# Modivcare Standing Order Form in 2027: Where to Send It, Lead Times, Changes, and Cancellations

Canonical URL: https://nemtguide.com/guides/modivcare-standing-order-form/ · Updated 2026-10-06

The Modivcare standing order form is the one-page request a dialysis center or other treating facility sends to book the same rides on set days for months. Each state has its own form and fax number on Modivcare's facility pages, or the facility enters it in TripCare. Most states recheck an order every three months, and every change goes to Modivcare, never to the driver.

- Use the form from the member's own state page. Each one names its own fax line, and South Carolina splits faxes by region.
- Most Modivcare states recertify a standing order every three months by asking the facility, so no new form is needed.
- Every change, hold, or cancellation goes to Modivcare, because its system keeps sending the original schedule until it hears otherwise.
- A company named in the requested provider box is noted, not guaranteed. Modivcare can still send the order to someone else.
- Several Modivcare pages still post forms for programs other brokers now run, so confirm the member's plan before anyone faxes.

A standing order is one form that books months of rides, so a wrong fax number or a late form delays every one of them. [Modivcare](https://nemtguide.com/brokers/modivcare/) posts a separate form for almost every state, each with its own fax line, lead time, and rules for renewals and changes. This page is the lookup for facility schedulers who file them and for the ride companies that run them.

## Which Modivcare standing order form to use, by state

Use the form on the member's own state page at modivcare.com/facilities, and fax it to the number printed on it. These are the forms posted for the Medicaid programs Modivcare arranges rides for as of October 6, 2026. The first column says who each form serves, and each state's broker page has the plans and regions in detail. The phone lines for questions are in the [Modivcare facility portal guide](https://nemtguide.com/guides/modivcare-facility-portal/).

| State and program | Send the form to |
|---|---|
| [Arkansas](https://nemtguide.com/brokers/modivcare/arkansas/), Little Rock area Medicaid | Fax 866-854-8882. No form file is posted, so ask the Facility Department to fax you one. |
| [California](https://nemtguide.com/brokers/modivcare/california/), Medi-Cal plans | Fax 877-601-0535 |
| [Delaware](https://nemtguide.com/states/delaware/) Medicaid | Fax 877-813-5599 |
| [Florida](https://nemtguide.com/brokers/modivcare/florida/), fee-for-service regions and three plans | Fax 1-866-779-5242 |
| [Hawaii](https://nemtguide.com/brokers/modivcare/hawaii/), HMSA plus ʻOhana through December 31, 2026 | Fax 1-866-475-5745 |
| [Illinois](https://nemtguide.com/brokers/modivcare/illinois/), Aetna Better Health and CountyCare | Fax 877-272-3629 |
| [Maine](https://nemtguide.com/brokers/modivcare/maine/), MaineCare in Modivcare counties | Fax 877-637-9091 or email MEdocument.review@modivcare.com |
| [Michigan](https://nemtguide.com/brokers/modivcare/michigan/), fee-for-service in Wayne, Oakland, and Macomb | Fax 866-569-1910 or email MIExceptions@modivcare.com |
| [Montana](https://nemtguide.com/states/montana/) Medicaid, rides from October 1, 2026 | Fax 888-649-2288 or email MTExceptions@modivcare.com |
| [New Jersey](https://nemtguide.com/brokers/modivcare/new-jersey/), NJ FamilyCare | Fax 877-457-3316 |
| [New Mexico](https://nemtguide.com/brokers/modivcare/new-mexico/), Presbyterian Turquoise Care | Fax 866-402-0522 |
| [North Carolina](https://nemtguide.com/brokers/modivcare/north-carolina/), health plans that use Modivcare | Fax 855-397-3607 |
| [Oklahoma](https://nemtguide.com/brokers/modivcare/oklahoma/), SoonerRide and SoonerSelect | Fax 800-597-2091 |
| [South Carolina](https://nemtguide.com/brokers/modivcare/south-carolina/), Healthy Connections | Fax by region: 866-420-6253 (Region 1), 877-272-3939 (Region 2), 877-272-3990 (Region 3), 877-272-3486 (nursing homes) |
| [Utah](https://nemtguide.com/states/utah/) Medicaid | Fax 877-637-9079 |
| [Virginia](https://nemtguide.com/brokers/modivcare/virginia/), Humana and Sentara plans | Fax 866-907-1491. Sentara's sheet gives a second number, below. |
| [West Virginia](https://nemtguide.com/brokers/modivcare/west-virginia/) Medicaid and WVCHIP | Fax 855-882-5998 |

A few states post more than one version or number, so pick carefully:

- **New Mexico** posts a Presbyterian form and a Blue Cross form with the same fax. Blue Cross and Blue Shield of New Mexico moves its Medicaid rides to MTM Health on November 1, 2026 ([the switch](https://nemtguide.com/news/bcbsnm-mtm-transition/)), so the Blue Cross form is for trips before then.
- **South Carolina** links one form under two names, one for dialysis and one for adult day care and mental health. It is one file, revised January 2012 under the LogistiCare name.
- **Florida** links a "Standing Order Change Form" that opens the same form as the new order. Tick "Update Existing" to change an order.
- **Hawaii** posts a PDF dated April 7, 2025 on the HMSA page and a Word version on the Hawaii page that serves ʻOhana, with the same numbers. HMSA facilities also have their own line, 833-283-6566, in Modivcare's quick reference guide of June 15, 2026.
- **Montana** posted a new form dated August 28, 2026 for the statewide program that took over on October 1, 2026. The state's July 9, 2026 notice names the same facility line, (866) 726-1469.
- **Virginia** has two fax numbers. Modivcare's form (version 5.24, April 2024) and its Virginia page give 866-907-1491. Sentara's provider sheet of October 2025 says Sentara standing orders go through TripCare, or by fax to 1-866-907-1497 when TripCare cannot be used, at least 5 days ahead for Sentara Community Plan and 3 days for Sentara Medicare. For a Sentara member, use the Sentara number, or call Modivcare's Virginia facility line, 866-679-6330, to confirm.

Fee-for-service rides in Virginia moved to MTM Health on October 1, 2026 ([the Virginia switch](https://nemtguide.com/news/virginia-ffs-nemt-mtm-health/)), so Modivcare's Virginia form now serves Humana and Sentara members. Facilities with a TripCare login can enter any of these orders online instead of faxing.

## Who fills it out and what it asks

A standing order comes from the facility where the treatment happens, not from the rider or the ride company. Oklahoma wants a facility representative such as a social worker, and Maine a treating provider or case manager. In New Jersey a nursing home may book the first three dialysis trips, and then the Facility Department asks the dialysis clinic for the standing order. South Carolina lets the member book the first three dialysis trips the same way.

Who may sign varies by state:

- **Utah** (form of September 10, 2024): a physician, physician assistant, nurse midwife, nurse practitioner, social worker, administrative assistant, or registered nurse.
- **Michigan:** facility staff working under the licensed provider who oversees treatment, such as a social worker, administrative assistant, clinical nurse specialist, certified nurse midwife, or registered nurse.
- **California:** the form has a physician's signature line, and it warns that no standing order is made without a Physician Certification Statement on file.

Most forms ask for the same core facts: the days, appointment and return times, start and end dates or "ongoing," the level of service, height and weight for a wheelchair, the pickup and drop-off addresses, the treatment type, and the ordering contact. Most also ask whether the member can sign the driver's log and whether that will be permanent. The California, Hawaii, Michigan, Montana, and North Carolina forms, and Modivcare's national form, also commit the facility to Modivcare's fraud, waste, and abuse checks, including attendance reports and recertifications.

Riders who need a wheelchair van or stretcher usually need a medical necessity form too, which the [Modivcare medical necessity form guide](https://nemtguide.com/guides/modivcare-medical-necessity-form/) covers by state. For a blank form to use with private-pay and facility-paid riders, see the [standing order form template](https://nemtguide.com/templates/nemt-standing-order-form/).

## How early to send it and how long it lasts

Send the form well before the first ride, then expect a call about every three months. Modivcare's staff recertify most orders with the facility, so the facility answers questions instead of filing again. Delaware and Arkansas use the same three days a week for three months rule as most states, and Arkansas takes standing orders only for ongoing treatment such as dialysis, not for therapy expected to end, such as physical or speech therapy. How standing orders work in general is in [NEMT standing orders](https://nemtguide.com/guides/nemt-standing-orders/).

| State | Who qualifies | Notice and renewal |
|---|---|---|
| California | 2 or more days a week for at least 3 months | Confirmed within 5 business days. Valid 3 months, then recertified. |
| Florida, Hawaii, New Mexico | 3 or more trips a week to the same place | Recertified every quarter |
| Maine | At least 1 day a week for 90 days (form); 3 or more days (facility page) | 2 business days before the start. Good 3 months, then recertified. |
| Michigan | 3 or more days a week for at least 60 days (form) | Good 3 months, then recertified |
| New Jersey | 3 or more days a week to the same place | Good 3 months, then recertified without a new form |
| South Carolina | 3 or more days a week for at least 3 months | Valid 3 months, then recertified |
| Utah | 2 or more days a week (form); 3 or more days for 3 months (FAQ) | Facility gets a call at the end of 3 months |
| Virginia | 3 or more days a week for 3 months or more | 48 hours on the form, 5 days on the facility page (can drop to 2). The order must stay the same for 90 days. |
| West Virginia | Recurring trips | At least 5 days before the first trip. Booked up to 3 months at a time. |

Utah's form and its facility page disagree on who qualifies, so a facility with a member who goes twice a week should ask the Utah Facility Department before relying on a standing order. Virginia's form warns that an order must stay the same for 90 days to qualify and that changes may be denied.

## How to change, pause, or cancel a standing order

Every change goes to Modivcare, not to the driver. Modivcare's Oklahoma, Florida, Hawaii, and New Mexico pages say its system keeps sending the original schedule on the daily manifest until Modivcare is told. Virginia's page adds that changes must come from a facility representative and must never be made with the transportation provider or driver directly. The weekly routine for catching changes is in [NEMT standing orders](https://nemtguide.com/guides/nemt-standing-orders/).

How each state takes a change or cancellation:

- **Utah.** Fax the Standing Order Change Form (September 10, 2024) to 877-637-9079. It has boxes for an address, time, day, facility, or level of service change and for cancelling the order. Facilities can also call 855-563-4405 or make the change online.
- **North Carolina.** One form, posted October 5, 2026, covers new orders, changes, and cancellations. A cancellation asks for the last day attended.
- **Maine.** Tick "Update," which replaces the old order, or "Terminate Existing Order" on the same form.
- **Virginia.** Fax a new form with the changes to 866-907-1491.
- **Delaware.** Call the Facilities Department at 866-469-2824 or send a new form.
- **Arkansas.** Call the Facility Department at 866-854-8882.
- **California.** Modivcare cancels a standing order when the member is hospitalized, so the facility must start it again after discharge.
- **Florida.** Use the Hurricane and Holiday Schedule Change Form for one-time changes. Modivcare's Florida facility website instructions also let a facility put a member's rides on hold during a hospital stay and restart them later.

In TripCare, a facility can edit, recertify, update, or end a standing order, and cancel single trips up to the day before. New Jersey's form also has a grid for six holidays, where the center marks itself open, closed, or on a changed schedule.

Modivcare's Nevada and Rhode Island pages still post standing order cancellation forms. Both pages now list only Medicare Advantage or group retiree ride lines, so confirm the member's plan before anyone uses them.

## Local and national standing order forms

Modivcare's Louisiana and Texas pages post two forms, a local one and a national one. Louisiana's page explains the split. Facilities call 1-866-886-4081 and fax the local form to 877-457-3349 for Medicaid health plans. For Medicare health plans, they call 888-589-6163 and fax the national form, which carries a Phoenix address, to 888-589-6164.

Check the member's plan before using either local form. The Louisiana Department of Health listed MediTrans as the broker for all five Healthy Louisiana plans and Verida for fee-for-service members as of June 2026. Texas's local form, dated February 3, 2022, goes to the Texas Exceptions Department, and Blue Cross and Blue Shield of Texas moved its Medicaid rides from Modivcare to MTM Health on October 1, 2026, per its August 26, 2026 notice. For a Medicare Advantage member whose plan uses Modivcare, use the national form. Mississippi's facility page also links the national form under the name "Dialysis Standing Order Form."

## What to check when Modivcare assigns you a standing order

A standing order on your manifest is steady work, and the form behind it tells you how to run it. Ask Modivcare or the facility for the details below before the first ride.

1. **Match the manifest to the order.** Check the days, appointment time, return time or [will-call](https://nemtguide.com/glossary/will-call-trip/), and level of service. North Carolina's form asks dialysis units to build in the time needed before and after chair time when they set the arrival time.
2. **Check the signature status.** The form says whether the member can sign your driver's log and whether that will last. Oklahoma uses a separate Unable to Sign Certification for this.
3. **Ask about holidays.** Get each center's open or closed answer for every holiday in writing, and see the [NEMT holiday schedule guide](https://nemtguide.com/guides/nemt-holiday-schedule/).
4. **Expect attendance checks.** Facilities submit attendance logs to Modivcare in TripCare, so report a no-show or a cancelled day the way your agreement says.
5. **Ask to be named.** West Virginia's form has a "requested provider (not guaranteed)" line and Virginia's a "preferred transportation or sole source provider" line. Modivcare's Oklahoma and New Mexico pages say a request is noted, but trips go out by routing rules that include provider compliance.

Clinics that know your company are the ones that write your name in that box. The [dialysis transportation guide](https://nemtguide.com/guides/dialysis-transportation/) covers how to win that relationship and keep it.

## Frequently asked questions

### Where do I get the Modivcare standing order form?

Open Modivcare's facility resources page, pick the member's state, and look under Forms. As of October 2026, 16 state pages post their own form, and in many states the Facility Department will fax one on request. Facilities with a TripCare login can skip the paper form and enter the standing order online.

### How far ahead do I send a Modivcare standing order?

It depends on the state. West Virginia's form asks for at least 5 days before the first trip, Delaware's for 3 days, and Maine's for 2 business days before the start date. Virginia's form says 48 hours, while its facility page asks for 5 days, which can drop to 2. In California, Modivcare confirms a new order within 5 business days.

### How long does a Modivcare standing order last?

Usually three months at a time. New Jersey, South Carolina, Michigan, Maine, and California say an order is good for three months and that Modivcare staff then recertify it with the facility, without a new form. Florida, Hawaii, and New Mexico recertify every quarter, and West Virginia books recurring trips up to three months at a time.

### Who can sign a Modivcare standing order form?

Someone at the treating facility. Utah's form lists a physician, physician assistant, nurse midwife, nurse practitioner, social worker, administrative assistant, or registered nurse. Maine's must come from a treating provider or case manager. California's has a physician's signature line and needs a Physician Certification Statement on file, or no standing order is made.

### Can a NEMT company send a standing order for its own rider?

No. Modivcare takes standing orders from the facility where the treatment happens, and Virginia's page says changes must come from a facility representative, not the transportation provider or driver. Your part is to send the facility to Modivcare and to ask it to name your company on the form. Utah's form also asks which company drives the member now.

### How does a facility cancel a Modivcare standing order?

On that state's form or in TripCare. Utah has a separate change form with a box for cancelling the order. North Carolina's form, posted October 5, 2026, covers new orders, changes, and cancellations and asks for the last day attended. Maine's form has a terminate box. In TripCare, a facility can end an order online.

## Official resources

- [Modivcare: Facility resources by state (every standing order form)](https://www.modivcare.com/facility-resources/)
- [Modivcare: TripCare login for facilities](https://tripcare.modivcare.com/login)
- [Modivcare: TripCare Resource Center and training](https://www.modivcare.com/tripcare-resource-center/)
- [Modivcare: Utah Standing Order Change Form](https://www.modivcare.com/wp-content/uploads/2022/10/UT-Standing-Order-Change-Form-9.10.2024.pdf)
- [Modivcare: North Carolina Standing Order Request and Cancellation Form](https://www.modivcare.com/wp-content/uploads/2026/10/NC-Standing-Order-Form.pdf)