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SIGNATURE DOCUMENT FOR
HEALTH AND HUMAN SERVICES COMMISSION
CONTRACT NO. HHS001033900003
The Contract for FeeForService (FFS) Nonemergency Medical Transportation
(NEXT) Demand Response Transportation
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How to fill out medical transportation fee-for-service demand
How to fill out medical transportation fee-for-service demand
01
Contact the medical transportation provider to determine if they accept fee-for-service demands.
02
Provide the necessary information such as date, time, pick-up location, drop-off location, and any special requirements.
03
Submit the fee-for-service demand form to the appropriate department or individual at the medical transportation provider.
04
Wait for confirmation of the demand and any additional instructions or requirements.
Who needs medical transportation fee-for-service demand?
01
Individuals who require specialized medical transportation services on a one-time basis.
02
Healthcare facilities that need to arrange transportation for their patients for specific appointments or treatments.
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What is medical transportation fee-for-service demand?
Medical transportation fee-for-service demand refers to the request or requirement for healthcare providers to bill and receive payment for non-emergency medical transportation services provided to patients under specific fee-for-service programs.
Who is required to file medical transportation fee-for-service demand?
Healthcare providers and transportation service companies that deliver medical transportation services to patients and are seeking reimbursement for those services are required to file the medical transportation fee-for-service demand.
How to fill out medical transportation fee-for-service demand?
To fill out the medical transportation fee-for-service demand, providers must complete the appropriate forms with details such as patient information, type of transportation provided, date of service, and any necessary supporting documentation to justify the request for payment.
What is the purpose of medical transportation fee-for-service demand?
The purpose of medical transportation fee-for-service demand is to ensure that healthcare providers can be reimbursed for the transportation services they provide to patients, thereby helping to facilitate access to necessary medical care.
What information must be reported on medical transportation fee-for-service demand?
The information that must be reported includes the patient's demographic details, transport origin and destination, medical necessity justification, mode of transportation, dates of service, provider information, and any relevant billing codes.
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