Mileage Reimbursement Guidelines for Blue Cross
This document outlines the guidelines for mileage reimbursement for Blue Cross Community Centennial members. It includes necessary steps to request reimbursement and important information about the process. Ensure compliance with the outlined requirements to obtain your reimbursement.
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How do I fill this out?
To fill out this form, gather all necessary member information and ensure that your trip has been approved. Write down the Trip Number on the Mileage Reimbursement Form. Finally, submit the signed form to ModivCare within the required timeframe.
How to fill out the Mileage Reimbursement Guidelines for Blue Cross?
1
Gather necessary member information.
2
Request approval for your trip from ModivCare.
3
Fill out the Mileage Reimbursement Form.
4
Get the form signed by your provider's office.
5
Submit the completed form to ModivCare within 60 days.
Who needs the Mileage Reimbursement Guidelines for Blue Cross?
1
Members of Blue Cross Community Centennial who travel for healthcare services.
2
Patients needing reimbursement for transport to appointments.
3
Individuals who do not have alternative transportation options.
4
Caregivers driving members to medical appointments.
5
Those seeking to track and claim mileage expenses.
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What are the instructions for submitting this form?
To submit the Mileage Reimbursement Form, complete all required fields and ensure the document is signed by the healthcare provider's office. Mail the completed form to ModivCare at the address specified on the form, or alternatively, contact them directly via phone at 1-866-913-4342. It's advisable to keep copies of your submitted forms for your records.
What are the important dates for this form in 2024 and 2025?
It is crucial for users to be aware of submission deadlines. Ensure forms are submitted within 60 days of the appointment date for reimbursement consideration. Keep an eye on any changes or updates for the years 2024 and 2025.
What is the purpose of this form?
The purpose of this form is to set clear guidelines for Blue Cross Community Centennial members seeking reimbursement for mileage. It simplifies the process of claiming back transportation expenses incurred while attending healthcare appointments. Proper completion and timely submission ensure members receive their entitled reimbursement.
Tell me about this form and its components and fields line-by-line.
- 1. Member ID: The unique identification number assigned to the member.
- 2. Full Name: The full legal name of the member.
- 3. Mailing Address: The address where the member receives correspondence.
- 4. Home Address: The physical address where the member resides.
- 5. Trip Number: The reference number assigned by ModivCare for the trip.
What happens if I fail to submit this form?
Failure to submit the form can result in non-reimbursement of travel expenses. Ensure that the form is completed correctly and submitted within the designated timeframe. Not following the guidelines may lead to delays or denial of refunds.
- Late Submission: Forms submitted after 60 days from the appointment date will not be reimbursed.
- Missing Trip Number: Without a Trip Number, reimbursement requests cannot be processed.
- Unverified Appointments: If the provider's office fails to verify your attended appointment, reimbursement may be denied.
How do I know when to use this form?
- 1. Traveling to Appointments: Whenever you visit a healthcare provider, use this form to ensure your travel expenses are reimbursed.
- 2. Scheduled Treatments: For regular treatments or check-ups requiring travel, submit this form in advance.
- 3. Last-Minute Appointments: If you have an unplanned visit to a provider, fill out the form after gaining approval.
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