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Get La Pt 42 2014-2025
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How to fill out the LA PT 42 online
The LA PT 42 form is an essential document for prospective transportation providers in the Louisiana Medical Assistance Program. This guide will walk you through the process of filling out the form online, ensuring that you submit a complete application without unnecessary delays.
Follow the steps to complete the LA PT 42 form online.
- Click the ‘Get Form’ button to access the LA PT 42 document and open it in your preferred online editor.
- Complete the driver information section by providing the full name, date of birth, mailing address, parish, telephone number, and Social Security number of the driver.
- List the individuals you will transport, including their names and dates of birth. Note that you can include a total of up to five Medicaid recipients.
- In the verification section, check if you have a current Louisiana driver’s license and fill in the driver’s license number.
- Confirm that your vehicle has a current Louisiana state inspection sticker by checking the appropriate box and providing the license plate number.
- Ensure that you have liability insurance that meets the state's minimum requirements, and provide the name of your insurance company.
- Once all information is filled out, attest to the accuracy of your information by signing the form. Ensure that your signature is witnessed by two individuals who are not family members.
- After completing the LA PT 42, save your changes, download a copy for your records, and prepare to print or share the completed form as needed.
Complete your documentation online to ensure a smooth application process.
Per Mile Travel Allowance (HCPCS Code P9603) CR 6524 instructs that Medicare contractors will pay for HCPCS code P9603, where the average trip to the patients' homes exceeds 20 miles round trip, at a total of $1.00 per mile.
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