Billing/Forms

Medport Inc. is approved by Ohio State Medicaid. We accept both Progressive Insurance and Passport waiver. We also accept CCBDD waiver Program. For those clients not having billable insurance we do offer transports C.O.D. or private billing.

Important Documents

The Ohio Department of Job and Family Services has revised the Physicians Certification Form, JFS 03452 and renamed it, Ambulette Certification of Medical Necessity. This form is required for practitioner certification of medical necessity for ambulette transport. The form has been revised or created to ensure consistency with revisions to documentation requirements in transportation rule 5101:3-15-02.

Adobe Reader (free) must be installed on your computer before you will be able to access these forms. The latest version of Adobe Reader may be found here

We will set up payment plans to fit your financial needs. Call our Customer Service line at 216-587-9715, and one of our representatives will assist you.

Mail Payments to:
MedPort Inc.
PO Box 25277
Garfield Heights, Ohio 44125


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