Medical Assistance Transportation

You may be able to get reimbursed for expenses to help you get medical care

Client Letter-Beltrami County Notice of Health Care Access Service

Notice of Health Care Access Services

Commonly Used Forms:

Request Form (Fill this form out to request MA Transportation services such as reimbursement for mileage, lodging, meals, and parking fees or if you need a ride to your appointment.

Reimbursement Form (Following an appointment(s), turn in this form for mileage, lodging, meals, and parking fees reimbursement).

Verification of Attendance Form (This is an optional form that can be used instead of providing an after-visit summary, when needed for out of the area appointments).

Medical Necessity Form (A supplemental form that can be used for a referral, continued care, and other medical necessary information).

Medical Necessity Form-Treatment Services (An optional form that a treatment facility can fill out for treatment services such as for medication).

PrimeWest Health members Medical Transportation must be scheduled by calling 1-888-814-6643 (toll free).

Blue Plus members Medical Transportation must be scheduled by calling 1-866-340-8648 (toll free).

The Beltrami County Health and Human Services MHCP Biennial Health Care Access Plan will pay for the most cost effective form of transportation to get you to a primary care provider within 30 miles of your home and a specialty care provider within 60 miles of your home. Transport beyond those respective distances will require referral based on medical necessity or health plan referral and approval from the county. If you have your own vehicle and can drive, you must use it when possible.

Prior Authorization for Health Care Access Service is required.

You must submit your request for medical transportation, lodging and meals no less than five business days in advance of your appointment. Failure to do so is not considered a medical emergency. You must include an appointment confirmation from the medical facility and a referral from a local physician when the appointment is more than 30 miles for primary care, or 60 miles for specialty care, from your residence.

IF YOU CHOOSE to get medical care from a provider that is not within 30 miles for primary or 60 miles for specialty care from your home, you may have to pay for your own transportation and ancillary service costs. This includes emergencies when you can get the services needed at a closer location.

IF YOU HAVE A MEDICAL EMERGENCY contact Beltrami County Health Care Access Services at 218-333-8023 immediately after the emergency to make arrangements for reimbursement of allowed expenses.