What is a trip authorization number in NEMT?

Where the number comes from

Whoever approves the trip issues the number. The prior authorization is the decision. The authorization number is the receipt for that decision, and you need the receipt to get paid.

Two programs show how differently it can work:

• New York. The prior authorization number is 11 digits. The broker approves the trip and sends it to the provider. The provider drives it, then attests to it through the broker’s system. Once the attestation checks out, the number is issued and the provider bills eMedNY with it.
• Texas fee-for-service. The Medical Transportation Program issues the authorization before the ride. Demand response providers enter it in item 23 of the claim. For a family member or friend reimbursed per mile, the MTP authorization number is printed on the service record form they mail in.

Broker programs issue their own trip IDs. In Rhode Island, MTM Health assigns a unique trip ID to each trip it authorizes, and providers may not transport a member without one. The claim goes to MTM within 90 days with an electronic trip log that carries the trip ID, the scheduled and actual pickup times, departure and arrival times, and the member’s signature. A missing data point means a denied claim.

Where it goes on the claim

On the paper CMS-1500, the number goes in item 23, Prior Authorization Number. The national instructions describe it as the payer-assigned number authorizing the service. The field holds up to 29 characters, with no hyphens or spaces. Electronic claims carry the same number. See 837P for NEMT and CMS-1500 for NEMT for field-by-field help.

Why the details must match

The number only works when the trip you bill is the trip that was approved. New York spells out three rules:

1. The claim must match the prior authorization, or it is not paid.
2. Changes to the location or day need approval before the trip.
3. GPS data that does not match the approved pickup, drop-off, and mileage keeps the attestation from producing a number at all.

New York also expects attestations within 30 days of the trip and claims within 90 days.

An example

A New York ambulette company finishes a Tuesday dialysis return. The driver’s GPS trail matches the approved addresses and miles, so the attestation produces an 11-digit prior authorization number. The biller puts that number on the eMedNY claim and submits it well inside the 90-day window. Had the rider asked for a new pickup address at the curb, the driver would have told her to call the broker, MAS, first.

Keeping numbers straight

• Attach each number to its trip leg, or to the round trip when the approval covers both legs.
• Check the trip against the approval before dispatch: date, addresses, mode, and attendant.
• Keep the approval records. Texas counts emails, database entries, and scanned copies as prior authorization documents. Records for riders 20 and younger must be kept until HHSC says otherwise.

In New York, providers who use an ATMS send their GPS trip data to the broker through it, and that data decides whether a number is issued.