Logisticare michigan 2026

1. Click ‘Get Form’ to open the Michigan Mileage Reimbursement Trip Log in the editor.
2. Begin by entering your name and mailing address in the designated fields. Ensure that your city, state, and ZIP code are accurate for proper correspondence.
3. If you are not the member, provide the member's name in the specified section. This helps in identifying the reimbursement request accurately.
4. Fill in the trip date and job number associated with your transportation service. These details are crucial for tracking purposes.
5. Complete the relationship to member field and include your phone number along with the member ID number for verification.
6. List the medical provider's name and phone number. This information is necessary for any follow-up regarding services rendered.
7. Ensure each date of service has a physician or clinician signature by adding their names and contact numbers as required.
8. Calculate total miles driven for reimbursement and enter this figure in the appropriate space provided on the form.
9. Finally, certify that all information is true by signing where indicated, ensuring compliance with reimbursement policies.

Start using our platform today to streamline your form completion process for free!