New York Facility Network

New YorkFacility Network

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 TitleDescription
Logisticare's Responsibilities in New YorkLists the types of transportation and geographical regions that LogistiCare is responsible for.
New York Facility Brochure Explains the processes used to request transportation through the LogistiCare Facilities department.
Facility Key Telephone NumbersThe phone and fax numbers for reaching the LogistiCare Facilities department.
Gas ReimbursementExplains the criteria and how plan members are reimbursed.
Gas Reimbursement FormA form, which must be completed by a medical professional, when requesting transportation for a member that has access to a vehicle or can be transported by friend or relative.
Mass Transit Department, MetroCard Request FormA form used for a Mass Transit request.
Mass Transit Department, MetroCard Hospital-Facility Reimbursement Form A member reimbursement form which is utilized by Hospitals, Facilities, and programs who distribute MetroCards for reimbursement.
MLTC - Single Trip Reservation FormA form used to request a single trip for a plan member.
Form W-9, Request for Taxpayer Identification Number and CertificationIRS Form W-9 is used by a person who files information returns with the IRS to report transactions.
Standing Order Request FormA form used to request recurring transportation for a member that goes to the same facility three or more times per week.
Single Trip FormA form used to request a single trip for a plan member.
Physician’s Transportation Restriction FormA form, which must be completed by a medical professional, when requesting transportation for a member that is not able to utilize public transportation.
AmeriChoice Announcement to FacilitiesInforms AmeriChoice providers that effective November 1, all non-emergency transportation services for members with transportation benefits must be pre-arranged through LogistiCare.
AmeriChoice Announcement to Transportation ProvidersInforms AmeriChoice transportation providers that effective November 1, LogistiCare will be arranging and providing all transportation for AmeriChoice members.
WellCare of New York, Inc. Announcement to FacilitiesInforms WellCare of New York Health Plan providers that effective December 1, 2010, non-emergency transportation services will be coordinated by LogistiCare.
Affinity Announcement to FacilitiesInforms Affinity Health Plan providers that effective November 1, all non-emergency transportation services for Medicaid, Medicare Advantage, and Medicaid Advantage members with transportation benefits must be pre-arranged through LogistiCare.
Amerigroup Announcement to FacilitiesInforms Amerigroup Health Plan of New York providers that effective November 1, all non-emergency transportation services for Medicaid, Medicare and MLTC members with transportation benefits must be pre-arranged through LogistiCare.
Nassau County Medicaid Announcement to FacilitiesInforms Nassau County Medicaid providers that effective January 1 2012, all non-emergency transportation services for members with transportation benefits must be pre-arranged through LogistiCare
Nassau County Medicaid -Single Trip FormA form used to request a single trip for a plan member.
Nassau County Medicaid- Closest Provider Form A Form to request the approval of medical transportation outside Nassau County’s Common Medical Marketing Area CMMA
Nassau County Medicaid Facsimile Cover Sheet A Form used by facilities when a fax is emailed to LogistiCare
Nassau County Physician’s Transportation Restriction Form A form, which must be completed by a medical professional, when requesting transportation for a member that requires transportation to and from a medical appointment
Nassau County Medicaid -Standing Order Request FormA form used to request recurring transportation for a member that goes to the same facility three or more times per week

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