Toggle navigation
Home
Enrollees
Overview
FAQ's
Downloads
News Bulletins
Medical Practitioners
Overview
FAQ's
Downloads
News Bulletins
Transportation Providers
Overview
FAQ's
Downloads
News Bulletins
Learn More
Contact Us
Long Island
Medicaid Ride
Back to LogistiCare.com
|
Secure Site Log in
Documents
Title
Description
Nassau and Suffolk County Transportation Providers
Transportation Providers servicing Nassau and Suffolk Counties
Download
Facility Services Web Portal Admin User Form
Request Form to Setup an Administrator Account for Requesting Transportation Online
Download
Form 2015, Medical Justification (Adobe PDF format)
Medicaid Transportation Justification Request Form. There is no trip information on this form.
Download
DOH Introduction Letter
List of Medicaid Covered Services in Nassau and Suffolk Counties
Download
Standing Order Request Form with Treatment Types DOH Revisited 04-16-15.
To request NEMT for fee for service enrollees needing regularly reoccurring transport one or more times per week for one or more months duration to a Medicaid covered service. Has 2015 attestation, and space to name the transportation provider.
Download
Logisticare Hospital Discharge Checklist
Information needed by Logisticare when calling in and scheduling a discharge.
Download
List of Medicaid Covered Service
List of Medicaid Covered Services in Nassau and Suffolk Counties
Download
Medicaid Transportation Request Fax Form With 2015 Attestation (called "Transportation Request Fax Form (3/5/15)")
LogistiCare Transportation Request fax form, for multiple trips, with the 2015 attestation (called "Transportation Request Fax Form (3/2012)"). Gives space for naming the transportation provider.
Download
NYDOH Approved Trip Reservation Call Script
Call Script that will be used by LogistiCare agents during trip request intake
Download
Nassau Suffolk DOH Webinar
Non-Emergency Medical Transport Webinar
Download
Quick Reference sheet for facilities.
Facility handouts for enrollees in 4 languages
Download
Long Island Requirements for the Quality of Transportation Services.
Requirements for participation as a Medicaid Transportation Provider.
Download
Referral to Another Medical Site Transportation Request Fax Form
Medical transportation request fax form to use when referring an enrollee to another medical practitioner.
Download
What LogistiCare is responsible for.
Key terms, phone numbers, and explanations for services provided by LGTC in Long Island
Download
NYS DOH Care Plan Grid for Social & Non-Medical Transportation by TBI & HARP enrollees
Care Plan Grid required by NYS DOH to be submitted for Transportation of TBI Waiver & HARP Participants
Download
Social Transportation Guidance for the Traumatic Brain Injury (TBI) Waiver Program
Guidelines for Approving Requests for Social Transportation of Persons Enrolled in the Traumatic Brain Injury (TBI) Waiver Program.
Download
List of Medicaid Covered Services.
List of Medicaid Covered Services in Nassau and Suffolk Counties.
Download
Outside Common Medical Market Area Form
NYDOH .form necessary to approve trip requests Outside the Nassau and Suffolk Counties Medical Market Area
Download
‹
›
×