as the need for a wheelchair-accessible vehicle, accompaniment by a caretaker, or any other special requirements. 6. Contact Information: The name, phone number, and email address of the person making the transportation request, as sometimes further communication may be needed. It is essential to consult the specific guidelines and requirements of the relevant IEHP transportation program or provider to ensure accurate and complete reporting of information on the transportation request form.

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