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  • Nc Dhb-5048 2022

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MEDICAID TRANSPORTATION EXCEPTION VERIFICATION Section 1 Identifying Information (DSS completes) County Department of Social ServicesDate Beneficiary Name Address Date of Birth Medicaid.

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The county department of social services shall render a decision on an individual's application for Medicaid within 45 calendar days from the date of application, except for applications in which a disability determination has already been made or is needed.

Medicaid is required to assure transportation to medical appointments for all eligible individuals who need and request assistance with transportation. Transportation will be available if the recipient receives a Medicaid covered service provided by a qualified Medicaid provider (enrolled as a NC Medicaid provider).

Medicaid passengers must obtain approval from DSS prior to scheduling (call 919-560-8607). To schedule transport, phone 919-489-8521, with as much advance notice as possible.

ModivCare: Transportation provider shall submit a W-9, Account Setup Agreement, and the trip information (run sheet, driver log, etc.) to ModivCare securely at ncnetwork@modivcare.com or may request authorization by calling 855-397-3604.

The NCFAST-20020 is a prepopulated renewal form for the beneficiary to validate that current information remains the same or indicate changes and provide self-attestation of eligibility requirements, including income.

For information about your ride after you set it up, call Ride Assist at 855-397-3602. Use this number to activate a Will Call pickup, or if your transportation is late for a scheduled pickup.

Help for urgent trips If you need transportation services right away, call ModivCare at 855-397-3602.

Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. Calls are recorded to improve customer satisfaction. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232