New York Medicaid requires this verification when an enrollee needs a specific mode of transportation to medical appointments, such as taxi or livery, ambulette or ambulance, instead of the mode they use for daily activities. The medical provider explains the condition that requires that mode and how long it will be needed. It supports, but does not replace, the transportation manager's prior authorization.
The enrollee's medical provider completes, signs and dates it with their own NPI. Accepted titles are physician, PA, dentist, RN, NP, OT, PT, LMSW, LCSW and mental health counselor.
Download the current version from the source each time; forms change without notice.
NYS 2015 (Verification of Transportation Abilities) Form
New York State Department of Health (Medicaid transportation manager: Medical Answering Services) takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
The enrollee's medical provider, using their own NPI. Accepted titles are physician, physician assistant, dentist, registered nurse, nurse practitioner, occupational therapist, physical therapist, LMSW, LCSW and mental health counselor. A form signed by someone outside those titles may be rejected.
No longer. Effective June 6, 2022, the Form-2015 must be submitted through the transportation manager's online portal. Forms submitted by any other method are not processed and must be resubmitted through the portal. Practitioners log in to their Medical Answering Services account to file it.
The policy requires renewal at least annually, at the end date indicated on the current form, or sooner if the enrollee's medical condition requires a different mode of transportation. The provider must also update it whenever the enrollee's status changes, and the state may request an update at any time.