List of Credentialing Documents Required for Louisiana:
Company Documents
- National Provider ID Number (Register here)
- Disclosure of Ownership - Corporate (Form Attached)
- Drug Free Workplace Statement (Form Attached)
- Acknowledgement of Company policies (Attached)
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- Maintenance of documentation for 10 years
- Attestation of LEIE, SAM, EPLS exclusion
- Driver Identification
- Daily Vehicle Inspection
- English Language Communication
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- W9 - Corporate (Attached)
- IRS Form CP 575 showing EIN
- Bank Letter Verification / Voided Check to confirm bank account information
- Direct Deposit Banking Information (Form Attached)
- Business License (Search HERE)
- A Certificate of Public Necessity (CPNC) issued by the Orleans Parish Taxicab Service and Enforcement Bureau for each provider, driver, and vehicle that will operate in Orleans Parish
- An NEMT permit issued by the Jefferson Parish Emergency Management Office for each provider, driver, and vehicle that will operate in Jefferson Parish.
- Transportation Provider Directory Information - Must be Added to OurRecords
Insurance Documents (Updated 4/7/2021)
- Certificate of Auto Liability Insurance (Example Attached)
- Please make sure that there is an "X" under the "Addl Insd" column
- It must have Veyo listed as the certificate holder. Address: 4875 Eastgate Mall, San Diego, CA 92121
- It must have Louisiana Department of Health (LDH) listed as the additional insured in the Description of Operations section. Address: 628 N. 4th Street | Baton Rouge, LA 70802
- It must have Louisiana Health Care Connections (LHCC) listed as the additional insured in the Description of Operations section. Address: 8585 Archives Ave, Baton Rouge, LA 70809
- Certificate of General Liability Insurance
- Please make sure that there is an "X" under the "Addl Insd" column
- It must have Veyo listed as the certificate holder. Address: 4875 Eastgate Mall, San Diego, CA 92121
- It must have Louisiana Department of Health (LDH) listed as the as the additional insured in the Description of Operations section. Address: 628 N. 4th Street | Baton Rouge, LA 70802
- It must have Louisiana Health Care Connections (LHCC) listed as as the additional insured in the Description of Operations section. Address: 8585 Archives Ave, Baton Rouge, LA 70809
- Commercial Auto and General Insurance Endorsement (Example Attached)
- Veyo will require an endorsement for both Auto Liability and General Liability
- It must have Veyo listed as the additional insured. Address: 4875 Eastgate Mall, San Diego, CA 92121
- It must have Louisiana Department of Health (LDH) listed as the additional insured. Address: 628 N. 4th Street | Baton Rouge, LA 70802
- It must have Louisiana Health Care Connections (LHCC) listed as the additional insured. Address: 8585 Archives Ave, Baton Rouge, LA 70809
- Workers Compensation
- Louisiana Department of Health requires that all providers carry a minimum of $500k in Worker's Compensation.
- If you do not have Workers Compensation, you are required to submit a waiver letter in line with state guidelines. (Attached)
Driver Documents
- Complete Driver List (Attached)
- Current Driver's License (Class D or CDL)
- Attestation of English Language Proficiency (Attached)
- CPNC permit for each driver to Operate in Orleans Parish (if applicable)
- NEMT permit for each driver for Jefferson Parish (if applicable)
- Background Check including Sex Offender Search
- Must be completed by LSP, FBI or approved agency and sent directly to Veyo by the BGC agency. Approved list of agencies is attached.
- Motor Vehicle Record
- Five Panel Drug Screen (at minimum - to be directly sent to Veyo by agency)
- Driver Compliance Communication (Attached)
- Driver Demographic Information - Must be Added to OurRecords
Training Requirements
*Copies of Certificates must be provided for each driver
- CPR Training Certification (Active Certification issued by a License Instructor)
- Defensive Driving Certification (In person course no less than 4 hours, renewed every three years)
- HIPAA Training Certification
- Infant/Child Restraint Systems Training
- Wheelchair Securement (if Applicable) and Passenger Assistance Safety and Sensitivity (PASS)
- In-person and must be renewed every two years
Vehicle Documents
- Vehicle List (Attached)
- Active LA inspection sticker or
- if applicable, the inspection sticker for vehicles operating in Orleans and Jefferson Parish
- CPNC permit for each vehicle to Operate in Orleans Parish (if applicable)
- NEMT permit for each vehicle for Jefferson Parish (if applicable)
- Vehicle Insurance Card
- Vehicle Registration
- Vehicle Data - Must be Added to OurRecords