Forms and Other Documents
- Attendant/Escort Medical Necessity Form
- Distance Verification Form
- Gas Mileage Reimbursement (GMR) Trip Log
- Online GMR Trip Log
- GMR Trip Log – Large Print
- Instructions for Updating GMR Payment Preferences
- Glossary of Terms
- Level of Need (LON) Form
- Level of Need (LON) Form: Ambulance and Stretcher
- Meals and Lodging Request Form
- MTM Link Brochure
- Parental Consent Form: Children Age 4-11
- Parental Consent Form: Children Age 12-15
- You can schedule a routine or urgent ride 24/7
- You must call at least two business days before your routine appointment
- Have your trip information ready when you call
- Be ready 15 minutes before your pick-up time
Important Toll-Free Phone Numbers:
- To schedule a ride, ask a question, or file a complaint, call 866-907-1493 (TTY: 711)
- If your ride is late, call 866-907-1493 (TTY: 711) and select the Where’s My Ride option
Frequently Asked Questions (FAQs)
MTM provides NEMT rides for most members enrolled in the following programs who do not have other ways of getting to their covered appointments:
- Wisconsin Medicaid (including IRIS)
- BadgerCare Plus
- BadgerCare Plus Express Enrollment for children and pregnant people
- Tuberculosis-Related Services-Only Benefit
- Family Planning Only Services
To find out if you can get rides through MTM, call 866-907-1493.
If you live in a nursing home and have not elected Hospice or are enrolled in Family Care, Family Care Partnership, or the Program of All-Inclusive Care for the Elderly (PACE), you cannot get rides through MTM. You need to continue to get rides the way you do now.
If you can drive yourself to your covered appointment and do not need gas mileage reimbursement (money for gas) or if you have another way to get to your appointment for free, you cannot get a ride through MTM. You need to continue to get rides the way you do now.
You can request a routine ride by calling MTM at 866-907-1493. This is the same number that you used to schedule a ride with Veyo. You may schedule a routine or urgent ride 24/7.
Please call 711 for TTY services.
There are several ways you can book a ride:
- You can use the web chat feature located on this website to chat with a live Representative in real time.
- You can use the MTM Link web portal or MTM Link Member mobile app to book your rides online; click here to create your MTM Link account or log into your existing account.
- You can call us at 866-907-1493 to speak with a Representative.
- You must call at least two business days before your appointment, unless your trip is urgent.
- If you need bus passes, it is best to call at least seven business days before your scheduled appointment to ensure timely delivery of your passes.
- We schedule routine and urgent rides24 hours a day, seven days a week.
When you call, please be ready to provide:
- Your name, home address, and phone number
- Your ForwardHealth ID (the ten-digit number listed on your ForwardHealth Card)
- The street address and the phone number where you want to be picked up
- The name, phone number, address, and ZIP code of the health care provider you are seeing
- The date and start time of your appointment
- The end time of your appointment, if you know it
- Any special ride needs, including if you need someone to ride with you
- General reason for the appointment (check-up, eye appointment, etc.)
Yes. You can use the MTM Link Member mobile app or web-based Member Portal to schedule and manage your rides. Using these tools, you can manage your rides without ever calling MTM. That means you can manage your rides at the time that is best for you, with no need to wait on hold to speak to a representative. Here are just a few of the things you can do through the app:
- Request new rides.
- Please note, the mobile app and web-based Member Portal may only be used to book routine rides. You must call us to book an urgent ride with less than two business days advance notice.
- You can also use the mobile app to tell us you are ready for a ride home after your appointment if you did not schedule a return ride initially. You can also request a return ride by calling us.
- Cancel rides you no longer need.
- Request gas mileage reimbursement trips.
- Claim your gas mileage reimbursement trips with the click of a button–no more paper trip logs required.
- Review details about your upcoming rides, including the status of your ride, the mode of transportation you will use, and your transportation provider’s name and contact information.
- See the status of your ride using the Where’s My Ride feature, including GPS data about your trip if available; if your driver is not sending data, or if a driver has not yet been assigned, you will see help text.
- View and update your contact information.
MTM is required by law to give you the least costly type of ride while also meeting your transportation needs. The type of ride will be based on your medical and transportation needs. MTM offers the following types of rides:
- Mileage Reimbursement: If you have a car and are able to drive yourself to your appointment, you may be eligible for mileage reimbursement. A friend or family member may be eligible for reimbursement to take you to your appointment.
- Public Transportation: We will see if you’re starting and ending points are within 1/2 mile of a bus stop. If you tell us you cannot take the bus due to medical reasons, your health care provider will fill out a Level of Need (LON) assessment. This form will tell us what prevents you from taking the bus.
- Ambulatory Vehicles: This may include sedan, van, or taxi.
- Wheelchair or Stretcher Vehicles: This may include a wheelchair van, stretcher van, or ambulance.
MTM will determine the most appropriate mode for you based on the information you provide. To do this, we will ask you questions about what you need for a ride and how you handle basic daily tasks. We may also consult your health care provider.
If you have a car and are able to drive yourself to your appointment, you may be eligible for gas mileage reimbursement (money for gas). A friend or family member may also be eligible for reimbursement to take you to your appointment. Here are some important things to remember about GMR:
- To be reimbursed for a trip, transportation for the member needs to be scheduled at least two business days before your appointment to ensure eligibility. The ride can be booked by calling 866-907-1493, or by using the MTM Link Member mobile app or web-based Member Portal.
- You can now submit your GMR claims using the MTM Link Member mobile app—this means no more paper trip logs or healthcare provider signatures are required! The mobile app uses GPS location data to verify you arrived at your appointment. Click here for more information, including instructional user guides.
- If you prefer to use a paper trip log, you may download a blank log under the Forms and Other Documents heading on this web page. You may also call 866-907-1493 and an MTM representative can mail one to you.
- If you use a paper trip log, your health care provider must sign the log for each trip listed on the form. Any health care provider at your appointment can sign this log. This includes nurses, therapists, physician assistants, or nurse practitioners. It does not have to be the
- The trip log needs to be filled out and returned to MTM within one year of the first health care appointment listed.
- Payment for approved trips can be made via a reloadable debit card, direct deposit (ACH), or mailed paper check.
If you are unable to travel by public transportation, a Level of Need (LON) assessment form must be completed by your health care provider. It should indicate the most medically appropriate mode(s) of transportation for you. This form can be found under the Forms and Other Documents heading on this web page.
You can go to any provider you choose that is in the network. However, if your provider is more than 100 miles away, your health care provider must fill out a Distance Verification Form. The Distance Verification Form can be found under the Forms and Other Documents heading on this web page.
A Distance Verification Form must be completed by your health care provider to verify that, for health care reasons, you need to travel to an appointment that is over 100 miles from your home. The Distance Verification Form can be found under the Forms and Other Documents heading on this web page.
You may be sharing a ride with another member who is traveling to and from the same area as you. Shared rides with other Medicaid members are allowed for certain types of trips. If there are special health circumstances which prevent you from sharing a ride with others, please tell MTM when you call to schedule your ride. Your health care provider will need to note this on a Level of Need Form to tell MTM that you should not be scheduled for a shared ride. This form can be found under the Forms and Other Documents heading on this web page.
Yes, when you schedule a ride by phone, MTM will ask if you want to sign up for text alerts. If you choose to sign up, MTM will send you text messages about your rides. These text messages will contain important information such as:
- Your ride details after you schedule a ride
- A reminder 24 hours before your pick-up time
- An alert when a driver is on the way to pick you up
- Details about your ride, which may include:
- The driver’s name
- The driver’s phone number
- The vehicle license plate number
- The make, model, and color of the vehicle
- An alert when the driver has arrived
You will also be able to cancel an upcoming ride or request a return ride by responding to an MTM text.
Note: If you sign up for MTM text messages, your phone carrier may charge you standard SMS text messaging rates. To stop MTM text messages at any time, reply STOP or UNSUBSCRIBE to any MTM text message.
If you have opted out of MTM text messages, you can opt back in by calling MTM at 866-907-1493. An agent can help you opt back in to the MTM text messaging program.
The day before your trip, you will get a reminder call about your upcoming ride. The call will either be an automated call or a call from your transportation provider. If you have signed up for text messages from MTM, you will also get a reminder by text. If there is a change to your ride after you receive the reminder (like a weather cancellation or change of provider), MTM or your transportation provider will notify you of the change.
Yes. MTM can schedule recurring trips, so you don’t have to schedule rides one at a time. MTM defines a recurring trip as a ride to and from the same location, at the same time, one or more times per week. Recurring trips can be scheduled up to three months at a time (six months at a time for dialysis appointments). To schedule a recurring trip, please call 866-907-1493 at least two days before the first scheduled appointment.
- Routine rides must be scheduled at least two business days prior to your health care appointment. Rides for the same day can be scheduled within three hours if you have an urgent need.
- Transportation for routine rides can be scheduled for the current month and the next month.
- Recurring trips can be scheduled up to three months at a time (six months at a time for dialysis appointments).
A routine ride is a ride to an appointment that does not require you to be seen right away, such as a ride to a yearly check-up or an eye doctor’s appointment. Most rides are considered routine.
An urgent ride can be one of the following:
- A health care situation in which you do not need to call 911 for immediate assistance, but you cannot wait two business days before seeing a health care provider
- A hospital discharge
- A ride to a follow-up appointment if the follow-up appointment is for the same health care issue and is scheduled within two days of your previous appointment
Urgent rides do not need to be scheduled with two business days’ advance notice. If you have an urgent need and must be seen by your health care provider on the same day, call 866-907-1493. MTM may need to verify urgency with your health care provider. MTM will coordinate urgent rides within three hours.
Please call 911 if you have a medical emergency.
Yes. A relative, a caregiver, or a health care provider may call and schedule transportation on your behalf.
When you call to schedule a ride, an MTM representative will ask you when you need a ride home. If you do not know the return time, MTM will assign the trip as a “will-call” ride. After your appointment is done, call MTM at 866-907-1493 when you are ready for your ride home. You may also use the MTM Link mobile app or interactive text messaging to tell us you are ready for your ride home. The transportation provider will arrive within one hour. If more than an hour has gone by, you can call MTM at 866-907-1493 to find out the driver’s estimated time of arrival (ETA).
When you call to schedule your ride, MTM will tell you when your ride will arrive. Pick-up times will vary depending on the distance to the appointment. You may request a different pick-up time if it is not after the recommended pick-up time. Your transportation provider will give you a reminder call the day before your ride. If you have signed up for MTM text messages, you will receive a text message when your driver is on the way.
You may travel with the following additional riders, known as Medically Necessary Additional Riders, when medically necessary:
- A medically necessary escort
- A parent or other relative, guardian, caregiver, or foster parent if you are a minor
- A newborn traveling with you to a post-partum visit
If you need someone to ride with you for medical reasons, your health care provider must complete an Attendant/Escort Medical Necessity Form. This form can be found under the Forms and Other Documents heading on this web page.
You may travel with the following additional riders, known as Non-Medically Necessary Additional Riders, who are not considered medically necessary in the following situations:
- Additional riders requested by a health care facility
- Additional riders under your care
- Additional riders who are your legal dependents
- An additional rider acting as your support person
If others must ride with you for non-medical reasons, the number of additional riders depends on the number of available seats in the vehicle. For example, if the vehicle has four available seats, you may bring three additional riders with you.
Minors, for transportation purposes, include anyone under the age of 18. All transportation requests must be made by an adult. The following minors may travel by themselves to an appointment:
- Minors age 16 – 17 years old, when traveling by bus or a vehicle.
- Minors age 12 – 15 years old, with a signed consent form on file with MTM when traveling by a vehicle only.
- Minors age 4 – 11 years old, with a signed consent form on file with MTM when traveling by a vehicle only with at least one other child to the same day treatment program or center-based applied behavior analysis program.
These forms can be found under the Forms and Other Documents heading on this web page.
Yes. Parents and caretakers must provide a car seat or booster seat for their children. Car seats are required for children until they are at least four years old and weigh 40 pounds. Booster seats are required for children until they are eight years old, weigh 80 pounds, or are 4’9″ tall. If you do not have a car seat or booster seat and one is not available at the time of your trip, you will not be able to take your ride.
Please note that you must install the car seat or booster seat in the vehicle. Drivers are not able to assist with the car seat or booster seat.
In accordance with local and federal laws in your area, service animals are permitted to accompany members at all times. Please help drivers keep vehicles clean for all riders by bringing a crate or blanket to reduce the risk of damage or mess.
You may need to fill a prescription or pick up a disposable medical supply after an appointment. You should try to do so on the way back from your appointment. All extra stops, including stops to fill a prescription, must be approved by MTM before the ride starts. Call MTM from your appointment to get permission to make the extra stop. Or, let MTM know ahead of time when you schedule your ride. We will notify your driver about the extra stops.
Call MTM at 866-907-1493 if you need to cancel or reschedule your ride, or if you need to make changes to your ride. This includes changes to your appointment date or time. Please call as soon as possible. Please cancel your ride even if it is a bus ride or a mileage reimbursement trip.
If you receive text alerts from MTM, you can also cancel your upcoming ride by responding to your text reminders with the appropriate message. If you use the MTM Link Member mobile app or web-based Member Portal, you can cancel your upcoming ride online.
If the transportation being canceled is part of a recurring trip series, please let MTM know whether the cancellation is for a specific date, or if it is for all upcoming trips in the repeating trip series.
If it is 15 minutes or more past your pick-up time and your ride is not there, it is considered late. Call MTM at 866-907-1493 to ask for an update on your driver’s estimated time of arrival (ETA).
If there is a snowstorm or bad weather, check with your health care provider to make sure their office is open. If you do not feel it is safe to travel, call MTM at 866-907-1493 as soon as possible to cancel your ride. Every effort is made to continue services during bad weather, but delays and cancellations may happen if travel conditions are unsafe.
When you call in to schedule a ride with MTM, you will be asked to complete a quick survey at the end of your call. The survey will ask for feedback on your experience with the call center and the MTM agent that you spoke with.
If you don’t speak English, call 866-907-1493. An agent who speaks your language will help you, or MTM will connect you with an appropriate translator.
Depending on your situation, different forms may need to be completed by you or your health care provider. Here are some of the most common examples:
- If you are unable to travel by public transportation or require an ambulance level of service, a Level of Need (LON) assessment form must be completed by your health care provider. It will indicate the most medically appropriate mode(s) of transportation for you.
- If you need to travel more than 100 miles to an appointment, a Distance Verification Form must be completed by your health care provider. It must verify that—for health care reasons—you need to travel beyond the approved distance from your home address.
- A parent, legal guardian, or caregiver is required to travel with any child under 16 years of age. If the child is traveling by themselves, the parents or guardians must complete the following Parental Consent Forms:
- 4-11 years of age: If a child between the ages of 4 and 11 is traveling by themselves to a day treatment program or center-based behavioral treatment program, parents must fill out, sign, and return the Parental Consent Form for Children ages 4-11.
- 12-15 years of age: If a child between the ages of 12-15 is traveling by themselves to an appointment, parents must fill out, sign, and return the Parental Consent Form for Children ages 12-15.
- Note: Minors requiring additional supervision or support may need to be accompanied by an adult for their rides. Please contact MTM for additional details.
- If you require a medically necessary escort, your health care provider will need to fill out the Attendant/Escort Medical Necessity Form.
- If you have a car and can drive yourself to your appointment, but cannot afford to pay for gas, you may be eligible for gas mileage reimbursement (money for gas). Contact MTM before you go to your appointment to see if you can be reimbursed for gas mileage. If you are eligible, you can either complete a Mileage Reimbursement Trip Log during your trip or use the MTM Link Member mobile app to submit your claim.
Each of the forms mentioned above can be found under the Forms and Other Documents heading on this web page.
We always want to provide excellent service. Anyone can make a complaint. You can also make suggestions about how we can serve you better:
- Through our convenient online form
- By calling MTM at 866-907-1493
- By writing to MTM at the following address:
8383 Greenway Blvd
Middleton, WI 53562
A complaint can be about many different things. Examples include a late pick-up, the condition of the vehicle you rode in, the behavior of another passenger, or the courtesy of an MTM agent. Please have the following information ready to help MTM in our investigation:
- Your first and last name
- Your ForwardHealth ID
- The date of your ride
- A description of the problem
- Any additional information that can help us investigate the issue
We follow up on all complaints. After submitting a complaint, MTM will let you know that they have received your complaint within 24 hours. MTM will then mail you a response within 10 business days. If your complaint is not resolved within 10 business days, MTM will mail you a final response within 30 business days of receiving your complaint. If MTM needs more time to resolve your complaint, we will mail you a letter telling you that we will resolve your complaint within 14 business days. If you are unhappy with how your complaint is resolved, you can follow the continued complaint process described in the response letter.
Sometimes, a request for a transportation service is denied. For example, you may have been denied a ride or payment for meals or overnight stays.
If you call to request a ride and the request is denied, you will have the option to speak immediately to a representative who does not work for MTM to review the denial for reconsideration. To request this immediate review, ask the MTM agent to transfer you to the independent reviewer. This review is only available during a call to MTM to schedule a ride.
If your NEMT request was denied, you will receive a letter in the mail further explaining the reason for the denial. You have the right to appeal all denials with MTM. You may appeal to the MTM Ombuds or request a fair hearing directly from the Division of Hearings and Appeals. Please refer to your denial letter for details on the appeals process.
If your NEMT request was denied, you will receive a letter in the mail further explaining the reason for the denial. You have the right to appeal all denials with MTM. You can:
- Appeal to the MTM Ombuds or
- Request a fair hearing directly from the Division of Hearings and Appeals, without first appealing to the MTM Ombuds
MTM Ombuds Appeal Option
If you would like to appeal to the MTM Ombuds, call 866-419-0551 or write to the following address:
MTM, Attn: MTM Ombuds
8383 Greenway Blvd, Suite 400
Middleton, WI 53562
Your letter to the MTM Ombuds should say you disagree with MTM’s decision related to your approved mode of transportation. Your letter should also include your name, address, and your ForwardHealth ID number. You must call or send your letter no later than 90 days from the date of the letter. If you request an appeal, MTM will send you a letter within 10 business days, even if the appeal is not resolved.
Fair Hearing with the Division of Hearings and Appeals Option
If you would like to request a fair hearing with the Division of Hearings and Appeals now, you must submit your request within 45 days of the date on the letter. To request a fair hearing with the Division of Hearings and Appeals, complete the Request for Fair Hearing form and send it to the following address:
Department of Administration
Division of Hearings and Appeals
P.O. Box 7875
Madison, WI 53707-7875
You can get the Request for Fair Hearing form online at www.dhs.wisconsin.gov/em/customerhelp, or by calling 1-608-266-3096. If you need help with asking for a fair hearing, please call 1-800-362-3002.
You can also choose to write a letter to the Division of Hearings and Appeals in place of the form. Your letter should include the following:
- Your name
- Your mailing address
- A brief description of the problem
- The name of the agency that took the action or denied the service
- Your social security number
- Your signature
For more information about fair hearings, refer to your ForwardHealth Enrollment and Benefits handbook online at www.dhs.wisconsin.gov/em/customerhelp or call 1-800-362-3002.