Single Case Agreement for Transportation Providers

How a single case agreement works

A single case agreement is a contract for one person’s care, not for a network seat. Health Net’s California provider policies describe it as a one-time arrangement between a non-participating provider and the plan, in the line of business the member is enrolled in. It lets the provider serve a specific patient for a specific service, for a single visit or episode of care, based on the plan’s prior authorization.

Two details from that definition matter for transportation companies:

You can be in network and still need one. Health Net also uses single case agreements for a participating provider serving a member in a line of business its contract does not cover, such as a commercial contract holder serving a Medi-Cal member.
The agreement travels with the bill. Health Net pays the agreed rate only on a paper claim with a copy of the agreement attached. A claim without it is incomplete and may be denied.

Where transportation providers run into them

Single case agreements fit the moments when a plan owes a member a service and its own network cannot supply it.

In Medicaid managed care, the obligation is written into federal rules. Under 42 CFR 438.206, when a plan’s network cannot provide a covered service to a particular member, the plan must cover it out of network, adequately and on time, for as long as the gap lasts. The out-of-network provider must coordinate with the plan for payment, and the member cannot be charged more than an in-network service would cost.

Two examples of how that plays out for a transportation company:

A service level the network lacks. For example, a member in a rural county needs a stretcher van and no network provider nearby runs one. The plan or its broker may ask an outside provider to take the trips under a one-off agreement.
A long or unusual trip. For example, a transfer to a specialty hospital several hours away, with waiting time and a return leg. Our guide to long-distance trip pricing covers how to cost one before you agree to a rate.

Workers’ compensation trips follow their own approval rules, covered in the workers’ comp transportation guide. If you want steady work from a plan rather than one case at a time, see contracting with Medicaid health plans.

Medicaid enrollment and single case agreements

The federal rule here is lighter than the one for network providers. CMS’s Medicaid Provider Enrollment Compendium says out-of-network providers under single case agreements are not network providers, so the federal screening and enrollment rule for network providers does not cover them. Nor must they enroll in fee-for-service Medicaid. CMS also suggests states may set a threshold of encounters after which an out-of-network provider must join the network, which would bring full screening and enrollment.

States can ask for more, and Ohio does. Its March 31, 2026 guidance says plans may pay only providers enrolled with the Ohio Department of Medicaid. Services under a single case agreement go through a dedicated single case process in the state’s provider enrollment system, which ends in a standard five-year provider agreement. A shorter path gives a provider one 120-day agreement to get claims paid, and only one. Claims from providers who never enroll are rejected at the state’s electronic front door.

Agree on these terms in writing

Get each of these from someone at the plan with authority to sign, before the first trip:

Who and what. The member, the dates, each leg covered, and the level of service.
Authorization. The authorization or trip numbers that must appear on the bill.
Rate. The base rate, mileage, waiting time, and attendant charges, or a flat fee, and whether loaded or total miles count.
Billing instructions. Where to send the bill, whether paper is required, and whether a copy of the agreement must be attached.
Enrollment. Any state enrollment step you must finish before the plan can pay.
Payment terms. When the plan pays and whom to call if it does not.

Keeping one-off rates straight in HealthRide

An agreement like this adds a payer with its own fares for a short run of trips. In HealthRide you add the plan as a payer with the agreed fares, so each trip under the agreement is priced the moment it is booked. When the trips are done, the invoice is built from them and priced from that payer’s rates.

Frequently asked questions

Medicaid enrollment: is it required for a single case agreement?

Federal rules do not require it, but your state might. CMS guidance says out-of-network providers under single case agreements are not network providers, so the federal rule that states enroll every network provider does not reach them. Ohio goes further than the federal floor: its plans may pay only providers enrolled with the state, and it runs a separate single case enrollment path for providers who are not.

Is the rider responsible for the gap between my price and the agreed rate?

Not for a Medicaid managed care member. Federal rules require plans to make sure an out-of-network service costs the enrollee no more than it would in network, and out-of-network providers must coordinate with the plan for payment. Settle the full price with the plan before the trip, because the agreed rate is what you will be paid.

Can a single case agreement be billed electronically?

Check the agreement, because some plans say no. Health Net requires paper claims with a copy of the single case agreement attached to get the agreed rate, says claims without the agreement attached are incomplete and may be denied, and does not support electronic submission for them. Ask the plan for its billing instructions in writing when you sign.

What is a single case agreement, and when do transportation providers use one?