Intelliride 25 Mile Form. I think the only one that is working is the MCTS form for o

I think the only one that is working is the MCTS form for over 25 miles. 0106 | Email: us. pdf . • Any additional passengers (a required escort), service animals, or medical equipment/devices How do I schedule a NEMT trip? If you live in the following counties, contact IntelliRide at 1-855-489-4999: • Adams • Broomfield • Jefferson • Arapahoe • Denver • Larimer • Boulder • Douglas • Weld Health First Colorado (Colorado’s Medicaid program) has a Non-Emergent Medical Transportation benefit that provides members with rides to medical appointments through IntelliRide. To file a request: 1. To schedule new trips, or confirm existing trips for after 9/1/2019, call IntelliRide at (303) 398-2155 or (855) 489-4999. This form is valid for the identified Member for 90 days from the date of the initial visit to the treating provider. Please send completed form to: Fax (720) 302. Here is how to use the new forms: Access links to the new electronic forms at the bottom of this page in the “Medical Documentation” section – the same place you have accessed PDF forms in the past. 8622 or mail it to 2222 Cuming Street, Omaha, NE 68102.

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