Type | Action | Invoice PA# SO Exp Date |
Status Caller Info |
Trip Date Mode Last Updated |
Enrollee Driver/Vehicle |
Trip Legs |
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Trip Date | Invoice # | Enrollee | Reason | Trip Status | Correction Status | Actions |
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Reason | Refused By | Refuse Date/Time | Trip Date | Enrollee |
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View | Created | Status | Source | Concern Type | Outcome |
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07/01/2020 | Provider Review | Enrollee | No Show | Pending | |
07/01/2020 | Closed | Enrollee | Cost Concern | Notified | |
07/01/2020 | Closed | MP | Fraud | Notified |
Action | Invoice PA# |
Trip Date | Enrollee First Name Enrollee Last Name |
Trip Legs |
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Please select a reason to undo attestation for this trip.
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to refuse this trip?
It cannot be undone.
Enter Your Requested Correction Below: (Limit 1000 characters) |
Mileage calculations are based upon NYSDOH guidance. Transportation Providers are to use the shortest, most appropriate route according to Google. |
PA Number Correction.
Pressing Submit will send the Request as a notification.
Note: It may take up to 5 hours for the PA Number to generate after attestation.
Change the address on invoice | |
Leg number: | |
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Leg number: | |
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Leg number: | |
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Leg number: | |
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Change the attestation on invoice to |
Action (Status) | Last Name | First Name | Drivers Lic # (State) | Expiration | Mobile Login | Set driver |
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Note: Reassigns can only be made if a trip has not been attested
Status |
Active
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Mobile Login |
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Last Name | |
First Name | |
Direct Phone | |
Email Address | |
Driver License # | |
Driver License State | |
Expiration |
Must enter a valid date
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Last Name | First Name | Expiration |
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Must enter a valid date
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Vehicle Type | Vehicle Name | Reg Expiration |
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Must enter a valid date
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Status | Vehicle Type | Vehicle Name | License Plate # | Reg Expiration |
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Must enter a valid date
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Please review this recent information that may be important to you.
From | Date | Subject |
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Please select the profile to use.
Company Name | County | Action |
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