Get Logisticare College Park

This guide will help you effectively complete the Logisticare College Park mileage reimbursement form. Whether you are a first-time user or need a refresher, this step-by-step approach will clarify the process and ensure accurate submissions.

Follow the steps to successfully complete your mileage reimbursement form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information, including your full name, contact details, and AmeriHealth Caritas Louisiana member identification number. This information is crucial for processing your reimbursement request.
3. Next, document the details of your medical visit. Provide the date of the appointment, the name and contact number of the physician, and the reason for the visit. Ensure that this section is accurate, as the physician's verification is mandatory.
4. Record the mileage information. Calculate the total miles traveled from your location to the medical appointment and back. This is essential for determining the reimbursement amount.
5. In the trip log section, detail any additional necessary information regarding your transportation, such as the mode of transport and any special notes relevant to the trip.
6. Before completing the form, ensure that the physician has signed it, confirming your visit. Their signature is necessary for the processing of your reimbursement.
7. Once you have filled out all sections of the form, review it for any errors or omissions. Accuracy is key to avoiding delays in the reimbursement process.
8. Finally, save your changes, and then download or print the completed form. Once printed, send it to the LogistiCare Claims Department at the designated address: 503 Oak Place, Suite 550, College Park, GA 30349.

Complete your mileage reimbursement forms online to ensure a smooth reimbursement process.