DialClerk Directory

ModivCare (LogistiCare)

Records, fax and other contacts

Find other published document channels. Confirm the department and purpose before sending any records.

fax other

South Carolina Medicaid — ModivCare nursing home fax (standing orders/complaint form)

Official page read
Phone

No phone listed for this route

Fax

877-272-3486

Nursing-home standing order requests and complaint forms

Published hours

Not published in this record

Product, plan and location

medicaid
South Carolina

Mailing address

Not researched for this route

'SC Nursing Homes' fax number listed for the standing order request and complaint forms on ModivCare's SC facility page.

View source ↗ · Source checked 2026-10-25

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fax other

Delaware Medicaid — ModivCare Medical Necessity Form and minor consent fax

Official page read
Phone

No phone listed for this route

Fax

866-813-5599

Medical Necessity Forms (stretcher or wheelchair level of service) and minor Consent and Release of Liability forms

Published hours

Not published in this record

Product, plan and location

medicaid
Delaware

Mailing address

Not researched for this route

Fax number ModivCare's Delaware page gives for these forms to the Facilities Department.

View source ↗ · Source checked 2026-10-25

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fax other

Delaware Medicaid — ModivCare Utilization Review fax (Medical Restriction Form)

Official page read
Phone

No phone listed for this route

Fax

866-832-9680

Medical Restriction Form for ambulatory members who cannot use the bus

Published hours

Not published in this record

Product, plan and location

medicaid
Delaware

Mailing address

Not researched for this route

Completed by the member's primary care physician, ideally with the standing order.

View source ↗ · Source checked 2026-10-25

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fax other

New York (Nassau County DSS) — ModivCare Facility Department fax

Official page read
Phone

No phone listed for this route

Fax

877-272-3768

Nassau County DSS Standing Order Request and Physician's Transportation Restriction forms

Published hours

Not published in this record

Product, plan and location

medicaid
New York

Mailing address

Not researched for this route

Separate fax listed for Nassau County DSS forms. ModivCare's state facility page is undated and some of its FAQ text appears to predate plan changes; confirm the member's current plan before relying on it.

View source ↗ · Source checked 2026-10-25

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Make the call count.

Find other published document channels. Confirm the department and purpose before sending any records.

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  • Recipient department and exact document request
  • Required release or authorization
  • Secure return contact and existing request reference

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  • Is there a secure portal or required form?
  • How is receipt confirmed?

This is a general administrative checklist, not payer policy or advice about a particular patient. Confirm the current plan instructions.

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