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Logisticare kansas 2026
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- Click ‘Get Form’ to open the Kansas Gas Mileage Reimbursement Trip Log in the editor.
- Begin by entering your name in the 'DRIVER NAME' field, followed by your relationship to the member and your mailing address.
- Input your phone number and complete the 'CITY/STATE/ZIP' section. If you are not the member, provide their name and ID number.
- Indicate whether this trip is a standing order by selecting 'YES' or 'NO'. Fill in the trip date and job number as required.
- For trips that are standing orders, circle the days traveled on the provided weekly calendar.
- List the medical provider's name and phone number. Ensure each date of service has a physician or clinician signature for reimbursement approval.
- Calculate total miles traveled and enter this information along with any additional provider details as needed.
- Finally, certify that all information is accurate by signing at the bottom of the form before submitting it for processing.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2014 | 4.5 Satisfied (54 Votes) |
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kansas mileage reimbursement form
Kansas City. Case Type. civil. Nature of Suit. Fair Labor Standards Act. Cause. 15:2(a) Fair Labor Standards Act. Party Names. Logisticare Solutions, LLC,
Dec 15, 2015 LogistiCare has held the brokerage contract since the inception of the program. Under Kansas redesigned NEMT program, each of the MCOsRead more