Get Application For Payment Of Duplicate Nemt Benefits. - Dhhr

This guide provides essential instructions for users on how to accurately complete the Application For Payment Of Duplicate NEMT Benefits from the Department of Health and Human Resources (DHHR) online. By following these steps, you will ensure a smooth and efficient submission process.

Follow the steps to complete the application accurately.

1. Press the ‘Get Form’ button to access the application and open it in your preferred editing tool.
2. Fill in your personal details in the designated fields, ensuring that you provide accurate information such as your full name, address, and contact number.
3. Provide your Medicaid identification number, if applicable, as this will identify your eligibility for the Non-Emergency Medical Transportation (NEMT) benefits.
4. Indicate the specific dates of travel for which you are requesting reimbursement. Ensure that these dates are within the allowable range, as specified by the policies.
5. List the providers and services you accessed during the indicated travel dates, providing details that correspond to your medical appointments.
6. Confirm that none of the requested reimbursement dates have previously received payment by double-checking your past application records.
7. Review your completed application for accuracy and completeness. It is crucial to ensure that all necessary information is included to prevent delays.
8. Once you have reviewed your application, you can save changes, download the document, print it, or prepare to share it according to your preferred method.

Take the first step to receiving your benefits by submitting your application online today.