Trip logs 2026

See details

4.4 out of 5

181 votes

The document outlines the process for submitting a Reimbursement Trip Log for Medicaid/CSHCN covered services. It details the necessary steps to obtain reimbursement, including calling MTM for a trip number, submitting required documentation, and ensuring forms are completed correctly. The document also specifies reimbursement timelines, eligible healthcare professionals for signing the log, and instructions for recording multiple trip legs.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out trip logs with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Reimbursement Trip Log in the editor.
Begin by filling in the Recipient Info section. Enter the First Name, Last Name, Address, City, State, Zip, Phone number, and Medicaid/CSHCN ID #.
In the Payment Info section, specify how you want your Re-Loadable Debit Card made payable and provide any additional required details.
For each trip leg, enter the Appointment Date and Time. Indicate whether it is a one-way or round trip and provide the Medical Provider's Name and Address.
Ensure that a healthcare provider signs each trip log entry. This can be done by having any enrolled Medicaid/CSHCN professional sign off on the service provided.
Review all entries for completeness. Incomplete forms cannot be processed, so double-check that all necessary information is filled out correctly.
Finally, keep a copy of your completed Trip Log for your records before submitting it via mail or fax as instructed.

Start using our platform today to easily fill out your trip logs online for free!

See more trip logs versions

We've got more versions of the trip logs form. Select the right trip logs version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (167 Votes)
2015	4 Satisfied (50 Votes)
2014	4.4 Satisfied (181 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the best app for tracking mileage?

The 5 Best Mileage Tracker Apps of 2025 Connecteam Best for Mileage Tracking With All-in-One Field Management. Everlance Best Standalone App for Business Mileage and Expenses. Triplog Best for Multi-Vehicle, Multi-Driver Businesses. MileIQ Best for Set-and-Forget Automatic Tracking.

What is a TripLog and how is it used?

TripLog is a mileage-tracking platform for individuals and businesses that automatically records, categorizes, and reports driving activity. Using your smartphones GPS, TripLog detects each drive in the background, prompts you to classify business vs. personal trips, and syncs your data to the cloud.

What is the TripLog function?

A trip log is a detailed account of all the journeys you, as an employee, have made with your car. Think of it as a logbook that outlines how and when the car was used, the distance covered, and who was behind the wheel. It also helps you keep track of whether the trip was for business or personal purposes.

What is a TripLog used for?

TripLog is a leading mileage and expense tracking solution built for individuals, teams, and organizations. With automatic mileage tracking, bank and credit card integrations, OCR receipt capture, and more, TripLog simplifies employee reimbursements and maximizes tax deductions.

What is a TripLog?

Automatic Mileage Tracker App. TripLog automatically tracks your mileage, making mileage reimbursement and keeping a mileage log for taxes a breeze. TripLog is the markets best mileage tracker app.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

Is TripLog free?

Yes, TripLog offers free mileage tracking. It includes unlimited manual and automatic trip tracking, but advanced features are locked behind paid plans.

Trip logs 2026

Here's how it works