How to Handle NEMT Will-Call Trips Without Breaking the Schedule

Why will-calls need their own plan

A will-call trip is a return ride with no pickup time until someone calls. CareOregon’s transportation provider manual (February 2024) defines it as a trip assigned without a scheduled pickup time, with the time set by a call from the member or another party saying the member is ready. You know the trip is coming. You do not know when.

Will-calls come from appointments with an unpredictable end: dialysis that runs long, outpatient surgery, specialist visits, imaging, and hospital discharges. CMS names dialysis and outpatient surgery as examples of covered services that can take hours to complete. That uncertainty makes will-calls hard to keep on time, and a late one leaves a rider who has finished treatment waiting to go home.

Will-call response standards

Your broker or plan sets the clock, and it starts when the rider says they are ready.

Two details matter as much as the number. First, the call usually goes to the broker, not your driver. Virginia’s handbook tells members to contact Modivcare, not the NEMT driver, when they are ready. Second, will-call timeliness is scored on its own. Mississippi’s 2018 contract with its statewide broker listed “Will Call” as a separate scheduling and dispatching category for liquidated damages, next to trips to and from appointments and hospital discharges. Between June 2022 and August 2023, the state assessed that broker $30,950 for 1,238 will-call instances (PEER Report #705, October 2024).

Plan capacity before the calls come

The fix for late will-calls happens the night before, when you decide how much open van time to leave in the afternoon.

1. Count your history. Pull the last four to eight weeks of will-calls. Group them by hour of the call and by facility.
2. Price each return in minutes. Drive time to the facility, boarding, and the ride home. Wheelchair and stretcher boarding takes longer than ambulatory.
3. Compare demand with open time. Line up the minutes of will-call work against the open minutes in your routes for the same hours.
4. Match by vehicle type. A free sedan does not help a wheelchair rider. Hold capacity by level of service.
5. Note an expected ready time. If the facility can give a rough end time at booking, put it on the leg. It is not a promise, but it tells you which hour to protect.
6. Stage near the sources. Plan routes so a capable vehicle passes near your biggest will-call facilities during their busy hours.

Here is a worked example. A hypothetical fleet averages 14 will-calls a day, and 10 of them come between 11:00 AM and 3:00 PM, mostly from two dialysis centers and a surgery center. Each return takes about 35 minutes of driving plus 10 minutes of boarding, so 10 returns need about 450 minutes of van time. The window is 4 hours, or 240 minutes per van. That fleet needs close to two vans’ worth of open time in those four hours: one float van plus gaps in two routes, or two lightly loaded routes near the dialysis centers.

When the call comes

A will-call workflow that runs the same way every time is what keeps response times inside the limit:

1. Log the call time. This is when the clock starts, and you will need it if the pickup is ever disputed.
2. Confirm the rider is really ready. Ask the facility whether discharge papers are done and which entrance the rider is at.
3. Choose the vehicle. Pick the closest van with the right equipment and a free seat, whose next scheduled trip will not go late because of this pickup.
4. Send it and give an ETA. Push the pickup to the driver’s app and tell the rider or facility when to expect the van.
5. Escalate early. If no vehicle can make the limit, tell the broker at once. A trip returned with notice is better than one that runs silently late.
6. Close it out. Record the pickup and drop-off times on the leg.

Wait at the facility or come back later

Sometimes the cheapest option is for the driver to wait. Often it is not. CMS guidance (SMD 23-006, September 2023) says states generally may not cover long wait times as a separate service, because the beneficiary must be present with the driver. It also recognizes that waiting is sometimes the most economical way to provide the return, and that states can build waiting costs into rates or cover wait time in limited circumstances through their state plan.

In practice, waiting makes sense when the facility is far from your next job and the treatment is short. Leaving makes sense when nearby work can fill the gap. For private-pay and facility contracts, you can price waiting directly. The trip pricing guide covers how to set a wait-time charge.

Where will-calls go wrong

• The will-call never makes it onto the schedule. It lives on a sticky note or in one dispatcher’s memory.
• The rider calls the driver directly, and the driver does not tell dispatch.
• The facility calls too early. The driver arrives and waits 40 minutes while paperwork finishes.
• The only free vehicle is the wrong type.
• A will-call is still open at the end of the day. Before drivers go off shift, check that every open return has a plan. A rider left waiting at a closed clinic is the failure riders and facilities remember.
• No after-hours plan. If trips can end after your office closes, set a clear after-hours contact. CareOregon asks drivers to try to pick up return riders within 15 minutes of the pickup facility’s closing time.

Hospital discharges are a special case of will-call, with their own paperwork delays. The hospital discharge transportation guide covers them in detail.

Measure your will-call response

Track two numbers every week:

• Will-call response rate = will-calls picked up within your contract limit ÷ all will-calls × 100
• Average response time = total minutes from call to arrival ÷ number of will-calls

For example, a month with 120 will-calls, 111 of them picked up within 60 minutes, has a 92.5% response rate. That is short of Indiana’s 95% standard. Break the misses down by facility and hour. If most come from one center between 1:00 and 3:00 PM, that is where to stage the next open vehicle. Will-call response feeds straight into your broker scorecard, alongside the measures in the on-time performance guide.

Running will-calls in HealthRide

In HealthRide, flexible return trips hold their place on the dispatch board and activate the moment the passenger is ready. The live map shows where every vehicle is, so the dispatcher can see which capable van is closest and assign the pickup in one motion.