Superior’s Medical Ride Program

Claim Form

• SafeRide Health ITP Service Record Claim Form - English (PDF)
• Registro de servicio de ITP de SafeRide Health (formulario de reclamación) - Spanish (PDF)

Individual Transportation Participant (ITP) Application Form

• ITP Application Form - English (PDF)
• Formulario de solicitud del participante de transporte individual (ITP por sus siglas en inglés) - Spanish (PDF)

Medical Necessity Form

• Medical Necessity Form - English (PDF)

Minor Consent Form

• SHP Minor Consent Form - English (PDF)
• Formulario de consentimiento de menores de SHP - Spanish (PDF)

Parental Accompaniment/Attendant Form

• SHP Parent Authorized Attendant Form - English (PDF)
• Formulario de autorización parental para el acompañante de SHP - Spanish (PDF)

What is Superior’s Medical Ride Program?

Superior’s Medical Ride Program provides NEMT to non-emergency health-care appointments for members who have no other transportation options. These trips include rides to the doctor, dentist, hospital, pharmacy, and other places you get Medicaid services.  

• Transportation services are available to STAR, STAR Health, STAR Kids, STAR+PLUS and MMP members.
  • Eligibility is based on product and program requirements.
  • CHIP and CHIP Perinate members are excluded under this program.
• Superior is required to facilitate the most cost-effective mode of curb-to-curb transportation that meets a member’s individual need.
  • Superior can authorize an attendant to accompany the member if an additional level of service is required.

What services are part of Superior’s Medical Ride Program?

There are many types of transportation services included in Superior’s Medical Ride Program. They include:

• Passes or tickets for transportation such as mass transit within and between cities or states, including by rail or bus.
• Commercial airline transportation services.
• Demand response transportation services, which is curb-to-curb transportation in private buses, vans, or sedans, including wheelchair-accessible vehicles, if necessary. These are types of rides where you are picked up and dropped off at the entrance/exit of your home or clinic.
• Mileage reimbursement for an individual transportation participant (ITP) using their own vehicle for a verified, completed trip to and from a covered health-care service. The enrolled ITP can be you, a responsible party, a family member, a friend, or a neighbor.
• If you are 20 years old or younger, you may be able to receive the cost of meals associated with a long-distance trip to obtain health-care services. The daily rate for meals is $25 per day for the member and $25 per day for an approved attendant.
• If you are 20 years old or younger, you may be able to receive the cost of lodging for your long-distance trip to obtain health-care services. Lodging services are limited to the overnight stay and do not include any amenities used during your stay, such as phone calls, room service, or laundry service.
• For some situations, if you are 20 years old or younger, you may be able to receive funds in advance of a trip to cover authorized NEMT (ride/transportation) services.

If you need an attendant to travel to your appointment with you, Superior’s Medical Ride Program will cover the transportation cost of your attendant.

Children 14 years old and younger must be accompanied by a parent, guardian, or other authorized adult. Children 15-17 years old must be accompanied by a parent, guardian, or other authorized adult or have consent from a parent, guardian, or other authorized adult on file to travel alone. Parental consent is not required if the health-care service is confidential in nature.

How do I get a ride?

You can request NEMT services through Superior’s Medical Ride Program provided by SafeRide. If you need a ride, call SafeRide. SafeRide has staff that speak English and Spanish and can also provide interpreter services if you speak another language.

You should request your NEMT services (rides) as early as possible, and at least two working (business) days before you need the ride. In certain circumstances, you may request NEMT services (rides) with less than two working (business) days’ notice. These circumstances include:

• Being picked up after being discharged from a hospital;
• Trips to the pharmacy to pick up a medication or approved medical supplies;
• Trips for urgent conditions. An urgent condition is a health condition that is not an emergency but is severe or painful enough to require treatment within 24 hours.

How soon should I arrange transportation?

Members should call or go online at least 2 business days prior to your appointment. If your appointment is urgent and scheduled in less than 2 business days, call as soon as you’re able.

How do I change or cancel my ride?

You must notify SafeRide prior to the approved and scheduled trip if your medical appointment is cancelled. To cancel your ride, call SafeRide at 1-855-932-2318 to change or cancel your ride. Please call 24 hours in advance to change or cancel your ride.

How do I obtain emergency transportation?

• If you have an emergency, call 911 or go to the nearest emergency room right away.
• If you are not sure if you need to go to the emergency room, call your Primary Care Physician (PCP).
• If you are unable to reach your PCP, you can always contact Superior’s 24-hour nurse advice line at 1-800-783-5386. A registered nurse is available for health questions 24 hours a day, 7 days a week.

Who do I call if I have a complaint about the transportation program?

If you have any problems with Superior’s Medical Ride Program, call SafeRide at 1-855-932-2318.