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DEPARTMENT OF HEALTH SERVICES Division of Medicaid Services F11237 (01/2022)STATE OF WISCONSIN Wis. Admin. Code DHS 106.13WISCONSIN MEDICAIDSPECIALIZED MEDICAL VEHICLE PROVIDERS AFFIDAVIT Wisconsin
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01
Gather all necessary information such as patient details, medical equipment needed, and destination.
02
Contact a specialized medical vehicle provider and provide them with the collected information.
03
Schedule the transportation for the patient ensuring all medical needs are accounted for.
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Ensure all required paperwork and authorizations are completed and handed over to the provider.

Who needs specialized medical vehicle providers?

01
Patients who require specialized medical care during transportation.
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Hospitals or medical facilities looking to transfer patients in a safe and timely manner.
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Specialized medical vehicle providers are companies or individuals who offer medical transportation services for patients with specialized medical needs.
Specialized medical vehicle providers are required to file their information with the relevant regulatory authorities or government agencies.
To fill out specialized medical vehicle providers, companies or individuals need to provide details about their services, vehicles, qualifications, and any other relevant information.
The purpose of specialized medical vehicle providers is to ensure that patients with specialized medical needs have access to safe and reliable transportation to and from medical appointments or treatments.
Information reported on specialized medical vehicle providers may include details about the company or individual providing the services, types of vehicles used, qualifications of drivers, and any certifications or accreditations.
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