How facilities pay NEMT invoices: ACH, checks, cards, and payment portals, and what each costs you

A hospital, nursing home, or senior living community pays your invoice through its accounts payable office, and the method that office uses decides how fast the money arrives, what it costs you, and how easy it is to steal. Facilities pay by ACH, paper check, or card, and some push card payments through a payables portal. The time to ask for the method you want is at vendor setup. This guide covers the payment side; billing facilities for NEMT rides covers the invoices, terms, and disputes.

The three ways to be paid, side by side

ACH is the cheapest and most traceable way to be paid, checks are the slowest and most exposed to fraud, and cards are fast but carry a percentage fee.

Getting set up as a vendor

A facility will not pay you until its vendor file is complete. Expect to send these:

• Form W-9. It gives the facility your taxpayer identification number for its information returns. For a single-member LLC that is disregarded for tax purposes, the current form (Rev. March 2024) asks for the owner as the line 1 name, the company name on line 2, and the owner’s SSN or EIN as the number. Match the name and number to what you use with Medicaid and your bank.
• ACH enrollment. The facility’s form or yours, with your bank’s routing and account numbers, signed by an owner. Attach a voided check or a bank letter.
• Certificate of insurance. Auto liability at the limits in your agreement, with the facility named as certificate holder or additional insured if the agreement requires it.
• Exclusion screening. Facilities that bill Medicare and Medicaid cannot be paid for services furnished by an excluded person, and anyone who contracts with someone on the OIG exclusion list risks civil money penalties. Expect the facility to check your company and owners, and possibly your drivers.

Skilled nursing facilities often pay for residents’ rides themselves. Medicare covers no wheelchair or stretcher van rides, so a van trip is never billed to Medicare. Even for the ambulance trips that Medicare bundles into a covered Part A stay, the outside supplier looks to the facility for payment, at a price the two sides negotiate. Skilled nursing facility transportation explains which trips fall on the facility.

ACH: the payment to ask for

ACH credits are what accounts payable offices use to pay vendors every day. The facility’s bank sends the money to yours on a settlement date the facility picks, you see it as a deposit with the facility’s name, and the payment leaves a trace number that both banks can follow if anything goes wrong. Ask for ACH in the agreement and on the first invoice.

Remittance detail: CCD or CTX

What arrives with the money matters as much as the money. Under Nacha’s formats:

• CCD entries carry a single addenda record with an 80-character free-text field. That fits a few invoice numbers. Nacha notes the text may or may not be shown to you, depending on your bank and how you view the account.
• CTX entries support up to 9,999 addenda records and can carry a full X12 remittance message, listing every invoice and any short payment.

Ask your bank how it shows addenda: in online banking, on a report, or not at all. If yours shows nothing, ask the facility to email a remittance advice on the payment date as well, listing each invoice number and amount.

What Nacha’s 2026 fraud rules change for you

Facilities now have to watch their outgoing payments more closely. Nacha’s fraud monitoring amendments require businesses that send ACH payments, and the banks that send and receive them, to set up risk-based processes reasonably intended to identify entries initiated because of fraud, and to review those processes at least once a year. Phase 1 took effect March 20, 2026, for all originating banks, for businesses that originated 6 million or more ACH entries in 2023, and for receiving banks that took in 10 million or more. Phase 2 took effect for everyone else on June 19, 2026, which, because that date was a federal holiday, meant Monday, June 22.

For a transportation vendor the effect is practical. Expect the facility to confirm any change to your bank account by calling a number it already has on file. Send changes on letterhead, signed, and ask them to call you back before they switch. Your own bank also monitors incoming credits now, and may contact you about a payment that looks out of pattern.

Paper checks: slow, and the payment type fraud targets most

Checks still arrive from many facilities, and they carry the most risk. In the Association for Financial Professionals’ 2026 survey, released April 14, 2026, 58 percent of organizations said checks were subject to fraud, the most of any payment type. Among organizations that plan to keep writing checks, 68 percent cited vendor requirements as a reason. Asking for ACH takes your company off that list.

The mail is the weak point. FinCEN’s February 2023 alert on mail theft and check fraud noted that banks filed more than 680,000 suspicious activity reports on check fraud in 2022, nearly double the 350,000 of 2021. It also said business checks are attractive targets because business accounts are often well funded and victims may notice later. A stolen check can be washed, re-made out to someone else, and deposited before you know it was sent.

Holds slow you down further. Under Regulation CC, the first $275 of a day’s check deposits must be available the next business day, and local checks by the second business day. Once a day’s check deposits pass $6,725, the bank may hold the excess for an extra reasonable period under the large-deposit exception. A monthly check from a busy dialysis center or nursing home can cross that line on its own.

If you must take checks, deposit them the day they arrive, by mobile deposit or at the bank. Keep a log of every check received, matched to invoices, kept by someone other than the person who deposits them. Internal controls for NEMT billing and cash covers that split. If you write checks yourself, ask your bank about positive pay, which flags any check presented on your account that does not match the list you send.

Cards and payment portals: fast money with a fee

Some accounts payable departments pay vendors with commercial or single-use virtual card numbers, often sent through a payables portal that invites you to enroll. The money arrives quickly, but you pay the card acceptance cost. Visa’s interchange schedule effective April 18, 2026, sets these rates for purchasing and corporate cards, before your processor adds its markup:

• Keyed online or by phone. Commercial card not present: 2.70 percent plus $0.10.
• Straight-through processing. A separate schedule starts at 2.00 percent plus $0.10 for payments under $7,000. Ask your processor whether a facility’s portal payments qualify.
• Large payments. Visa’s large purchase program applies lower percentages plus a flat fee to card-not-present payments over $10,000, for example 0.70 percent plus $49.50 from $10,000.01 to $25,000.

Here is an example. A facility pays a $6,400 monthly invoice by virtual card. Keyed as a commercial card not present, interchange is $172.90 that month. At the straight-through rate, it is $128.10. Over a year, that is roughly $1,540 to $2,070 in interchange alone, which may be more than you would accept as a discount for paying early.

You have three choices: accept the card, ask for ACH instead, or build the cost into the facility’s rates when the agreement renews. Surcharging a card is restricted by card network rules and banned in some states; quoting private-pay ride prices and charging riders by card cover those limits. Card payments also show up at tax time on Form 1099-K from your processor rather than on the facility’s own 1099, as 1099 forms for NEMT providers explains.

Business email compromise: the fraud aimed at your payments

The costliest fraud for a vendor rarely touches your own systems. A criminal emails a facility’s accounts payable office, posing as you, with new bank details, and the next payment goes to the criminal. The facility believes it paid. In the FBI’s 2025 Internet Crime Report, business email compromise drew 24,768 complaints and more than $3.04 billion in reported losses. The AFP’s 2026 survey found 74 percent of organizations were affected by it in 2025.

Close the gap before it is used:

1. Agree on a verification step at setup. Tell the facility in writing that you will never change bank details by email alone, and that any change must be confirmed by a call to the number in its vendor file.
2. Protect your email. Turn on two-step sign-in for every account that sends invoices, and watch for forwarding rules nobody set up.
3. Watch for missing payments. A facility that always pays on the 15th and then misses a month is a reason to call the same day, not next month.
4. Act within hours. If money went to the wrong account, the facility should call its bank to request a recall and file at ic3.gov. In 2025 the FBI’s recovery team worked 3,900 incidents and froze $679 million, 58 percent of the attempted theft.

Matching each payment to its invoice

A payment you cannot match is money you cannot count as collected. Post every deposit the day it arrives against the invoices it pays, using the remittance detail or the facility’s emailed advice. When a payment is short, record what was paid and open a dispute on the specific lines left unpaid, rather than letting the difference sit as a mystery. Send each facility a monthly statement of open invoices so its accounts payable office sees the same balance you do. NEMT accounts receivable covers aging and follow-up.

Where HealthRide fits

Facility staff can open and pay their invoices in their own HealthRide portal, by card through our secure card processor. ACH, check, and wire payments you receive are recorded against the invoice they pay, so every facility balance lives in one ledger, and a past-due list shows which facilities to call. See invoicing.