Submit Your Gas Mileage Reimbursement Trip Log Online

Thank you for your interest in participating in the Wisconsin Medicaid and BadgerCare Plus Mileage Reimbursement Program. Visit the Gas Mileage Reimbursement page for more information on the program.

To submit your Mileage Reimbursement Trip Log online, click below to fill out the form. To submit your trip log by fax or mail, follow the directions on the trip log. A blank trip log can be found on our Member Resources page. Your trip log must be sent to Veyo within one year of the first trip listed on the log. Payment for approved trips will be made within three weeks by check or electronic funds transfer (EFT) directly to your bank account. Veyo does not make payments by debit card.

Wisconsin Gas Mileage Reimbursement Form

Click the button below to submit a request for gas mileage reimbursement for your health care appointment.