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MTM, Inc. fax number

(877) 318-1435

Trip Logs

Used for: Submitting Trip Logs for MTM Wisconsin NEMT or Gas Mileage Reimbursement; online, fax, or postal submission.

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Fax destination details

Department: Trip Logs
Purpose: Submitting Trip Logs for MTM Wisconsin NEMT or Gas Mileage Reimbursement; online, fax, or postal submission.
Form: Gas Mileage Reimbursement Trip Log — Gas Mileage Reimbursement Trip Log
Address: MTM, Attention: Trip Logs, 16 Hawk Ridge Dr., Lake St. Louis, MO 63367
Voice phone: 866-907-1493 (TTY: 711)
Website: Visit organization website

Before you send

Confirm that this exact department handles your document or request.
Check the organization website or call its main line for the current fax number.
Include a cover sheet and any case, member, claim, or form reference required.
Keep the delivery confirmation with your submission records.

Fill out the trip log with trip details and required signatures (healthcare facility and member); submit via MTM online portal, or by fax (1-877-318-1435) or mail to MTM, Attention: Trip Logs; include any receipts; for medical trips, a healthcare provider signature is required.

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