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MTM Trip Scheduling

(Includes Meridian, Harmony/Wellcare, Aetna and some Humana plans)

MUST BE DONE AT LEAST TWO BUSINESS DAYS AHEAD OF TIME

1. Complete a Petersen Trip Ticket before calling for a trip reservation. The MTM operator will ask for the following information so be sure to have it all written down:

a. Member’s name (resident)

b. Member’s date of birth

c. Member’s address (will be the facility name and address)

d. Member’s (facility’s) phone number

e. Member’s ID # (Medicaid number)

f. If in a wheelchair, combined weight of wheelchair and resident. Give the default weight of 200lbs

g. Provider’s name (the medical provider that they are seeing)

h. Provider’s address

i. Provider’s phone number

j. Time of the appointment (actual appointment time for verification)

k. Estimated return time (can be “left open” if unsure)

l. Facility’s fax number and DON’s name (for Level of Need forms)

2. Call one of these phone numbers and follow the prompts:

a. Meridian/MTM 1-844-299-6238

b. Harmony/Wellcare, Humana, Aetna 1-866-606-3700 (select Member not Provider)

3. Provide the operator with the needed information about the trip

a. Be sure that the operator lists the facility name in the resident address. This will be important for the home office.

4. If the resident is wheelchair bound or needs an attendant, MTM will need to obtain a LON (Level of Need) form. This is the same as the state’s CTS form. The MTM operator will ask for the medical provider’s fax number for this form but, per MTM, give them the facility’s fax number and DON’s name instead

5. Explain to the operator that this is a resident of a Petersen Health Care facility and that the facility van needs to be selected for transportation. The PHC vendor code is C344 . If they cannot find Petersen Health Care, tell them that the MTM supervisor has said that they may need to “force in” Petersen Health Care with the C344 vendor code. If there are continued problems, ask for a supervisor.

6. Write the trip log number provided down on the PHC trip ticket. The driver will need this trip number for the MTM daily driver’s log.

7. Make note of the scheduled pick-up time provided by the operator. This time will be used on the MTM daily driver’s log. If they don’t give you the scheduled pick up time, please ask for it.

Please have patience with this process. We are all learning the best system because MTM has never contracted with a company like ours before. If you run into troubles, ask to speak with a supervisor. If you feel that something else needs to be shared with all PHC facilities about ways to make the reservation process easier, please email mspears@ or call 309-689-5869.

MTM Daily Trip Log

o All drivers should have a MTM Daily Trip log to document any MTM managed trips. Here is a breakdown of how to complete the log

▪ Transportation Provider-Facility’s name /Petersen Health Care

▪ Date of Service, Driver’s License Number, Vehicle VIN are self-explanatory

▪ MTM Trip Number-provided at the time of scheduling. Suggested to use a PHC trip ticket when scheduling and write this number on it

▪ Recipient’s printed name-name of rider

▪ AM/PM of pick up- write AM or PM based on the time of pick-up

▪ Scheduled Pick-up time will be set when calling in the trip. Ask for it if they don’t tell you

▪ Pickup Arrival-time when the pickup/loading begins

▪ Pickup Departure-time when the vehicle is ready to pull away

▪ Drop off time-time when the unloading takes place at the medical provider’s address

▪ Member’s Signature-signature of the resident or community rider. The driver can write “PUTS” (stands for patient unable to sign) if the rider cannot sign for themselves

o Each “leg” of the trip has its own line. So, there will be a line for leaving the facility/home of a community rider and then a line for the return trip

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