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Logisticare gas reimbursement schedule michigan 2011 form

Logisticare gas reimbursement schedule michigan 2011 form-2025

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The document is a Michigan Gas Mileage Reimbursement Trip Log that requires drivers to provide details such as their name, address, trip date, job number, and medical provider information. It mandates physician or clinician signatures for each service date to ensure reimbursement approval. The log must be submitted to the LogistiCare Claims Department along with total mileage and invoice amount.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (111 Votes)
2019	4.4 Satisfied (199 Votes)
2016	4.4 Satisfied (113 Votes)
2011	4.4 Satisfied (192 Votes)

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How to fill out a mileage reimbursement form?

0:14 1:08 Navigate to the trip card and click arrive and sign. If prompted enable location. Services. ThisMoreNavigate to the trip card and click arrive and sign. If prompted enable location. Services. This will allow you to submit for reimbursement faster.

How to fill out a Modivcare form?

Example of mileage reimbursement Company ABC pays its sales staff 58 cents per mile driven to and from customer locations. As an employee, you are sent to meet with XWY Builders, a round-trip journey of 50 miles. Using the companys cent-per-mile formula, you would receive 0.58 cents X 50.

How much does modivcare pay for gas reimbursement?

Effective January 1, 2024, the mileage reimbursement rate changed from 65.5 cents to 67 cents per mile as directed by Internal Revenue Service (IRS). Effective January 1, 2024, the mileage reimbursement rate changed from 65.5 cents to 67 cents per mile as directed by Internal Revenue Service (IRS).

How to fill out modivcare mileage reimbursement form?

How to fill out the ModivCare Mileage Reimbursement Instructions? Receive a trip number when scheduling your appointment. Fill out the entire reimbursement form excluding the physicians signature. Obtain a signature from your healthcare provider on the form. Submit the form via mail, email, or fax.

How does mileage reimbursement work for Modivcare?

How to fill out the Modivcare Mileage Reimbursement Form Instructions? Collect all required information about the driver and member. Fill in the trip details including date, job number, and medical provider. Ensure that each entry has the necessary signature from a physician or clinician.