Transcription of PROVIDER TYPE SPECIFIC CHECKLIST PACKET FOR THE …
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(PT 42) Revised 05/14 PROVIDER TYPE SPECIFIC CHECKLIST PACKET FOR THE LOUISIANA MEDICAL ASSISTANCE PROGRAM (Louisiana Medicaid Program) Non-Emergency Medical transportation (PT 42) Revised 05/14 STOP!!! If an owner or a co-owner has been convicted of any of the criminal offenses listed below, you must contact NEMT Program Desk at 225 342-9404 before going any further: Medicaid, Medicare, any other healthcare program fraud; Neglect or abuse of a patient; Unlawful manufacture, distribution, prescription or dispensing of a controlled substance; Fraud, theft, embezzlement, breach of fiduciary responsibility, or other financial misconduct; Sexual acts; Interference or obstruction of an investigation into any of the above criminal offenses.
Open a checking account in the name of your proposed transportation business entity. Obtain a suitable vehicle (no pick up trucks or two door sports cars). Complete a MT-10 Form (enclosed) and submit it to the Louisiana Public Service Commission.
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