Intelliride Colorado Forms Pdf. They accept trip reservations and arrange member rides for covered

They accept trip reservations and arrange member rides for covered services with qualified transportation providers. Your regional organization is on your enrollment letter, Health First Colorado ID, and on the PEAK and Health First Colorado Mobile App. IntelliRide considers the requirements set by Health First Colorado and input from the patient’s medical provider to approve or deny a Medical Certificate of Transportation Services. Dear Medical Professional: This form will be used to determine the members most appropriate mode of transportation based on his or her functional abilities and limitations. To qualify for reimbursement, your trip must be scheduled with IntelliRide, assigned to mileage reimbursement, and your medical provider must verify your Once your trip is completed, you can email the form to claims. Transportation scheduling and services are provided throughout Colorado by Intelliride. Verification form for transportation services more than 25 miles The member’s medical provider must complete this form to verify the medical necessity of trips that exceed 25 miles, one way. ; their affiliates, parent entities and subsidiaries as Additional Insureds. 8622 or mail it to 2222 Cuming Street, Omaha, NE 68102. o Client must schedule trip with Transdev prior to the appointment.

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