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Are you ready to join us? Completing this application is the first step.

Driving for LogistiCare | Circulation:

Driving for LogistiCare Circulation means making a difference in the lives of others. Our members recognize all that our drivers do for them: making sure they get to their appointments, helping them get in and out of vehicles, and assisting with their needs. It’s a rewarding job.

Our clients depend on us to build the best non-emergency transportation network possible for our members – and our national network of 5,500+ transportation providers delivers. They are willing to invest in and commit to some of the industry’s most stringent requirements. And they do it because they know they are responsible for helping to improve the health and quality of life for the members they transport.

Learn more about driving for LogistiCare
https://www.logisticare.com/drive-with-logisticare

Application Instructions:

Completing this application is a required first step in becoming a new transportation provider for LogistiCare | Circulation. This application must be completed and submitted online, and only takes about 20-30 minutes to complete. Responses should be completed by an authorized representative of your company.

What happens next?

We know your time is valuable, so we aim to review and respond to the majority of applications within 10 to 14 business days of receipt. Review of your application may be deferred if any information is determined to be incomplete or if additional documentation is required to help us verify your company's conformance with our Transportation Provider Standards.

Submitting Proof of Insurance (the "Certificate of Insurance" or "COI"):

Please be advised that LogistiCare Solutions LLC, 1275 Peachtree St NE 6th Floor, Atlanta, GA 30309 will need to be added as an additional insured on your insurance policy prior to contracting with us, but is not a requirement when submitting this application. 

In this application we require you to submit proof of insurance (your COI), and while adding LogistiCare as an additional insured when submitting this application is not required, you will be asked to do so if a formal offer to contract with us is extended.

Questions & Contacting Us:

For questions related to this application, please contact our Provider Relations Team:

Phone: 866-431-4635 (Mon-Fri, 9AM to 5PM ET)
Email: network@logisticare.com
Part A: Company Contact Information
Enter 9 digits without dashes
National Provider Identifier number (10 digits)
If applicable
Street and Suite Number, if applicable
Start with www
Ownership Disclosure: Please list the names of any person(s) who are officers, general partners, or directors of the company, and anyone who holds greater than a 5% ownership share.
MM/DD/YYYY

Part B: Credentialing and Verification of Licensure

Insurance & Credentialing Information

Submitting Proof of Insurance (the "Certificate of Insurance" or "COI"):

Please be advised that LogistiCare Circulation will need to be added as an additional insured on your insurance policy prior to contracting with us, but is not a requirement when submitting this application. 

We will provide the required information (company name and address) prior to contracting.
Insurance Information
Enter a whole number
Required for submission
Vehicle Certification
I certify that I have read Section I (Vehicle Standards) of Circulation's Transportation Provider Performance Standards and that Company is in compliance with all vehicle requirements.
Driver Certification
I certify that I have read Section II (Driver Standards) of Circulation's Transportation Provider Performance Standards and that Company is in compliance with all driver credentialing and training requirements.
Other Business Licensure
Please list any other relevant state, local, or other business licensure or certifications you currently hold or intend to obtain in the next three months.
Dispatch Communications 
Example: 24 x 7 x 365; 9 - 5 M-F

Part C: Service Area and Fleet Operations

Company's Service Area
Application is specific to a single service area state.
Transportation Services & Fleet's Available Capacity
Directions: For each vehicle type below, enter (1) the number of vehicles in your fleet and (2) the percent of trip capacity that you are able to make available to serve LogistiCare's rides.

For Example: if you have five sedan vehicles, but a minimum of half their time must be spent serving trips for a hospital contract you hold, then under "Sedan (non-taxi)" you would enter "5" as the "# of vehicles" but since only half their time is available for the trips you'd like from LogistiCare, then enter "50%" in the "% of Total..." field. 
Sedan (non-taxi)
Enter a whole number
Taxi
Enter a whole number
Mini Van
Enter a whole number
Full Size Van
Enter a whole number
ADA Compliant Wheelchair Van
Enter a whole number
Non Emergency Stretcher/Gurney
Enter a whole number
Non-Emergency Ambulance
Enter a whole number
Other Services Provided

Part D: Services 

Service Hours
Service Hours 
Directions: Please tell us your normal operating hours in which you will accept trips. Start by selecting the day, start time and end time. Then click link below to add additional days/times.
Medical Transportation Experience 
DWMBE Status 
Application Submission Attestation of Truthfulness and Authority
The responses in this application will become part of the Company's official record on file with LogistiCare and should be submitted by an authorized representative of the Company.

Certification and attestation: By submitting this application I am hereby certifying and attesting that I am an authorized representative of the Company, and that the responses provided in this application have been made truthfully and are accurate to the best of my knowledge.
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