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  • La Pt 42 2014

Get La Pt 42 2014-2025

Icaid Recipient Name Date of Birth (mm/dd/yyyy) 1. / / 2. / / 3. / / 4. / / 5. / / Medicaid Plastic Card Control Number(16 digit CCN Number on Medicaid Card) Check off the boxes and fill in the information below: A . I have a current Louisiana Driver s license that is not suspended or revoked. Yes No Driver s License Number: B. I have a current Louisiana State inspection sticker on my car. Yes No Car License Plate Number: C. I carry liability i.

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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.

  1. Click the ‘Get Form’ button to access the LA PT 42 document and open it in your preferred online editor.
  2. 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.
  3. 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.
  4. In the verification section, check if you have a current Louisiana driver’s license and fill in the driver’s license number.
  5. Confirm that your vehicle has a current Louisiana state inspection sticker by checking the appropriate box and providing the license plate number.
  6. Ensure that you have liability insurance that meets the state's minimum requirements, and provide the name of your insurance company.
  7. 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.
  8. 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.

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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.

Scheduling medical transportation and being reimbursed through our gas reimbursement program is easy! Your friend, neighbor or relative will be reimbursed $.40 per mile from your residence to your medical appointment and for your return trip home.

What expenses will the Medicaid program reimburse? The Medicaid program will reimburse for the pre-approved round-trip loaded miles to and from your qualified medical appointment. ... Please see the Non-Compensable Expenses section below for those expenses not considered reimbursable by the Medicaid program.

If an applicant is eligible and the services received are those that are covered by Medicaid, Medicaid will pay the unpaid medical and care bills. In some states, Medicaid will cover bills that have previously been paid (so that the care providers may reimburse payers).

Mileage, meals, and lodging are covered while receiving Medicaid-covered medical care outside the client's community. Mileage is a set amount per mile for a Medicaid client to travel in a privately owned vehicle. Allowances for meals and lodging are also a set amount.

You may have to pay Medicaid back if: Bills were paid when you were not eligible for Medicaid. If you are age 55 or older, the state may recover what has been paid in medical services from your estate after you pass away.

For example, in Florida, where several national brokers such as Logisticare and MTM are thriving, making more money with the expansion of Obamacare, one provider is currently making almost $40 per one-way wheelchair plus $2.50 per mile for a minimum of 7 miles.

The Medicaid program is jointly funded by the federal and state governments, and the federal government pays states for a specified percentage of expenditures, called the FMAP. FMAP rates vary by state based on criteria such as per capita income.

Medicaid covers a lot of the same medical services a traditional health insurance plan would. Hospital care and doctor visits are paid for with low or no copays for adults and children alike. ... Health services that Medicaid will pay for in full are: Emergency care.

Medicaid covers the cost of emergency medical transportation for eligible individuals. ... This coverage is called non-emergency medical transportation, because it does not involve a medical emergency. Medicaid may give you a ride if you do not have a car that works or do not have a driver's license.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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