Florida Facility Network

FloridaFacility Network

Downloads

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 TitleDescription
Florida Toll Free Reservations & Ride Assist Phone NumbersThis contains the contact information for the programs LogistiCare services.
Medicaid Beneficiary Intake FormThis is the Beneficiary intake form for Medicaid members.
Medical Provider and Member Electronic Data Interchange (EDI) ProgramTransportation reservations can be arranged by facilities and members. This outlines the program.
Member Services Website DirectionsThis gives the directions for members to access and utilize the website to make reservation.
Medical Facility EDI Administrator User FormThis is the form for facilities to register their facility and use the website for reservations.
Mileage Reimbursement Guidelines & Mileage Reimbursement Pay ScheduleMany programs offer Mileage Reimbursement. The program is outlined in this download and the payment schedule for the Mileage Reimbursement program.
Mileage Reimbursement Trip LogThis is the log sheet for recording scheduled appointments. When completed this sheet is submitted for reimbursement.
FL Child Consent FormFL Child Consent Form
FL Physician Transportation Restriction FormFL Physician Transportation Restriction Form
FL Single Trip RequestFL Single Trip Request
FL Standing Order FormFL Standing Order Form
AHCA beneficiary handbook (non MMA)Provides information on how to access transportation, beneficiary rights and responsibilities and other program information.

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