Late broker payments: checking what you are owed and escalating the right way

Before you call a broker payment late, find the clock that applies to it and check the trips behind the shortfall. Denied trips, offsets, and claims that were never clean can all look like a late payment. A payment that is truly overdue gets resolved faster when you can name the trip IDs, the submission dates, and the clause the broker missed. This guide walks through that check, then the escalation path, then how to keep cash moving while you wait.

First, find the payment clock that applies

The payment deadline comes from your provider agreement, not from a general rule. The federal Medicaid prompt-pay rule at 42 CFR 447.45 sets 30-day and 90-day targets for a state agency paying practitioner claims, and 42 CFR 447.46 carries those targets into Medicaid health plan contracts. Neither one sets a deadline for a broker paying a transportation company. That clock lives in your agreement, sometimes backed by terms the state wrote into its contract with the broker.

Georgia’s NEMT manual sets a default for agreements that name no date: 15 business days from the broker’s receipt of an undisputed invoice. MediDrive pays Colorado providers for completed and verified invoiced trips every two weeks. MTM Health’s Virginia handbook allows six months after the service date for a clean claim and 365 calendar days to contest any denial.

Note the qualifiers: uncontested, properly submitted, clean. The clock starts only when the claim is complete. Rhode Island’s broker contract calls a claim clean when the broker can process it with nothing further from you or anyone else. MTM Health’s handbooks translate that for a trip: every claim needs the trip ID, the planned and actual pickup, when the vehicle left and arrived, and the rider’s signature, and the trip must show as completed. Leave out any piece and the claim is denied, which is a different problem from a late payment.

Why broker payments come in short or slow

Work through these causes before you escalate. Each one is written into a broker agreement or handbook.

1. The claim was not clean. Missing times, a missing signature, or a trip not marked completed. WellTrans returns trip logs with initials instead of signatures, notes that the rider could not sign, or whited-out changes.
2. The driver or vehicle was not approved. MTM Health and WellTrans both refuse payment for trips run by uncredentialed drivers or vans.
3. The claim was filed late. Past the submission window, the money is usually gone. See timely filing limits.
4. An offset was taken. WellTrans deducts liquidated damages from amounts due, after giving at least 10 days’ written notice that you can contest. Both agreements let the broker recover overpayments from future payments.
5. An attendance check went unanswered. WellTrans confirms that riders attended their appointments. Leave its written question about a trip unanswered for 30 days and the trip counts as never run, with the amount taken back from your next check.
6. Medicare came first. For trips billed to Medicare first, MTM Health’s Virginia handbook and the WellTrans agreement start the submission clock on the date Medicare denies the claim.
7. The broker’s client paid late. The WellTrans agreement allows it to delay provider payments until its client pays amounts validly due.
8. You gave notice. MTM Health’s agreement withholds payment on all unpaid claims after a termination notice until it has audited the records.

One cause is not allowed everywhere. CareOregon’s manual says payment may not be withheld during an audit, though overpayments found later can be taken from future invoices.

Reconcile every unpaid trip

A late-payment complaint that lists trip IDs gives the broker something to act on. One that says “you owe us about $3,000” invites a request for details. Build the list first.

1. Export your completed trips for the month, with trip ID, date, and the amount you expect.
2. Export the broker’s payment history. MTM Link has a Claim Payments section that exports a payment summary to a spreadsheet, and each payment opens a remittance page with its details. American Logistics puts a summary of yesterday’s serviced trips on its website each day, plus one covering the previous week.
3. Match the two lists by trip ID.
4. Put every unmatched or short-paid trip in one bucket: not submitted, submitted and pending, denied, paid short, or offset.
5. For pending trips, count the days since submission and compare them with your agreement’s clock.

Here is how that looks with illustrative numbers, using a $55 average trip.

The month looked $4,400 short. Only $1,375 of it is actually late. The rest is $935 not yet due, $1,650 to submit or appeal, and $440 lost to a credentialing gap. Our guide to NEMT trip reconciliation covers the monthly routine, and NEMT accounts receivable covers aging by payer.

Escalate in order, and in writing

Move up one level at a time, and keep a dated log of every call, email, and letter.

1. Your account manager. Send the overdue list: trip IDs, service dates, submission dates, amounts, and the payment clause. Ask for a status on each trip by a specific date. At MTM Health, that is your Virginia field monitor or your Rhode Island vendor account manager.
2. The broker’s formal process. MTM Health’s handbooks let providers file a complaint through the account manager, the website contact page, or a letter to Quality Management in Lake Saint Louis, Missouri. Rhode Island’s contract requires MTM Health to run a provider grievance process that covers claims and billing, acknowledge each grievance within five business days, and resolve it within 60 days where possible. Under the WellTrans agreement, a stalled dispute goes first to a senior manager named by each side. If they cannot settle it, the Family and Social Services Administration (FSSA), Indiana’s Medicaid agency, arbitrates for free, and its decision binds both parties.
3. The health plan. When a Medicaid health plan hired the broker, the plan keeps ultimate responsibility for meeting its state contract under 42 CFR 438.230, even for work it hands to a transportation vendor. In Texas, for example, Blue Cross and Blue Shield of Texas contracts with a transportation vendor for its Medicaid members’ rides, so a vendor that will not pay is ultimately the plan’s problem too.
4. The state. Texas HHSC asks a provider with a complaint about a health plan to contact the plan first, then email hpm_complaints@hhs.texas.gov with the provider name, NPI, phone, contact person, and the member’s Medicaid ID for the complaint. In Colorado, trip, billing, and payment issues go to MediDrive provider support first, and HCPF takes general NEMT questions at nemt@state.co.us.

Use the notice clause for anything formal. MTM Health’s agreement treats notice as given on personal delivery, three mail delivery days after it goes by certified mail with return receipt, or on delivery by a national courier.

States have strong tools when they choose to use them. Rhode Island’s contract lets the state charge MTM Health $1,000 a day for failing to pay providers on time and, for a pattern of improperly denying, delaying, or recouping provider payments, penalties equal to 150% of the claims involved, a freeze on new enrollment, or termination. It also requires 12% annual interest on clean claims unpaid after 30 days. A clear, documented complaint gives the state something to act on.

Protect your cash while you wait

A slow payer should not become a cash crisis. These steps keep money coming in while the dispute runs.

• Bill this month’s trips on schedule. An open dispute about older claims does not pause the filing deadline for new ones.
• Keep running assigned trips. The WellTrans agreement says you must keep running trips even while amounts are contested. Leaving without the notice the agreement requires forfeits everything still owed to you, and MTM Health can deduct what it spends to re-cover trips you abandon while serving its 30-day notice.
• Do not bill riders. Under MTM Health’s agreement, members are off limits for billing even when nobody else pays, with an exception for copays MTM authorizes.
• Plan any financing early. If you sell your broker receivables or assign the payments to a lender, MTM Health’s agreement wants written notice and evidence of the arrangement no less than 30 calendar days ahead of the first payment you assign. See NEMT factoring.
• Spread the risk. For example, a broker that is 30% of revenue can be late without sinking you. One that is 90% cannot. Our guide to NEMT payer mix covers the targets, and NEMT cash flow covers the reserve.

Tracking what each payer owes in HealthRide

The payer summary report in HealthRide breaks down each payer’s completed trips, cancellations, billed revenue, and unpaid balance for whatever period you pick, so a growing balance stands out before it turns into a dispute. The trip log exports each leg’s scheduled and actual times and GPS miles as backup when you appeal a denial. Checks and ACH deposits are recorded in the same payments ledger as card payments, so you can see what has actually arrived.