NEMT glossary
The words, codes, and abbreviations you run into in non-emergency medical transportation, each explained in plain English with how it plays out on a real day.
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Billing codes
32 terms
- A0080A0080 pays per-mile mileage when a volunteer with no vested interest drives a Medicaid member. The official descriptor, units, and 2026 state rates.
- A0090A0090 pays mileage when a family member, neighbor, or the member drives to a Medicaid appointment. The descriptor, units, and how four states use it in 2027.
- A0100A0100 is the HCPCS code for a non-emergency taxi ride. The descriptor, how units work, which mileage code pairs with it, and 2026 rates in four states.
- A0110A0110 is the HCPCS code for non-emergency bus transportation. How states use it for tickets and passes, what they pay, and the receipts they expect.
- A0120A0120 covers mini-bus, mountain area, and other transportation systems. How states use it for ambulatory vans, what they pay in 2027, and how to bill it.
- A0130A0130 is the HCPCS base code for a wheelchair van trip. The official descriptor, units, the mileage code it pairs with, and 2026 rates in four states.
- A0140A0140 covers non-emergency air travel on private or commercial flights. What it pays for, how states price tickets, and the prior approval rules in 2027.
- A0160A0160 pays per-mile mileage when a caseworker or social worker drives a Medicaid member. The official descriptor, who bills it, and how states pay in 2027.
- A0170 to A0210A0170 to A0210 are HCPCS codes for NEMT ancillary costs: tolls and parking, plus meals and lodging for member and escort. Descriptors and 2026 rates.
- A0424A0424 is the HCPCS code for an extra ambulance attendant. Where Ohio, Oregon, Indiana and New Mexico stand, and how it differs from an escort code.
- A0425A0425 bills ground ambulance miles, one unit per loaded mile. How Medicare counts them, which Medicaid programs use it for vans, and 2026 state rates.
- A0428A0428 bills one non-emergency BLS ambulance trip. Crew, vehicle, and medical necessity rules, 2026 Medicaid rates, and why stretcher vans bill differently.
- A0999A0999 is the unlisted ambulance service code. How payers price it by hand, what to send with it, and how Florida, Texas, Arkansas and Oregon use it.
- Diagnosis codes on NEMT claimsSome Medicaid programs want an ICD-10 code on every ride claim. The defaults Colorado, Arizona, Indiana, North Carolina, and Texas use, and where Z59.82 fits.
- HCPCS Level IIHCPCS Level II is the CMS code set behind every ambulance and NEMT claim. How it differs from CPT, where the ride codes sit, and how quarterly updates work.
- NEMT billing unitsA billing unit is the count on each claim line: a trip, a mile, a half hour, or a day. How units work by code and how Medicare, Indiana, and Oregon round miles.
- Origin and destination modifiersOrigin and destination modifiers are letter pairs like RP or JR that show where a NEMT trip started and ended. Every letter and how states use them.
- Place of service codeNEMT claims usually carry place of service 41, 42, or 99 in box 24B. Which code Colorado, Oregon, North Carolina, Texas, and Medi-Cal want, and why.
- S0209S0209 is the per-mile code for wheelchair van mileage. The official descriptor, how it pairs with A0130, which miles count, and 2026 rates in four states.
- S0215S0215 is the general per-mile code for non-emergency transportation. Which trips it pairs with, how four states use it in 2027, and the mileage rules to follow.
- S9992S9992 covers travel to a clinical trial site and local fares for the participant and one companion. Who pays it, its sister codes, and when to invoice instead.
- T2001T2001 bills a patient attendant or escort on a non-emergency trip. What it covers, how units differ by state, and 2026 rates from California to Illinois.
- T2002T2002 is the HCPCS code for non-emergency transportation billed per diem. What a per diem unit means, how it differs from T2003, and how states pay daily costs.
- T2003T2003 bills one non-emergency transportation encounter or trip. How Texas, Louisiana, Nevada, and Colorado use it in 2027, the modifiers, and the rates.
- T2004T2004 covers non-emergency transport on a commercial carrier with a multi-pass. How Colorado, Oregon, North Dakota, and New York use it and what it pays.
- T2005T2005 is the HCPCS base code for a non-emergency stretcher van trip. Who qualifies, how it pairs with T2049 mileage, and 2026 rates in five states.
- T2007T2007 bills waiting time for non-emergency vehicles in half-hour units. When states pay it, how many units they allow, and the documentation they want.
- T2049T2049 is the per-mile code for stretcher van mileage, billed next to T2005. The descriptor, which miles count, and 2026 rates compared with wheelchair miles.
- TK modifierTK marks an extra rider or companion on a non-ambulance trip. Who that person is in Indiana, Illinois, Colorado, and South Dakota, and the rate each state sets.
- TN modifierTN flags a rural trip or one outside the provider's usual area. How Arizona, Alaska and South Dakota define it, what each pays, and when to leave it off.
- U modifiersU1 to UD are HCPCS modifiers each state defines for itself. How Texas, Indiana, Colorado, Ohio, and Nevada use them on rides, and how to read your own list.
- Wheelchair ICD-10 codesZ99.3 is dependence on wheelchair, Z74.01 is bed confinement status, and R26.2 is difficulty in walking. What each means and what ride forms ask for.
Billing and claims
34 terms
- Assignment of benefitsAn assignment of benefits lets a rider's insurer pay your company directly. Where rides qualify, why Medicaid pay cannot be assigned, and what the form says.
- Base rateHow NEMT base rates work: the fixed pay for each one-way trip, codes A0130 and T2005, what the base includes in each state, and private-pay pricing.
- Billing provider vs rendering providerThe billing provider gets paid for the trip; the rendering provider did the work. Where each ID goes on the CMS-1500 and 837P, and mismatches that stop payment.
- CapitationCapitation pays a plan or broker a fixed sum per enrolled member each month, used or not. How it reaches NEMT brokers, and why it shapes provider rates.
- Claim adjustment reason codes (CARCs)CARCs are the standard codes that explain why a payer paid less than you billed. How group codes work, the CARCs NEMT providers see most, and remark codes.
- Claim rejectionA rejected claim was stopped by front-end edits, so it has no appeal rights and may not count as filed. Why NEMT claims reject and how to resend them in time.
- Claim scrubberA claim scrubber tests each claim against payer rules before it goes out. What to check on a transportation claim, Medicaid unit limits, and a short checklist.
- Clean claimA clean claim can be processed without asking anyone for more information. The federal Medicaid definition, the payment clock it starts, and NEMT examples.
- ClearinghouseHow a billing clearinghouse formats, checks, and routes electronic claims, what payers send back, whether a transportation company needs one, and HIPAA duties.
- Contractual adjustmentA contractual adjustment is the part of a charge the payer's rate does not cover. Reading it on an 835, who absorbs it, and spotting an underpayment in it.
- EFT enrollmentSetting up direct deposit with Medicaid, health plans, and brokers: the ACH standard, the voided check or bank letter, the test deposit, and the first payment.
- Fee-for-service (FFS)In fee-for-service Medicaid, the state pays an enrolled transportation provider for each trip it bills, at fee schedule rates. How FFS NEMT billing works.
- HSA and FSA eligible transportationWhen a van, taxi or ambulance ride to care counts as an HSA or FSA expense, how the two accounts differ, whose fares count, and what a receipt should show.
- Internal control number (ICN)An ICN is the number a Medicaid payer gives each claim it accepts. How to read one, where it appears, and when you must quote it on a correction or appeal.
- Medicaid fee scheduleThe state price list that caps what fee-for-service Medicaid pays per code. Where transportation rates are posted, how to read them, and how broker pay differs.
- Medicaid fiscal agentA Medicaid fiscal agent processes and pays claims for the state. What it handles, what goes to the state or a broker instead, with examples from four states.
- Medicaid ID number formatMedicaid member IDs run from 8 to 12 characters depending on the state. The formats ten states publish and how to catch a bad ID before a claim rejects.
- Medicaid provider numberState Medicaid programs give every enrolled transportation company its own ID. When it replaces the NPI on claims, where to look it up, and what resets it.
- Mileage reimbursementNEMT mileage reimbursement pays riders, family, or friends per mile to drive to Medicaid care. 2026 rates and the rules in Texas, Missouri, and California.
- MMISEach state's MMIS enrolls Medicaid providers, pays fee-for-service claims, and issues remittances. The parts a NEMT company touches, with state examples.
- Net 30Net 30 means an invoice is due 30 days after the start date in your contract. What net 15, net 45 and 2/10 net 30 mean, and the wording that makes terms hold.
- Payer IDThe payer ID on an electronic claim decides which payer receives it. Where to look one up, how Medicaid, plans and brokers differ, and the cost of a wrong one.
- Pended claimA pended claim was accepted but not yet paid or denied. Why transportation claims pend, where they appear on a remittance, and what to do while one waits.
- Prior authorizationPrior authorization is the payer's approval of a NEMT trip before it happens. When it is required, who grants it, and why unapproved trips often go unpaid.
- Purchase orderA purchase order is a numbered approval a buyer issues before a ride is provided. Why hospitals and counties return invoices without one, and what to do.
- Remittance advice remark codes (RARCs)Remark codes (RARCs) add the detail a reason code leaves out. What M, MA, and N codes mean, how alerts differ, and the remark codes transportation claims draw.
- Single case agreementA single case agreement is a one-time contract with a plan outside your network. When NEMT providers get one, how Medicaid treats it, and the terms to settle.
- Taxonomy codeA taxonomy code tells payers what kind of provider you are. The NUCC transportation codes NEMT companies use, including 343900000X, and how states apply them.
- Third-party liability (TPL)Third-party liability means another payer owes before Medicaid does. What counts as a third party, how states enforce the order, and who a NEMT provider bills.
- Timely filing limitFederal rules cap Medicaid filing at 12 months, but states and brokers set far shorter deadlines. Real NEMT limits, the exceptions, and how resubmissions count.
- Trading partner agreementA trading partner agreement sets the terms for sending claims electronically. Who signs one, Medicaid EDI enrollment, submitter IDs, and testing first.
- Trip authorization numberA trip authorization number is the ID a broker or state issues for an approved NEMT trip. Where it comes from, where it goes on a claim, and why it must match.
- UCC lienA UCC lien is a public UCC-1 filing showing a creditor claims your business assets. What it means for a NEMT company, a lender search, and how to remove one.
- Usual and customary chargeYour usual and customary charge is your normal public price. Why Medicaid claims carry it, how lesser-of payment works, and how private-pay prices count.
Brokers and Medicaid
70 terms
- Alternative Benefit Plan (ABP)Alternative Benefit Plans cover Medicaid expansion adults. Federal law still requires rides to covered care, but waivers in Iowa and Indiana cut NEMT for some.
- Assurance of transportationThe assurance of transportation makes every state Medicaid plan ensure rides to covered care. What 42 CFR 431.53 guarantees riders and how states carry it out.
- ATMSIn NEMT, an ATMS is dispatch software a broker accepts for trip data, GPS, and billing. What it means, how New York and Colorado use it, and your options.
- Atypical providerAn atypical provider is paid by Medicaid for services HIPAA does not treat as health care, so it bills with a state ID. How states apply it to NEMT companies.
- Bid protestA bid protest is a written challenge to a ride contract solicitation or award. Deadlines run from 72 hours to 10 days, and a timely filing can pause the award.
- Blanket purchase agreement (BPA)A blanket purchase agreement lets a federal buyer order rides call by call from an agreed price list, with no guaranteed volume. How calls and limits work.
- CAGE codeA CAGE code ties your company to one address in federal contracting. How SAM.gov assigns it free, how to look one up, and what keeps it current.
- Certificate of good standingA certificate of good standing shows a state still lists your company as active. Who asks for it in NEMT, what it costs, and how a missed filing can end it.
- CHIP transportationMedicaid expansion CHIP carries the Medicaid ride benefit. Separate CHIP programs can leave rides out. How the two differ, with Indiana and Texas as examples.
- CP 575The CP 575 is the IRS notice that confirms your EIN. What Medicaid and brokers do with it, and how to replace a lost one with Letter 147C or a digital copy.
- CredentialingCredentialing is how a broker or plan checks a NEMT company, its drivers, and its vehicles before sending trips. What gets checked, and how it differs.
- Cure noticeA cure notice is a written warning to fix a breach before the buyer ends the contract. The federal 10 day rule, ride contract examples, and how to answer.
- Dual eligibleDual eligible riders have Medicare and Medicaid. Which program pays for their rides, where D-SNP benefits fit, and the order to bill when both apply.
- Dual special needs plan (D-SNP)A D-SNP is a Medicare Advantage plan for people with both Medicare and Medicaid. How its ride benefits work and how they sit beside Medicaid NEMT.
- Emergency MedicaidEmergency Medicaid pays only to treat an emergency medical condition, so scheduled rides are left out. The federal rule, 2026 changes, and state examples.
- Encounter dataEncounter data is the record of each service a Medicaid plan or broker reports to the state. Which trip details providers supply, and why incomplete trips fail.
- Enrollment brokerA Medicaid enrollment broker helps members choose a health plan and never books rides. The federal rules, who riders call in Texas and North Carolina, and why.
- Enrollment moratoriumA Medicaid enrollment moratorium freezes new provider sign-ups six months at a time. How NEMT freezes work, who is exempt, 2026 examples, and what to do next.
- EPSDT transportationEPSDT requires Medicaid to offer children under 21 help with rides and scheduling, including a parent's trip. What 42 CFR 441.62 means for providers.
- Evergreen clauseAn evergreen clause renews a contract by itself unless you give notice by a deadline. How broker and county contracts differ, and what two state laws say.
- Exclusivity clauseAn exclusivity clause limits who else you can serve or reserves your vans for one buyer. Where it appears in broker and facility contracts and how to narrow it.
- Flow-down clauseA flow-down clause passes a broker's or state's contract duties to the ride companies below it. What flows down, the rules behind it, and how to spot it.
- Force majeure clauseA force majeure clause excuses a missed ride when an event outside your control stops it. What it covers, the notice deadlines, and how penalties treat it.
- HRSNHRSN means health-related social needs. What CMS approved in 1115 demonstrations, what it rescinded in March 2025, and how ride companies get paid.
- Human service transportationHuman service transportation is travel paid by health, aging, disability, and job programs. The federal council, Section 5310 plans, and where NEMT fits.
- IDIQ contractAn IDIQ contract guarantees a small minimum and lets the buyer order rides as task orders up to a ceiling. How the minimum, limits and cancellation work.
- In lieu of services (ILOS)In lieu of services let Medicaid health plans pay for substitutes the state plan does not list. The federal rules, the 5 percent cap, and where rides fit in.
- Invitation for bid (IFB)An IFB is sealed, public, lowest-price buying. What makes a ride bid responsive, how ties and pricing mistakes are handled, and which buyers use it.
- Least costly appropriate transportationMedicaid pays for the cheapest ride that still fits the rider's condition. How states and brokers apply the rule and how it shapes the trips you get.
- Managed care organization (MCO)A managed care organization is a health plan paid a fixed monthly rate per Medicaid member. How MCOs cover NEMT, hire brokers, and shape which fleets get trips.
- Master services agreement (MSA)A master services agreement holds the terms that stay fixed while rates and services change. What goes in it, what to read twice, and how it differs from a PO.
- Medicaid provider agreementThe contract a NEMT company signs with the state Medicaid agency: record, disclosure and NPI duties, how it differs from a broker contract, and how it ends.
- Medicaid redeterminationThe regular Medicaid eligibility review: why riders lose rides after a missed renewal form, what changes for expansion adults in 2027, and what providers see.
- Medicaid spend-downMedically needy members qualify only after medical bills use up their excess income. How spend-down periods work, which trips are covered, and split-bill days.
- Medical loss ratio (MLR)Medical loss ratio is the share of a plan's revenue spent on care, not overhead. The 85 percent Medicaid standard, why ride brokers are exempt, state floors.
- Medical necessity formA medical necessity form shows why a rider needs a wheelchair van, stretcher, or ambulance. Who signs it, how long it lasts, and real examples from four states.
- MLTSS (managed long-term services and supports)MLTSS plans deliver Medicaid long-term care through managed care. How their members get medical and non-medical rides, with Tennessee and Pennsylvania examples.
- Mobility managementMobility management is federally funded coordination that links riders with transit, human service rides, and NEMT. Who does it and how to work with them.
- NEMTNEMT is Medicaid transportation to scheduled, non-emergency care for people with no other way to get there. The federal rules, who qualifies, and who pays.
- NEMT brokerA NEMT broker manages Medicaid rides for a state or health plan. It takes ride requests, credentials fleets, assigns trips, and pays providers. How it works.
- NEMT carve-outA NEMT carve-out keeps rides out of Medicaid health plan contracts, so a state broker or fee-for-service runs them. How it differs from a carve-in, by state.
- Network adequacyNetwork adequacy rules decide whether a Medicaid plan or broker needs more transportation companies. How 42 CFR 438 reaches NEMT, and why networks close.
- Non-medical transportation (NMT)Non-medical transportation means different things by program: waiver rides to jobs and day programs, or Medi-Cal rides to care. How NMT differs from NEMT.
- Option yearAn option year is an extra contract year the buyer may add by notice at a price set in advance. How ride contracts price options and the five-year limit.
- Past performance questionnaireA PPQ is the form a buyer sends to the references on your bid. What it asks, why it goes straight to the contracting officer, and how it differs from CPARS.
- Piggyback contractA piggyback contract lets one public agency buy rides under another agency's competitively bid contract. What federal grant rules and two state laws require.
- Prepaid ambulatory health plan (PAHP)A PAHP is a prepaid Medicaid plan with no hospital duties. Some states pay NEMT brokers this way. What the label means for broker rules, appeals, and providers.
- Presumptive eligibilityPresumptive eligibility gives short-term Medicaid while an application is decided. Which groups get full coverage, the pregnancy limit, and when rides stop.
- Provider enrollment application feeThe 2026 Medicaid enrollment application fee is $750. Which states charge NEMT companies, when it repeats, who is exempt, and how a hardship exception works.
- Provider enrollment effective dateThe Medicaid effective date is the first day of service a state pays for. How Texas, Ohio and North Carolina set it, and why broker rides need credentialing.
- Qualified Medicare Beneficiary (QMB)QMB pays Medicare premiums and cost-sharing, not the full Medicaid package, so QMB-only members usually have no Medicaid ride. How to spot the difference first.
- Quality assurance surveillance plan (QASP)A QASP is the buyer's plan for checking your ride service. See the on-time standards, sampling methods and consequences in VA's 2026 ride solicitations.
- RecredentialingRecredentialing is the periodic re-check a broker or health plan runs on a NEMT provider already in its network. What gets rechecked and how often.
- Request for qualifications (RFQu)A request for qualifications approves ride companies before trips are offered. What it asks, whether price is in it, and what a spot in the pool gets you.
- Request for quotation (RFQ)An RFQ asks for prices on a defined ride need. The federal and state dollar limits, what a VA ride quote must include, and when a quote binds you.
- Retroactive Medicaid eligibilityMedicaid can reach back as far as three months before the application month, and less from 2027. Billing past rides, filing limits, and refunding riders.
- Ryan White medical transportationRyan White funds rides for people with HIV to care and support services. How HRSA lets agencies pay for them, the last-payer rule, and how ride companies join.
- Section 1115 waiverSection 1115 demonstrations let a state waive or reshape the Medicaid ride benefit for some groups. Current examples from Iowa, Georgia, and Hawaii.
- Section 1915(b) waiverA 1915(b) waiver can make Medicaid riders in an area use one broker or a set group of ride companies. What it allows, what the filing shows, and when it ends.
- Section 1915(c) waiverA 1915(c) waiver lets a state Medicaid program pay for home and community-based services. How long it lasts, who runs it, and where non-medical rides fit.
- Section 5307Section 5307 is the FTA formula grant for urban transit agencies. See what it pays for, how a ride company is paid under it, and the rules it brings with it.
- Social Services Block GrantThe Social Services Block Grant (Title XX) gives states $1.7 billion a year, and some counties and agencies spend it on rides. How to find those contracts.
- Sources sought noticeA sources sought notice is federal market research, not a bid. What VA ride notices ask for, how many days you get, and how answers shape the set-aside.
- SSBCISSBCI is a Medicare Advantage benefit for chronically ill members that can pay for non-medical rides. Who qualifies and how rides are arranged and paid.
- State plan amendment (SPA)A state plan amendment is how a state changes Medicaid rides and pay. Real NEMT amendments, how CMS approves them, and what the cover sheet tells you.
- Termination for convenienceTermination for convenience lets one side end a ride contract without cause. Notice periods in broker and county contracts, and what you can recover.
- Time-and-materials contractA time-and-materials contract pays hourly rates up to a ceiling instead of a price per trip. See the federal limits and how ride work is billed by the hour.
- Transportation network company (TNC)A transportation network company arranges rides through an app. How Medicaid programs and brokers use TNCs for NEMT, the rules they follow, and their codes.
- VA beneficiary travelVA beneficiary travel pays eligible veterans 41.5 cents a mile and covers approved wheelchair van and ambulance trips. Eligibility, deductibles, vendor rules.
- Waiver transportationWaiver transportation is a Medicaid HCBS waiver service for rides to jobs, day programs, and community activities. How it is authorized, delivered, and billed.
Dispatch and operations
33 terms
- Additional stopAn extra stop on a Medicaid ride needs the broker's approval first. Pharmacy stops on the way home, leg limits, billing, and what drivers should tell riders.
- Advance noticeHow far ahead NEMT rides must be booked in Texas, North Carolina, Louisiana, and Vermont, the urgent and discharge exceptions, and broker timelines.
- Appointment timeIn NEMT the appointment time is the arrive-by deadline and the pickup time is worked back from it. Early-arrival limits by state, return timing, and an example.
- Computer-aided dispatchComputer-aided dispatch is the software that assigns NEMT trips to vehicles, tracks each ride, and logs pickups. What brokers call it and what it must record.
- Deadhead milesDeadhead miles are the miles a NEMT vehicle drives with no rider on board. Why Medicaid does not pay for them, plus a worked example of what they cost.
- Demand response transportationDemand response transportation sends a vehicle when a rider books, with no fixed route. What the FTA says, how it differs from fixed route, and where NEMT fits.
- Dialysis chair timeDialysis chair time is a patient's fixed treatment slot at a dialysis center, usually three days a week for about four hours. What it means for NEMT rides.
- Face sheetA face sheet is the identifying page at the front of a patient chart. What it holds, which parts a ride needs, and the HIPAA rules for keeping and sharing it.
- GeofenceA geofence is a virtual boundary around a pickup or drop-off that notes when a van arrives or leaves. How it works in NEMT, its accuracy limits, and data rules.
- Late cancellationA late cancellation is a NEMT ride cancelled after the notice deadline, often with the van already on its way. Deadlines by program and how to handle one.
- Loaded milesLoaded miles are the miles driven with the rider on board, and the only miles Medicaid pays NEMT providers for. How three states measure and bill them.
- Maximum ride timeMaximum ride time limits how long a NEMT rider stays in the van: direct time plus 45 or 60 minutes, New York's one-hour standard, and the effect on grouping.
- MicrotransitMicrotransit is on-demand shared van service run by transit agencies in set zones. How it differs from NEMT in booking and eligibility, and where Medicaid fits.
- Missed tripA missed trip is a scheduled NEMT ride the provider never ran. How programs define it, the 0.25 percent limits, broker penalties, and records that protect you.
- Multi-loadingMulti-loading puts two or more NEMT riders with separately booked trips in one vehicle at once. Ride-time limits, billing rules, and when it makes sense.
- No-showA NEMT no-show is a rider who is not at the pickup after the driver waits the required time. Broker wait rules, reporting steps, and what it costs you.
- Pickup windowA pickup window is the span around a scheduled NEMT pickup when arrival counts as on time. Broker and state rules, the ADA paratransit standard, and an example.
- Revenue per vehicle hourRevenue per vehicle hour divides what a van earns by the hours it ran. The formula, why it beats revenue per trip, a worked example, and a target from costs.
- Same-day tripA same-day NEMT trip is a ride requested for today, outside the usual advance-booking rule. Notice rules by state, urgent pickup limits, and planning tips.
- Service areaA NEMT service area is the counties or ZIP codes a provider agrees to serve. How brokers use it to offer trips, the duties it carries, and out-of-area rules.
- Spare ratioA spare ratio compares backup vehicles with those needed at peak. FTA's 20 percent guideline, what takes vans off the road, and sizing spares for small fleets.
- Split shiftA split shift breaks a driver's day into two blocks with an unpaid gap. When the gap can stay unpaid, California and New York premiums, and scheduling tips.
- Trip denialA trip denial is a broker or health plan refusing a Medicaid ride request. Usual reasons, the notice the member gets, appeal deadlines, and what providers see.
- Trip legA trip leg is one one-way NEMT ride from pickup to drop-off. How A and B legs work, why each leg carries its own status and miles, and how legs are billed.
- Trip logA NEMT trip log is the signed record of each ride as it happened. The fields Minnesota, Arizona, and Louisiana require, and the gaps that get claims denied.
- Trip manifestA NEMT trip manifest is the list of trips one driver runs in a day, in pickup order. What it contains, how it changes, and how it differs from a trip log.
- Trip statusNEMT trip statuses track a ride from scheduled to completed, no-show, or canceled. What each one means, the time stamps behind it, and why brokers pay on them.
- Trip turnbackA trip turnback is when a NEMT provider returns an accepted trip to the broker. Timing rules, accepted reasons, and what late turnbacks cost.
- Trips per hourTrips per hour is a NEMT productivity measure: completed one-way trips divided by hours in service. How to calculate it, a worked example, and what moves it.
- Vehicle utilizationVehicle utilization measures how much of a NEMT vehicle's time and miles produce paid work. Three ways to measure it, a worked example, and common fixes.
- Wait timeWait time in NEMT covers three rules: how long drivers wait at pickup, how long riders wait for a return, and when waiting is billable with T2007.
- Wait-and-return tripA wait-and-return trip keeps the driver at the clinic to bring the rider home. When programs allow it, how T2007 waiting pays, and when it beats a will-call.
- Will-call tripA will-call trip is a NEMT return ride with no set pickup time. The rider calls when the appointment ends. How will-calls work and how to plan for them.
Service levels and vehicles
40 terms
- Ambulatory transportationAmbulatory transportation is NEMT for riders who can walk and sit in a regular seat. Who qualifies, vehicle and driver rules, and the codes used to bill it.
- AmbuletteAn ambulette is a wheelchair or stretcher van for nonemergency medical trips. How New York licenses and pays ambulettes, and how they differ from ambulances.
- Bariatric transportationBariatric transportation moves riders whose size or weight exceeds standard NEMT equipment. Lift and cot ratings, staffing, and how states bill these trips.
- Bed-to-bed transportBed-to-bed transport means a stretcher crew moves a patient from one bed to the next. The staff it takes, where the job ends, and Georgia's dialysis rule.
- Broda chairBroda chairs are tilt-in-space positioning wheelchairs. Which models are crash-tested as vehicle seats, how to secure them, and when to book a stretcher.
- Chair carChair car is the Massachusetts broker term for a wheelchair van in human service transportation. How MART's rate sheet prices chair cars, and the vehicle rules.
- Curb-to-curbCurb-to-curb is the most basic NEMT assistance level. What the driver does and does not do, how it compares with door-to-door and hand-to-hand, and who it fits.
- Door-through-doorIn door-through-door NEMT service, the driver helps the rider from inside the pickup building to inside the destination. Who offers it and who needs it.
- Door-to-doorIn door-to-door NEMT service, the driver helps the rider between the vehicle and the building door at each end. How programs define it and who needs it.
- Flex seatingFlex seating uses seats that fold or flip out of the way so one van can switch between seated riders and wheelchair positions. Federal rules and planning tips.
- Ford QVMFord QVM was Ford's list of vetted van builders, replaced by Ford Pro Upfitter in 2023. What each name covers, what it leaves out, and how to check a converter.
- Geri chairA geri chair is a padded recliner on casters used in nursing homes. Why it is not a wheelchair in the van, and how to choose a wheelchair or stretcher ride.
- GVWRGVWR is the most a vehicle may weigh fully loaded, as rated by its maker. What it means for wheelchair and stretcher vans: payload, lifts, CDL lines, and taxes.
- Hand-to-handIn hand-to-hand NEMT service, the driver takes the rider from one responsible person and hands them to another. Who needs it and how to run the handoff.
- Kneeling systemHow the kneel on a wheelchair minivan lowers the rear suspension to flatten the ramp, how many degrees it saves, and when drivers should switch it off.
- Level of serviceLevel of service is the vehicle type and driver help a NEMT rider needs. How payers assign ambulatory, wheelchair, and stretcher levels and how each is billed.
- Levels of assistanceContact guard, standby, minimal, moderate, and maximal assist defined from CMS scales, and what each means for an ambulatory, wheelchair, or stretcher ride.
- Litter vanA litter van is Medi-Cal's term for a stretcher van. Who qualifies under Title 22, crew and equipment rules, the T2005 rate, and how authorization works.
- Livery vehicleA livery vehicle is a for-hire car used for ambulatory Medicaid rides. How livery works in New York City: TLC licenses, practitioner orders, and claim rules.
- Lowered-floor vanA lowered-floor van has a deeper floor so a seated wheelchair rider clears the door and roof. Side vs rear entry, headroom, ground clearance, and NEMT fit.
- MedicarA medicar is Illinois Medicaid's wheelchair van category, next to the service car for seated riders. The 89 Ill. Adm. Code 140 rules and the 2026 fee schedule.
- Mobility assistance vehicle (MAV)A mobility assistance vehicle (MAV) is New Jersey's licensed wheelchair van. The N.J.A.C. 8:40 license, fees, vehicle and crew rules, and Medicaid MAV trips.
- Non-ambulatoryNon-ambulatory transportation is for riders who cannot walk to the vehicle. How Kentucky, Georgia, Indiana, and New York use the term, and which level fits.
- ParatransitADA paratransit is the ride service transit agencies run for people who cannot use their buses or trains. How it differs from Medicaid NEMT in rules and fares.
- Protected transportProtected transport is Minnesota Medicaid's ride level for riders at risk of harm. Vehicle equipment, MnDOT certification, crew training, and 2026 rates.
- Sitting toleranceSitting tolerance is how long a person can safely sit upright. How payers use it to pick a wheelchair van or a stretcher, and why the whole trip counts.
- Specialized medical vehicle (SMV)A specialized medical vehicle (SMV) is Wisconsin Medicaid's lift or ramp van provider. DHS 105.39 certification, Trans 301 van rules, and where trips come from.
- Stair chairA stair chair moves a seated rider up or down stairs when there is no elevator or ramp. How NEMT crews use one, weight limits, state rules, and billing.
- Stretcher chairA stretcher chair is a transport wheelchair that reclines toward flat. How payers classify riders who use one, why it is not a gurney, and securing it.
- Stretcher transportationStretcher transportation moves a stable rider lying flat in a stretcher van with two crew. Who qualifies, equipment and staffing rules, and how T2005 is billed.
- Tilt-in-space wheelchairA tilt-in-space wheelchair tips the whole seat back without changing the hip angle. Why riders use one, the travel position, transit options, and what to ask.
- Transfer boardA transfer board lets a rider slide sideways between a wheelchair and a seat. Who can use one, how to set up the move, weight limits, and what drivers may do.
- Transport chairA transport chair is a light wheelchair with small wheels that a companion pushes. Why most are not built as vehicle seats, and how to handle riders in one.
- Two-person assistA two-person assist adds a second trained crew member to a ride. The triggers in state rules, who can fill the seat, how payers treat it, and what to record.
- Weight-bearing statusWeight-bearing status is the doctor's order on how much weight a rider may put on a leg. What it means for the van step, the transfer, and the ride level.
- Wheelchair docking systemHow a wheelchair docking system locks a chair to the van floor with a bracket and base, how it is crash tested, and why NEMT fleets rarely rely on one.
- Wheelchair sizesA standard wheelchair has a 16 to 20 inch seat and is wider overall. Seat widths and weight limits for bariatric, transport, and pediatric chairs.
- Wheelchair transportationWheelchair transportation carries riders seated in their own wheelchair in a lift or ramp van. Who qualifies, securement rules, and how A0130 trips are billed.
- Wheelchair-accessible vehicleA wheelchair-accessible vehicle has a lift or ramp, securement stations, and door clearance for riders who stay seated. ADA and FMVSS specs for NEMT vans.
- WTORSA WTORS is the set of tiedowns that anchor a wheelchair and the belts that restrain its rider. What each part does, the WC18 and J2249 tests, and daily checks.
Compliance and safety
69 terms
- Abuse and molestation coverageAbuse and molestation coverage answers claims that a rider was abused on a trip. Why policies exclude it, which contracts require it, sublimits, and screening.
- Additional insuredAn additional insured is a broker, plan, or facility your insurer names on your liability policy through an endorsement. Contract terms, wording, and cost.
- AM Best ratingAn AM Best rating grades an insurer, not your policy. The minimums Washington, Arizona, Ohio and Oregon contracts set, and what to do if yours falls short.
- Certificate of insurance (COI)A certificate of insurance is the one-page ACORD 25 summary of your policies. What NEMT brokers and customers require on it, and how to keep it current.
- Certificate of public convenience and necessity (CPCN)A CPCN is a state permit to carry passengers for hire. What it grants, which medical carriers are exempt, how four states test applicants, and how filing works.
- Certified Transport Specialist (CTS)The Certified Transport Specialist credential from NEMTAC: what the online course covers, the $55 fee, the two-year term, and which payers ask for it.
- Change of ownership (CHOW)A Medicaid change of ownership (CHOW) is any shift in who owns or controls an enrolled provider. Deadlines, new enrollment, broker consent, and receivables.
- Civil monetary penalty (CMP)What the Civil Monetary Penalties Law covers, the 2026 maximum fines and assessments, how an OIG case runs, and transportation companies that have paid.
- Combined single limit (CSL)A combined single limit is one per-accident cap for bodily injury and property damage together. How it differs from split limits and how brokers set minimums.
- Corporate integrity agreement (CIA)A corporate integrity agreement is the five-year deal OIG makes instead of excluding a provider. What it requires, what a breach costs, and ambulance cases.
- Corrective action plan (CAP)Brokers and states demand a corrective action plan after an audit finding or a missed standard. What a NEMT provider puts in one, deadlines, and follow-up.
- Critical incidentA critical incident is a serious event a waiver program or broker wants reported at once. The federal rules, broker definitions, and one state's deadlines.
- Declarations pageThe declarations page is the front of your policy: insured, period, vehicles and limits. What reviewers read on it and why a certificate is not enough.
- DVIR (driver vehicle inspection report)A DVIR is the written end-of-day vehicle report 49 CFR 396.11 requires for commercial motor vehicles. When NEMT vans need one and what it has to show.
- Employment practices liability insurance (EPLI)EPLI pays defense and damages when drivers or staff sue over firing, harassment, or discrimination. What it excludes, rider claims, and who needs it.
- Escort and attendantAn NEMT escort is a companion who rides with the patient. An attendant rides along to help. Who provides each, rules for minors, and how T2001 is billed.
- Experience modification rate (EMR)The experience mod compares your workers' comp claims with similar employers and multiplies your premium. How to read it, which years count, and why buyers ask.
- Extended reporting period (tail coverage)Tail coverage keeps a claims-made policy answering late claims after it ends. Basic and supplemental tails, retro dates, state rules, and contract terms.
- False Claims ActKnowingly false Medicaid bills cost triple damages plus a penalty per claim under the False Claims Act. How it reaches NEMT trips, brokers, and whistleblowers.
- Fidelity bondA fidelity bond pays an employer back when an employee steals. What it covers, which ride contracts ask for one, and the separate bond a 401(k) plan needs.
- FMCSA ClearinghouseWhich NEMT drivers fall under the FMCSA Drug and Alcohol Clearinghouse, the queries and $1.25 fee, what employers report, and the 2024 CDL downgrade rule.
- Form E filingForm E is the certificate an insurer files with a state agency to prove a passenger carrier has liability coverage. Who files it, which states ask, how it ends.
- Fraud, waste, and abuse (FWA)How CMS and Medicaid rules define fraud, waste, and abuse, a NEMT example of each, and why the label decides whether a billing problem means a refund or a case.
- Gait beltA gait belt buckles around a rider's waist so a helper can steady a stand, pivot, or short walk. When NEMT drivers use one, when not to, and program limits.
- Garaging addressThe garaging address is the spot each van spends its off hours. How insurers rate by it, what follows when it is wrong, and when to update it with your agent.
- Ghost policyA ghost policy is workers' comp written on zero payroll. Why NEMT owners buy one for brokers, how it differs from an exemption, and the bill the audit can add.
- HIPAA privacy officerThe people a NEMT company must name under HIPAA: a privacy official, a complaint contact, and a security official, plus who may hold all three.
- Hired and non-owned auto (HNOA)Hired and non-owned auto coverage protects a business when rented or employee-owned cars are used for work. What it covers, its gaps, and when NEMT needs it.
- Hold harmless agreementA hold harmless clause makes your company pay for claims and losses tied to your trips. Broad, intermediate, and limited forms, and what insurance will cover.
- Insurance binderAn insurance binder is written temporary coverage until the policy issues. California's 90-day limit, Florida's 60-day line, and which agencies take one.
- Litigation holdA litigation hold stops routine deletion once a lawsuit is likely. When the duty starts, what a ride company must keep, and how courts treat lost records.
- Loss control inspectionA loss control inspection is the insurer's review of how you run drivers, vans, and safety. Who sends it, what it checks, and what follows the recommendations.
- Loss runsLoss runs are an insurer's report of your claims by policy year. What they show, state deadlines for sending them, how far back they go, and open reserves.
- Mandated reporterA mandated reporter must tell child or adult protective services about suspected abuse. When NEMT drivers count, how fast to report, immunity, and penalties.
- MCS-150Form MCS-150 registers and updates a USDOT number. Who files it, how the last two digits set your due date, what it asks, and what a missed update costs.
- MCS-90B endorsementThe MCS-90B is the federal endorsement that guarantees an interstate passenger carrier's liability minimums. Who needs it, the minimums, and what it leaves out.
- Medicaid Fraud Control Unit (MFCU)Medicaid Fraud Control Units are state prosecutors of provider fraud and patient abuse. How they work, the NEMT cases they bring, and what to do if one calls.
- Medicaid payment suspensionUnder 42 CFR 455.23 a state must halt Medicaid payments when a fraud allegation it has checked looks credible. Notice timing, exceptions, and how a hold ends.
- Medicaid RAC auditMedicaid Recovery Audit Contractors review paid claims for a share of what they recover. Lookback limits, record requests, and how RACs differ from UPICs.
- Medical payments coverageAuto MedPay covers treatment costs for anyone injured in or boarding your van, whoever caused it. How it differs from PIP, typical limits, and who pays first.
- Medical review officer (MRO)A medical review officer is the doctor who checks a driver's drug test before the employer sees it: the interview, what you receive, and safety reports.
- Minimum earned premiumMinimum earned premium is what an insurer keeps when you cancel soon after the start. Pro rata versus short rate, a worked example, and state refund rules.
- Minimum necessaryWhat HIPAA's minimum necessary standard requires of a NEMT company, the six cases it skips, and how roles and written protocols put it into practice.
- Motor vehicle record (MVR)An MVR is the state record of a driver's license status, violations, and crashes. What NEMT brokers allow, how often to pull one, and consent rules.
- NAICS codeNEMT companies file under NAICS 485991, Special Needs Transportation. When 621910 or 488999 fits better, why tax forms show 485990, and where the code matters.
- Named driver exclusionA named driver exclusion removes coverage whenever one listed person drives your vans. Why insurers offer it, how far it reaches, and which states limit it.
- Named insuredThe named insured is the business the policy is written for. Why it must match your legal name on broker and Medicaid papers, and what the first one handles.
- Negligent entrustmentNegligent entrustment holds a van owner liable for handing the keys to someone unfit. What must be proved, how it differs from vicarious liability, the defense.
- Notice of cancellation endorsementA notice of cancellation endorsement makes your insurer warn a named broker or facility before a policy ends. What buyers ask for, from 15 to 45 days.
- OIG exclusion list (LEIE)The LEIE is the federal register of people and firms banned from Medicaid and Medicare work. Who a NEMT company screens, how often, and what a miss costs.
- Ownership disclosureFederal rules (42 CFR 455.104 to 455.106) make NEMT companies report 5 percent owners, managers, family ties, and convictions. What to list and when.
- Portable oxygenRiders can bring portable oxygen on NEMT trips if they manage it themselves. Federal and state rules, securing tanks, which vehicle to send, and billing.
- Pre-adverse action noticeWhat a pre-adverse action notice must contain, how long to wait before deciding, the final notice that follows, and the exception for remote DOT applicants.
- Premium finance agreementPremium financing spreads an auto premium over monthly payments. What the agreement states, the 10-day notice before a lender cancels, and where refunds go.
- Provider risk levelsEvery Medicaid provider is screened as limited, moderate, or high risk under 42 CFR 455.450. What each tier triggers and where transportation companies land.
- Radius of operationRadius of operation is how far a van travels from its garage, and insurers rate it in bands. How the bands work, what a 150-mile trip changes, and what to ask.
- Reasonable modificationWhen the ADA makes a ride company change a policy for one rider: rules for private firms and paratransit contractors, grounds to say no, and DOT examples.
- Reservation of rights letterA reservation of rights letter says your insurer is defending a claim but may still deny it. What it cites, when you may pick your own lawyer, what to do next.
- Risk retention group (RRG)A risk retention group is a liability insurer owned by the businesses it covers. What it may write, why no guaranty fund backs it, and how to check one.
- SAM exclusionsSAM.gov lists people and firms debarred by any federal agency, OIG exclusions included. Who must check it, how often, and how it differs from the LEIE.
- Scheduled auto (symbol 7)A scheduled auto policy covers only the vans listed on it, shown as symbol 7. How auto symbols work, the 30-day rule for new vans, and what brokers accept.
- Stop gap coverageStop gap coverage is employer's liability added to a general liability policy where only a state fund writes workers' comp. What it pays for, who asks for it.
- Substance abuse professional (SAP)What a substance abuse professional does after a driver fails a DOT drug test: the evaluation, treatment, return-to-duty test and six or more follow-up tests.
- SURSSURS is the Medicaid claims-review function that profiles provider billing and flags outliers. The federal rules behind it and how NEMT trips get flagged.
- Umbrella insuranceUmbrella insurance adds liability limits above your auto, general liability, and employer's liability policies. Umbrella vs excess, contract limits, and gaps.
- Unified Carrier Registration (UCR)UCR is a yearly fee interstate carriers pay by fleet size under 49 U.S.C. 14504a. Which NEMT companies owe it, the 2026 and 2027 fees, and how vans count.
- Uninsured motorist coverageWhat UM and UIM coverage pay when an uninsured or underinsured driver hits your van, how written rejections work in Texas, Florida and Pennsylvania, and more.
- Unique Entity ID (UEI)A Unique Entity ID is the free 12-character code SAM.gov gives a business. When a NEMT company needs one, ID-only versus full registration, and renewals.
- Waiver of subrogationBrokers and counties want your insurer barred from collecting from them after it pays your claim. How the waiver works on each policy, blanket forms, and fees.
All terms, A to Z
A
- A0080
- A0090
- A0100
- A0110
- A0120
- A0130
- A0140
- A0160
- A0170 to A0210
- A0424
- A0425
- A0428
- A0999
- Abuse and molestation coverage
- Additional insured
- Additional stop
- Advance notice
- Alternative Benefit Plan (ABP)
- AM Best rating
- Ambulatory transportation
- Ambulette
- Appointment time
- Assignment of benefits
- Assurance of transportation
- ATMS
- Atypical provider
B
C
- CAGE code
- Capitation
- Certificate of good standing
- Certificate of insurance (COI)
- Certificate of public convenience and necessity (CPCN)
- Certified Transport Specialist (CTS)
- Chair car
- Change of ownership (CHOW)
- CHIP transportation
- Civil monetary penalty (CMP)
- Claim adjustment reason codes (CARCs)
- Claim rejection
- Claim scrubber
- Clean claim
- Clearinghouse
- Combined single limit (CSL)
- Computer-aided dispatch
- Contractual adjustment
- Corporate integrity agreement (CIA)
- Corrective action plan (CAP)
- CP 575
- Credentialing
- Critical incident
- Curb-to-curb
- Cure notice
D
E
F
H
I
L
M
- Managed care organization (MCO)
- Mandated reporter
- Master services agreement (MSA)
- Maximum ride time
- MCS-90B endorsement
- MCS-150
- Medicaid fee schedule
- Medicaid fiscal agent
- Medicaid Fraud Control Unit (MFCU)
- Medicaid ID number format
- Medicaid payment suspension
- Medicaid provider agreement
- Medicaid provider number
- Medicaid RAC audit
- Medicaid redetermination
- Medicaid spend-down
- Medical loss ratio (MLR)
- Medical necessity form
- Medical payments coverage
- Medical review officer (MRO)
- Medicar
- Microtransit
- Mileage reimbursement
- Minimum earned premium
- Minimum necessary
- Missed trip
- MLTSS (managed long-term services and supports)
- MMIS
- Mobility assistance vehicle (MAV)
- Mobility management
- Motor vehicle record (MVR)
- Multi-loading
N
P
- Paratransit
- Past performance questionnaire
- Payer ID
- Pended claim
- Pickup window
- Piggyback contract
- Place of service code
- Portable oxygen
- Pre-adverse action notice
- Premium finance agreement
- Prepaid ambulatory health plan (PAHP)
- Presumptive eligibility
- Prior authorization
- Protected transport
- Provider enrollment application fee
- Provider enrollment effective date
- Provider risk levels
- Purchase order
R
S
- S0209
- S0215
- S9992
- SAM exclusions
- Same-day trip
- Scheduled auto (symbol 7)
- Section 1115 waiver
- Section 1915(b) waiver
- Section 1915(c) waiver
- Section 5307
- Service area
- Single case agreement
- Sitting tolerance
- Social Services Block Grant
- Sources sought notice
- Spare ratio
- Specialized medical vehicle (SMV)
- Split shift
- SSBCI
- Stair chair
- State plan amendment (SPA)
- Stop gap coverage
- Stretcher chair
- Stretcher transportation
- Substance abuse professional (SAP)
- SURS
T
- T2001
- T2002
- T2003
- T2004
- T2005
- T2007
- T2049
- Taxonomy code
- Termination for convenience
- Third-party liability (TPL)
- Tilt-in-space wheelchair
- Time-and-materials contract
- Timely filing limit
- TK modifier
- TN modifier
- Trading partner agreement
- Transfer board
- Transport chair
- Transportation network company (TNC)
- Trip authorization number
- Trip denial
- Trip leg
- Trip log
- Trip manifest
- Trip status
- Trip turnback
- Trips per hour
- Two-person assist
U