NEMT trip booked at the wrong level of service, address, or time: fixing it before the van rolls

The trip is the authorization

A broker trip is not a suggestion. Its mode, its level of assistance, its addresses and its times are what the broker approved and what it will pay for. When one of them is wrong, the fix is a change to the authorization, made by the broker, before the van leaves. Your dispatcher’s job is to catch the error early and get it changed.

Broker manuals put this in plain terms. CareOregon’s provider manual lists the changes that need the brokerage’s approval: pickup times, appointment times, and pickup or destination addresses. Vehicle type is on the list too, unless the vehicle you offer still meets the member’s needs. CareOregon does not pay for a trip that was not run as authorized, and a provider that keeps changing trips without approval risks corrective action, up to suspension or loss of the contract. TennCare puts the same limit in its managed care contract: the health plan must keep providers and drivers from moving an assigned pickup time unless the plan says yes.

The errors come in three kinds:

• Level of service. A wheelchair user booked as ambulatory, a rider who must lie flat booked for a wheelchair van, or hand-to-hand help missing for a rider with dementia.
• Address. An old home address, a pickup at a relative’s house the broker never heard about, or the wrong office of a practice with several locations.
• Time. A pickup that cannot reach the appointment, a.m. and p.m. swapped, or times stated in two different time zones.

What happens on the claim is covered in the guide to level of service downgrades. This guide covers dispatch: finding the error, getting it changed, and keeping a record.

Catch it when you accept the trip

The cheapest moment to find an error is when the trip lands in your queue, days before the ride. MTM Health’s Virginia provider handbook, approved August 10, 2026, offers trips to providers seven days ahead of the appointment and expects any trip a provider cannot cover to be turned back no later than 24 hours before the scheduled pickup. MTM’s portal tips rule out turnbacks on the day of the ride and ask providers to look over upcoming trips every day.

The manifest gives you what you need to check. MTM’s Virginia manifests carry the mode, how much help the rider gets between the door and the van, whether the rider brings an escort or you must send an attendant, the member’s weight including mobility devices or equipment, and special needs and pickup details. The handbook makes reviewing and following that information the provider’s responsibility.

Read each new trip for these mismatches:

• Notes that contradict the mode. “Power chair,” “can’t stand,” or “hospital bed” in the notes of a sedan trip.
• Weight against your lift. Under 49 CFR 37.165(b)(1), a provider may decline a rider when the person and chair together are heavier than the lift’s rated capacity. Find that out now, not at the curb.
• Addresses that look wrong. A pickup at a hospital for a rider who lives at home, or a destination that does not match the provider name. Call the office number on the manifest to confirm which location the rider is seeing.
• Times that do not add up. A pickup that leaves less drive time than your maps show, or an appointment at 3:00 a.m.

CareOregon’s manual lists “provider does not supply vehicle type required for trip” among acceptable reasons to ask for reassignment. If the trip is right but your fleet cannot run it, give it back early.

The night-before check

A short call to each rider the day before catches what the manifest cannot. MTM’s portal tips tell providers to call each participant the day before and confirm the pickup time, and MTM Wisconsin tells its members that their transportation provider will give them a reminder call the day before. Use the call to check the facts that change most often:

1. Confirm the pickup time and the address where the rider will be waiting.
2. Ask how the rider is getting around right now: walking, walker, manual chair, power chair, or bed.
3. Confirm the appointment time and the office address.
4. Ask whether anyone is riding along, and whether a child seat is needed.
5. Ask whether the return is at a set time or a call when ready.

Ask open questions. “How are you getting around these days?” brings out the new power chair that “You still use the walker, right?” hides. A rider who was discharged after surgery last week may need a wheelchair van for a few weeks even though every trip in your system says ambulatory. Anything that does not match goes to the broker that evening, not to the driver in the morning. The trip intake guide covers the booking questions that prevent most of these errors in the first place.

Wrong level of service: why the rider never goes in the wrong vehicle

A rider who needs a higher level than the trip shows does not ride. The reasons are physical and legal, and drivers should know both.

A wheelchair rider needs a securement position. Under the ADA vehicle standards in 49 CFR 38.23, each securement location needs a clear floor area 30 inches wide and 48 inches long, a securement system that lets the occupied chair move 2 inches at most in any direction, and its own lap belt and shoulder harness for the rider. A sedan or minivan has none of that. Moving the rider into a car seat is not the answer either. Under 49 CFR 37.165(e), the driver may suggest a transfer to a regular seat, but the rider decides, and many riders cannot transfer safely at all. The securement standards guide covers the equipment side.

The same logic runs up the ladder. MTM’s Virginia handbook describes wheelchair vans for riders who use a wheelchair but can sit upright during transport, and stretcher vans for riders who must travel lying down. If a rider has to lie down for any part of the ride, a wheelchair position cannot hold them safely, whatever the manifest says.

The reverse case is easier. A rider booked for a wheelchair van who walks out with a cane can usually ride in that van, because it meets their needs. CareOregon’s manual uses this example: a wheelchair van with ambulatory seats carrying a member booked for a sedan does not need a separate approval. The broker still pays the authorized level and no more, so tell it what you found so future trips are booked right.

Getting the broker to change it

When the error surfaces at the door, the driver stops and the office takes over:

1. The driver does not load the rider. They explain that the van is not set up for the rider’s needs and that the office is fixing it now.
2. The driver calls dispatch with the trip number and what they see: “Rider is in a power chair, trip is booked ambulatory.”
3. Dispatch calls the broker. Brokers do not want providers editing trips. MTM’s portal tips say providers should not change the mode of an assignment, and MTM Wisconsin sends trip errors to Provider Support and asks members to call MTM themselves for changes to their trips.
4. The broker changes the mode. Some programs need a clinician’s form for a higher level. Under MTM’s Rhode Island handbook (last updated July 1, 2026), a member may need a doctor to fill out a Level of Need form before qualifying for wheelchair or stretcher service, and in the meantime MTM allows the requested mode for as long as two weeks.
5. The broker reassigns or approves you. If you have the right vehicle free, offer it. If not, the broker moves the trip to someone who does.
6. Someone tells the clinic. MTM’s standard provider agreement makes you report a serious delay to MTM right away and work out another way to get the rider there while the visit is still possible. If the rider is going to miss it, the broker or the rider calls the office to reschedule.

A trip the broker hands you after its pickup time has already slipped is a separate case. CareOregon keeps the booked time on those trips, notes on its side that the assignment came late, and does not hold the late arrival against you.

Wrong address

A wrong address in the trip record is different from a hard-to-find door, which the guide on pickup address problems covers. Here the broker has the wrong place. The rider moved, is staying with a daughter after a hospital stay, or is seeing a specialist at the practice’s second office across town.

The fix is the same: the broker changes it, not the driver. MTM Wisconsin’s provider page says a member who wants a change of destination needs MTM’s approval first. CareOregon’s manual lists changing origin or destination addresses without prior authorization among the violations that can lead to suspension. Two habits catch most address errors early:

• Call the destination office during acceptance when the address and provider name do not obviously match. Practices with several sites are the usual cause.
• Ask about the pickup address on the night-before call, especially after a hospital stay or a move.

Wrong time

A pickup time is wrong when the rider cannot reach the appointment on time from it. Work it out before the day: drive time at that hour, loading time for the mobility level, and the check-in time the program expects. TennCare’s contract counts a drop-off as late unless the rider arrives 15 minutes or more before the appointment. It also bars making riders arrive over an hour ahead, or dropping them at an office that has not yet opened its doors. Other programs’ windows are listed under appointment time.

Two clerical errors are worth checking on every trip:

• Time zones. TennCare manifests state the pickup time in the time zone of the pickup location and the appointment time in the zone of the appointment. Tennessee spans Eastern and Central time, so a trip from Chattanooga to a Nashville specialist can look an hour short or an hour long until both are converted.
• Clock format. TennCare lets its plans use a.m./p.m. or 24-hour time, but requires the same format across the plan, its providers, and drivers. As an example of what mixing them does, a pickup entered as 2:00 next to a 14:30 appointment can be read as 2:00 a.m.

If the time is wrong, ask the broker to move it. Do not send the driver early on your own. MTM’s standard provider agreement lets MTM penalize you, or simply not pay for the trip, when your late arrival means the member misses the visit.

Log who changed what

Every correction gets a short entry on the trip, written at the time of the call:

• What was wrong and what it was changed to.
• The name of the person at the broker who approved it, and the time.
• The new trip or authorization number, if the broker issued one.
• Whether the rider and the clinic were told.

That entry protects you when the claim pays a different level than the van that ran, and when a complaint arrives weeks later. CareOregon expects trip records to carry the authorization or trip number and the mode, kept at least six years. MTM’s standard agreement sets a 10-year retention period, longer if a law or the client calls for it. TennCare’s driver logs need notes for cancellations, incomplete requests, no-shows, and incidents. Bill only the level on the final authorization; the downgrades guide explains what payers do with anything else.

Catching mismatches in HealthRide

HealthRide warns you before a wheelchair trip goes to a van without a lift, which matters most on the day a trip’s level is corrected. Every change, from the office or from the road, shows up for everyone in real time, and every change is recorded. See how assignments work on the dispatch board.