Submit a request – Veyo RideView Support

Your email address

What type of help can we assist with?

What type of concern do you have?

What type of RideView Technical Support is needed?

What State Are You In?

*If this concern is urgent, please contact the Veyo Call Center immediately*

*If the member would like to file a grievance, please contact the member's health plan*

Member's Health Plan

Is this a Discharge?

Does your member require assistance to and from the vehicle

Member First Name

Member Last Name

Member Phone Number

Member Date of Birth (Or Account Pay Facility Name)

Member ID

Trip Date

Who is receiving the compliment?

What is the name of the person receiving the compliment?

If you do not recall the name, please provide any informative and/or descriptive details in the Description box below

What was the date of the interaction?

What was the approximate time of the interaction?

Facility Address

Facility Name

What is your job title at your facility?

Please provide your name

What is a good contact number to reach you at?

Trip Date(s)

Passenger First Name

Passenger Last Name

Confirmation Number

What is the passenger's ID (MID/AHCCCS ID/etc.) *If Account Pay, put Facility Name*

What was the name of the Agent that was spoken to?

Please provide the agent's name if you recall

What was the date of the call?

Was the trip going to or leaving your facility?

What number did you or the member call?

What number did you or the member call from?

What was the approximate time of the call?

If preferred, you may also attach your schedule using the attachments section below,

Do your holiday hours differ than your normal hours? If so, please provide those details.

What dates are these closures?

What holidays is your facility closed?

Subject

RideView Trip Rescue Disclaimer

In order to process your trip rescue, we will need either a screenshot of the trip in RideView, or the open trip card with ALL member/trip details and upload the screenshot in the attachments portion (add or drop files here) below. If you do not have a screenshot, please fill out as much detail below to assist us with your trip rescue. Please be sure to include your email so we can respond quickly to your urgent request. Note: Only one form per member, this will allow an agent to work on your request quickly.

Description

Please enter the details of your request. A member of our support staff will respond as soon as possible.

Attachments

Add file or drop files here