NEMT claim status: where to look up a trip claim, what the 277 codes mean, and when to follow up

Look it up before you call or resend

A status check tells you where a claim sits in the payer’s system today. Do it before you call and before you send anything a second time. A duplicate does not move the first claim along, and it can cost you later. In Indiana, a denied claim resubmitted without corrections is processed as a duplicate and denies again for the same reason, and that copy does not count as an effort to resolve the claim if you later ask for a filing limit waiver. Medi-Cal asks providers to hold off on a Claims Inquiry Form while the current remittance lists the claim as suspended.

The status also tells you which kind of problem you have:

• Never accepted. The claim bounced before processing. Fix the data and submit a fresh claim. See claim rejections.
• Still in process. The claim is waiting on the payer. Leave it alone unless the payer asks you for something.
• Finished. It paid, paid less than billed, or denied. Read the reason codes, then correct or appeal. NEMT claim denials and appealing a denied NEMT claim cover those cases.

Reading the status codes

Electronic status responses use X12 claim status category codes, and most portals show the same codes or a plain-language version of them. The first letter gives the stage: A for acknowledgment, P for pending, F for finalized, and R for a request for more information. X12 defines a pended claim as one with no remittance advice issued yet, or only part paid.

Each status also carries a more detailed claim status code, and ePACES shows both codes with their descriptions. With a P3, X12 requires that detailed code to name the information the payer asked for.

Medicaid fee-for-service: three state systems

Each state’s claims processor has its own lookup, and each one has limits worth knowing before you search.

Texas

Texas Medicaid reports every accepted claim on a weekly Remittance and Status (R&S) Report, grouped as paid, denied, or still in process. TMHP considers for payment, and lets you look up, only the claims marked accepted in the 27S batch file, which holds the Claim Response report. A claim rejected at that stage will not show in the status lookup at all. TMHP gives an electronic claim 10 business days to reach the R&S Report and a paper claim at least 30.

If it is still missing after that, two lookups tell you what happened: the claim status inquiry in TexMedConnect, and the Automated Inquiry System at 800-925-9126. Either one shows the claim as pending, paid, or denied, or tells you the claim is not on file. A claim TMHP has no record of can be sent again, and the new copy is still held to the 95-day filing deadline. Once 95 days have passed, the fallback is a signed copy mailed to TMHP’s Inquiry Control Unit with every document that shows you billed the first time, including electronic rejection reports. That route stays open for 120 days from the date printed on the rejection report or R&S Report. Keep every R&S Report for at least five years. Once a claim prints as paid or denied, its status changes only if the provider, HHSC, or TMHP takes further action. The Texas NEMT guide covers who pays which trips there.

New York

The Claim Status Inquiry in eMedNY’s ePACES returns its answer within moments and covers paper claims as well as electronic ones. It returns the last 10 adjudicated claims that match the search and looks back only 2 years. Search by the rider’s Client ID with a From date of service. Adding the Transaction Control Number printed on the remittance narrows the answer to that one claim. Run the search under the individual provider’s ID, since eMedNY asks that status inquiries not use a group ID.

The response shows the claim and line status codes, the date that status took effect, the paid amount, and, once paid, the remittance trace or EFT number and its release date. That trace number is what ties a deposit back to the claim.

California

For a Medi-Cal claim that shows neither a payment nor a denial on the Remittance Advice Details, the tool is a Claims Inquiry Form sent as a tracer. The fiscal intermediary searches its payment records and answers by letter whether a claim is on file, with the date paid or denied if it is. Tracers can go in at any time, but the search covers only the past 36 months of adjudicated claims. A tracer meant to prove timely submission has to arrive within the original six-month billing limit. Response letters can also be read in the Medi-Cal Provider Portal.

Broker trips live in the broker’s system

When a broker pays for the trip, the state’s portal never sees the claim. The status, the denial reason, and the appeal all sit with the broker.

• MTM Health, Virginia. Each trip is billed under its trip ID, and a clean claim has to be submitted to MTM no later than six months past the ride date. MTM’s handbook calls a claim clean when its electronic trip log includes the trip ID and the member’s signature, plus the pickup time as scheduled and as actually run, and the times the trip departed and arrived. A missing item, or a trip whose status has slipped out of completed, means a denial. Denials can be contested through MTM’s online claims portal for 365 calendar days, and a claim sent by mistake is voided by calling the provider’s Field Monitor.
• Verida, Indiana. The weekly cutoff is Wednesday: a clean claim in by then is paid within 14 days, and Verida sends a remittance advice with every payment cycle. Claim questions, including short payments and overpayments, start with an administrative review requested in the Verida Provider Portal.
• Louisiana health plan trips. The state’s NEMT bulletin (IB 21-02, revised September 8, 2026) has the broker give a reference number for every reconsideration request, and the provider can use that number in a later appeal.

For every broker, note the claim or reference number, the date of each contact, and who you talked to. The broker guides cover the major brokers one by one.

The 276 and 277 inquiry

If claims go out electronically, status can come back the same way. HIPAA defines the claim status transaction as a provider’s inquiry to a health plan and the plan’s response (45 CFR 162.1401). The standard is the X12 276 request and 277 response, version 005010X212, required since January 1, 2012.

Since January 1, 2013, the transaction has also carried a federal operating rule, CAQH CORE’s Phase II Claim Status Rule (45 CFR 162.1403). It sets three service levels:

1. A real-time inquiry gets its answer within 20 seconds, measured as 90 percent of responses in a calendar month.
2. A batch of inquiries sent by 9:00 p.m. Eastern on a business day comes back by 7:00 a.m. Eastern the next business day.
3. The system answering inquiries is available at least 86 percent of each calendar week.

The 277CA that comes back after a batch claim file is a different report. It says whether each claim was accepted into the payer’s system or rejected. eMedNY, for example, generally returns it within 4 hours of an 837 batch. A 277 answering a 276 reports where an accepted claim stands now. 837P for NEMT covers the acknowledgments that follow a claim file.

Timing the follow-up and keeping the proof

A status check is worth doing on a schedule tied to each payer’s cycle rather than whenever a deposit looks short. The waits above are a starting point: 10 business days for a Texas electronic claim, 14 days for a clean Verida claim, and 45 days after Medi-Cal acknowledges a Claims Inquiry Form for an adjustment or reconsideration. The guide to Medicaid payment timing sets out the full payment cycles.

Save what each lookup returns. The filing deadline does not pause while a claim is being researched. Indiana accepts remittances, the 277 response to a 276 inquiry, and printed screens from its provider portal as proof of reasonable and continuous attempts to resolve a claim, and it rejects provider-made notes and timelines. Timely filing limits explains how payers count the last billing day for each trip.

Keeping the trip side ready

A P3 or R4 status means the payer is waiting on information or documents, and on a transportation claim that is often the record of the ride itself. In HealthRide, each trip leg keeps the on-screen signature, pickup and drop-off timestamps, and GPS-recorded miles. Export the trip log covering that rider and date as a PDF or a spreadsheet and send it with the claim number.