Broker trip offers: which rides to accept, when to decline, and the cost of turnbacks

A broker trip offer is a decision with a deadline. Say yes to a trip you cannot cover and you risk a provider no-show. Say no too often, or too late, and your share of future work shrinks. Each broker writes its own deadlines and penalties into its handbook or provider agreement, and the numbers below show how far apart they are, so you can set your own policy against them.

How offers arrive and how long you have to answer

Brokers send work in a handful of ways: straight to a named provider, on a daily list or manifest, through an open marketplace, or by phone for urgent rides. Many brokers use several at once, and each route comes with its own clock.

Two points stand out. First, handback deadlines at MTM Health and WellTrans count back from the pickup or the appointment, so a trip reviewed late leaves less room to return it. Second, a quiet “no” is not free. MTM Health’s Virginia dispatchers chase pending offers by phone, and SafeRide measures your response rate as well as your acceptance rate.

What a late or frequent turnback really costs

A turnback made inside the window is routine. A late one, or a steady stream of them, costs you in four ways.

Scorecard points. MTM Health’s Virginia handbook sets the trip re-route standard, meaning trips turned back or returned to MTM, at under 0.5%. Its Rhode Island scorecard rates turnbacks under 3.99% as green, 4% to 6.99% as yellow, and 7% or more as red. Miss them and MTM can put you on an improvement plan, charge liquidated damages, or drop you from its network.

Fees. The WellTrans agreement caps reroutes at 15% of monthly trips and adds $200 for every point over the cap. When a trip assigned 36 hours or more ahead goes back with under 12 hours of notice, you owe WellTrans the gap between your price and the cost of the replacement ride, or $100 when nobody covers it.

Access. Under MTM Health’s Rhode Island handbook, trying to return a trip taken from the Marketplace can get your Marketplace access suspended or removed. Under CareOregon’s provider manual in Oregon, a pattern of last-minute returns can lead to a corrective action plan that reduces the rides offered to you or narrows the hours or service area you are set up for.

Complaints. MAS, the Medicaid transportation broker in New York, says a refusal made within 48 hours of the pickup time carries ten times the chance of a complaint from a rider, facility, or other stakeholder.

The worst outcome is holding a trip you cannot run. Rhode Island’s broker contract defines a turnback as a trip the provider refuses inside the time the broker allows, and says a turnback does not count as a vendor no-show. A trip you keep and never run is a missed trip, and brokers score it far more harshly. In Virginia, MTM Health files an assigned trip that is refused or left undone under vendor no-shows, and its standard for those is below 0.25%. WellTrans bills $100 each time a vehicle fails to show.

Reasons brokers accept, and trips you may not refuse

Brokers expect returns for real capacity problems. CareOregon’s provider manual in Oregon lists the reasons it accepts and the ones it does not.

CareOregon also says it will not penalize a provider for returning trips that were assigned outside its stated area or hours. You are expected to tell the brokerage when that keeps happening.

A few trips are off limits for refusal. New York’s Medicaid transportation manual forbids refusing or reassigning Preferred Provider Opportunity trips, which run under partnerships between a medical provider and a transportation company that the state health department monitors. It also bars an ambulette that accepts the Medicaid fee from turning down Medicaid rides within the area its state license covers. Safety refusals follow a process too: the WellTrans agreement lets a provider refuse a rider who threatens anyone’s safety only after consulting WellTrans, and charges if you skip that step. Our guide on when a provider can refuse a ride covers the civil rights limits.

Deciding which offers to take

Run every offer through the same five checks first.

1. Level of service. Match the mode and assistance level on the offer (ambulatory, wheelchair, stretcher, curb-to-curb or hand-to-hand) to a van and driver you have. MTM Health’s Virginia manifests also list the rider’s weight including mobility devices, escorts, and any attendant you must supply.
2. Credentials. The driver and vehicle you plan to use must be approved by that broker on the trip date. WellTrans will not pay for a trip unless it approved both the driver and the vehicle in advance, and MTM Health’s Virginia handbook warns of lost payment for trips driven by unapproved drivers.
3. The clock. Check the pickup window, the appointment time, and the return. In Virginia, a will-call return allows 45 minutes from the rider’s ready call, and a hospital discharge allows three hours. Both hold a van long after the first drop-off.
4. The money. Compare the payment to the time the trip takes, including the drive to the pickup and back. Deadhead miles are where thin trips lose money.
5. The relationship. A standing dialysis order or a facility you serve every week can be worth more than its single-trip margin, because repeat work keeps the schedule full week after week.

A worked example

The figures below are illustrative, not any broker’s rates. Say your wheelchair van costs $48 an hour to run with a driver, fuel included. Two offers arrive for the same afternoon:

The higher-paying trip loses money once the empty driving is counted. Offer B can still make sense if it chains into another trip near its drop-off, which is why offers are best judged against the whole day’s schedule rather than one at a time. Our deadhead cost calculator puts a number on the empty miles in your own fleet.

Do not let the math turn into cherry-picking. Declining one unprofitable trip is a business decision. Declining every low-paying trip type is the pattern CareOregon names as unacceptable.

Keep your broker profile honest

Most unwanted offers trace back to a profile that has drifted from what your fleet can actually do. MTM Health’s Virginia handbook says it assigns trips from each provider’s setup: how many vehicles you have, your hours, how far the trip runs, and whether your credentials are current. MAS requires New York providers to keep their Transportation Provider Profile current, holidays and closures included, and says it may adjust a profile itself to end a pattern of refusals.

A tidy profile does not buy a guaranteed volume. WellTrans’s agreement says it owes no specific number of trips and can pull back a trip already given to you. American Logistics calls its work a supplemental source of income with no promised volume, and CareOregon’s manual promises contracted providers no set volume. Your profile and your record are what keep offers coming.

Update each broker when any of these change:

• The counties or service area you cover
• Operating hours, weekend coverage, and holidays
• The number of wheelchair, stretcher, and ambulatory vehicles in service
• Drivers added, suspended, or leaving
• Urgent-trip availability. MTM Health will not assign a Virginia urgent trip without the provider’s prior authorization.

Build the day around the deadlines

A short, fixed routine keeps you inside every window.

1. Morning: clear new offers and marketplace trips before any 30-minute timers run out. Check the next seven days for trips you already know you cannot cover and return them now, not the night before.
2. Midday: compare tomorrow’s assigned trips against confirmed drivers and vans. Anything uncovered goes back before the 24-hour or 12-hour line.
3. Afternoon: take same-day and next-day work only for vans that are truly free. Accepting urgent trips you later drop does more harm than never taking them.
4. Weekly: count your turnbacks, declines, and no-shows per broker as a share of trips and compare them with each broker’s standard. See NEMT standing orders for protecting your repeat work.

Where software helps

HealthRide connects with brokers such as MTM, Alivi and Sentry, and their new trips appear on your board by themselves, with no retyping from a portal. With broker and private rides in one schedule, Ryder Go plans your whole day in one click, which makes open vans and gaps easy to spot when you decide what else to take on. See how broker connections work.