Get Mi Logisticare Mileage Reimbursement Trip Log 2021-2025

Completing the MI Logisticare Mileage Reimbursement Trip Log is essential for users seeking reimbursement for their travel related to medical appointments. This guide provides clear, step-by-step instructions to help you accurately fill out the form online.

Follow the steps to complete the trip log effectively.

1. Click ‘Get Form’ button to access the mileage reimbursement trip log and open it for editing.
2. Enter the driver's name in the designated space provided on the form. Ensure the information is spelled correctly for identification.
3. Specify the driver's relationship to the member. This is important for processing the reimbursement.
4. Fill in the driver's mailing address, followed by the city, state, and ZIP code. Accuracy is important to ensure correspondence reaches you.
5. Provide the driver's phone number for any follow-up regarding the trip log.
6. If the member’s name differs from that of the driver, enter it in the space provided alongside the member ID number.
7. Record the trip date, which is key for validation purposes.
8. Assign a trip/job number. This can usually be found on your travel reservation or provided by the service.
9. List the name and phone number of the medical provider or clinician overseeing the appointment.
10. Ensure that the physician or clinician signs the form. This signature is necessary to confirm the validity of the trip.
11. Accurately note the total miles traveled for the trip. This will determine the reimbursement amount.
12. In the designated section, provide additional names and phone numbers as required, if traveling with multiple passengers.
13. Complete the total mileage to be paid and the total amount for this invoice.
14. Indicate the batch number and batch date for internal tracking of submissions.
15. Sign the document to certify that all information provided is true and accurate.
16. Once complete, save the changes and proceed to download, print, or share the form as needed.

Start filling out your MI Logisticare Mileage Reimbursement Trip Log online today for a smooth reimbursement process.