Presbyterian mileage reimbursement form 2026

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  1. Click ‘Get Form’ to open the presbyterian mileage reimbursement form in the editor.
  2. Begin by entering your Employee Name and Member Number in the designated fields. This information is crucial for identifying your request.
  3. Fill in your Work Telephone and Home Telephone numbers to ensure that you can be contacted if there are any questions regarding your submission.
  4. Provide your complete Mailing Address, including street number, name, city, state, and zip code. Accurate details will facilitate smooth communication.
  5. In the section for Reimbursable Expenses, list each service date along with the type of service and amount incurred. Ensure that all entries are clear and legible.
  6. Attach original itemized receipts as required. For smaller receipts, tape them to an 8 ½ X 11 paper for clarity.
  7. Review all entries for completeness before signing the form at the bottom. An incomplete form may delay processing.

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All Medicaid beneficiaries, who are eligible for transportation services and DO NOT receive transportation services through a managed care plan, should contact Verida to schedule a ride. Beneficiaries may docHub the Fee-For-Service broker, Verida, at 1(855)325-7626.
Transportation services through BCBSNM contractor, LogistiCare: trip must be medically necessary (doctor appointments, dialysis, counseling). To reserve a ride, call 1-866-913-4342, M-F 8-5; Hearing Impaired (TTY): 1-866-288-3133. Must reserve 3 business days (72 hrs.)
How do I contact Medicaid transportation services? If customers or providers have complaints about Medicaid transportation services or other medical transportation services, contact the Department of Health by e-mail at or by phone at (518) 473-2160.

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The Alabama Medicaid Agencys Non-Emergency Transportation program helps eligible recipients pay for rides to dental and doctor offices, hospitals and other medical facilities when the service is also covered by Medicaid.
Payer Name: Presbyterian Health Plan|Payer ID: PREHP|Professional (CMS1500)/Institutional (UB04)[Hospitals]
To schedule transportation: Call us at 1-844-879-7341.

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