Get Mileage Reimbursement Trip Log And Invoice Mail To ...

The mileage reimbursement trip log and invoice is an essential document for requesting reimbursement for travel related to medical appointments. This guide provides step-by-step instructions on how to complete this form online, ensuring accuracy and compliance for your submission.

Follow the steps to fill out the mileage reimbursement trip log and invoice

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your driver name in the designated field. This is the name of the person requesting reimbursement.
3. Specify your relationship to the member in the corresponding field. This information helps identify your connection to the individual for whom you are providing transportation.
4. Fill in the driver mailing address, ensuring it is current and accurate for communication.
5. Provide your phone number in the designated area to enable contact if necessary.
6. Complete the city, state, and ZIP code fields to give your full address.
7. Input your driver's license number in the given space to confirm you are eligible to drive.
8. Enter the member ID number associated with the person you are transporting.
9. Certify that you have a valid Virginia driver’s license and that your vehicle meets the inspection and insurance requirements by affirmatively checking the appropriate box.
10. Indicate if the trip is a standing order by answering yes or no and circle the days traveled weekly.
11. List all providers' names and phone numbers. This includes any healthcare professionals relevant to the trip.
12. Ensure you obtain the physician or clinician's signature on each date of service for reimbursement approval.
13. Input the total mileage to be paid along with the total amount for this invoice.
14. Fill out the batch number and batch date to properly classify your submission.
15. Remember to certify the accuracy of the information provided by adding your name and signature in the final section.
16. Once all sections are completed, users can save their changes, download the form for their records, print it for submission, or share it as necessary.

Complete your mileage reimbursement trip log and invoice online to ensure timely processing of your reimbursement.