Audit Cover Sheet

TO: Audits Dept FROM: cityrsa@gmail.com

FAX: 866-214-0528 PAGES: 01

PHONE: DATE: 04/25/2024

E-MAIL:
A2CAUDITS@AMR.NET

Access2Care Audit Cover

SheetPlease include the following information with all audit

documentation.

1. A driver log (s) with all of the required information present

2. Manifests or driver logs with multiple transports- You must indicate which trips are in audit status.

3. Driver’s license number of the driver who transported member for the audited trip

4. VIN number of vehicle used to transport the member for the audited trip

IMPORTANT NOTE: If you do not include the above information the requirements for the audit will not
besatisfied. Please remember you must include this Audit Cover Sheet.

If the trip required information is not received within (20) calendar days from the date the trip is cleared,
the tripwill be denied for payment due to UNTIMELY FILING per your A2C contract.

Please send all driver logs to the dedicated Access2Care Audits Dept. via. Fax at 866-214-0528 or email
A2CAudits@amr.net If you would like to itemize your audits for easy identification and processing please use
thesecond page that is attached.

Total audits Total Pages

02 01
 Access2Care Audit Cover Sheet
Itemized Audit Information
{Optional)

Audit Cover
Sheet
Trip Number Member Name

52027751T CAMACHO, MARIA

52027751R CAMACHO, MARIA