To get paid for driving yourself to a covered medical appointment, the MTM mileage reimbursement trip log has to reach MTM within 60 days of the oldest trip on it, filled in completely, signed by a healthcare professional at the facility, and tied to a trip number you got by calling MTM on or before the day of the visit.1MTM. Gas Mileage Reimbursement2MTM. Reimbursement Trip Log Miss any one of those pieces and the form gets rejected.
Call MTM for a Trip Number First
Before you drive to your appointment, call MTM to get a trip number. The call has to happen on or before the day of the medical visit. The phone number is on the back of your health plan card, or you can reach MTM through member services. Write the trip number down as soon as you get it. It goes on the log, and without it the form cannot be processed.2MTM. Reimbursement Trip Log
Fill Out the Log Section by Section
Download and print the log from MTM’s member portal, or request a paper copy by phone. The form has three parts: member info, payment info, and trip entries.2MTM. Reimbursement Trip Log
At the top, put your first and last name, Medicaid number, address, and phone number. In the payment section, name the person who should be paid. If you drove yourself, choose “Self” under the relationship field. If someone else drove you, enter that driver’s name, date of birth, address, and phone number. Your health plan sets the rules for who can be paid as a driver, so check the plan’s trip log instructions if you’re not sure.
Each log has room for up to seven trip legs. For every leg, record the trip number MTM gave you, the appointment date and time, whether it was round trip or one way, your pickup address, and the healthcare provider’s name, address, and phone number. Do not try to track your own mileage. MTM calculates the distance from the addresses you enter.1MTM. Gas Mileage Reimbursement
At the bottom, sign and date the member certification. If a parent, legal guardian, or representative is filling out the form for the member, that person signs instead.
Get the Provider Signature at the Visit
A healthcare professional at the facility has to sign the log to confirm you were there. It does not have to be your doctor. Nurses, therapists, physician assistants, and nurse practitioners can all sign.2MTM. Reimbursement Trip Log Bring the log to the appointment and get the signature before you leave. Coming back for it later is difficult.
If you forget the log or cannot get a signature on the spot, ask the provider’s office for a note on their letterhead stating that you were seen and the date of the visit. Attach that note to your completed log in place of the signature line.2MTM. Reimbursement Trip Log
Submit the Log Within 60 Days
The completed log has to reach MTM within 60 days of the oldest trip on it. Late submissions can be denied outright, and even a log that arrives close to the deadline leaves no time to fix errors.1MTM. Gas Mileage Reimbursement You have three ways to send it in:
- Mail to MTM Health, Attention: Trip Logs, 16 Hawk Ridge Drive, Lake St. Louis, MO 63367. Build in several days of transit time.1MTM. Gas Mileage Reimbursement
- Fax to 1-888-513-1610. Keep the transmission confirmation page as proof of when you sent it.
- Upload through the MTM member portal by logging in, choosing the trip log submission option, and attaching a scan or clear photo of the completed form.3Wisconsin Department of Health Services. Non-Emergency Medical Transportation Gas Mileage Reimbursement
Faxing or uploading creates an immediate timestamp, which helps if there’s ever a question about when the log arrived.
Skip the Paper Log With the MTM Link App
The MTM Link Member app replaces the paper log entirely and pays out faster. You tap “I’m Leaving” when you head out, “I’m Here” when you arrive at the provider (the app checks your location against the provider’s address), and “Submit Reimbursement” once the location check passes for every leg.4MTM. MTM Link No provider signature is needed, and payment comes through within seven business days.1MTM. Gas Mileage Reimbursement
How and When You Get Paid
App-based trips are typically paid within seven business days. Paper logs take longer because MTM verifies them manually, and payment is generally issued within 15 business days after that verification.1MTM. Gas Mileage Reimbursement3Wisconsin Department of Health Services. Non-Emergency Medical Transportation Gas Mileage Reimbursement
By default, payment loads onto a Focus Card, a reloadable U.S. Bank debit card.1MTM. Gas Mileage Reimbursement Some state programs let you switch to direct deposit or a paper check instead. Check your state’s program to see what’s available.
Why Trip Logs Get Rejected
Most denials come down to a handful of preventable mistakes:
- No provider signature or facility stamp, and no letterhead note attached in its place. This is the most common reason logs are rejected.5Wisconsin Department of Health Services. MTM Presentation
- Altered dates. Erasing, scratching out, or using white-out on dates will trigger a rejection. If you make a mistake, start a fresh form.
- Submitting before the appointment. The log has to go in after the visit, not ahead of it.
- Submitting more than 60 days after the oldest trip on the log.1MTM. Gas Mileage Reimbursement
- Missing trip number, which leaves the system with no way to match your drive to an authorized visit.2MTM. Reimbursement Trip Log
If your claim is denied, log in to the MTM member portal or call customer service to find out why. Fix the problem and resubmit quickly so you still fall inside the 60-day window.