Mtm mileage reimbursement 2026

1. Click ‘Get Form’ to open the mtm mileage reimbursement form in the editor.
2. Begin by entering your personal information in the 'Patient Info' section. Fill in your first name, last name, ForwardHealth ID number, address, city, state, zip code, and phone number.
3. In the 'Payment Info' section, specify who the ComData Card should be payable to and provide their relationship to you.
4. For each trip listed, enter the trip number obtained from MTM, Inc., along with the appointment date and time. Indicate whether it is a round trip or one-way.
5. Fill in the health care provider's name and contact details for each trip. Ensure that they sign off on the log to verify that you were seen for a Medicaid/BadgerCare Plus covered service.
6. Review all entries for accuracy before submitting. Make sure to keep a copy of your completed log for your records.

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