A denial log for NEMT claims: each denied trip, its fix, and how it ended
A claim denial log is a numbered list of every denied or short-paid trip claim, kept until each one is paid or written off. Each row holds the payer, claim number, rider and trip, date of service, the group, reason, and remark codes, the cause in plain words, the fix, the deadline to act, the date you resubmitted or appealed, and the result. A weekly review keeps deadlines from passing.
On this page
How the log works
Open a row the day a denial shows up on a remittance or in a broker portal, and close it only when the money arrives or you decide to write it off. One row per denied claim line. A claim with two denied legs gets two rows, because the legs can have different causes and different fixes.
- Log it the day it arrives. Number rows in order (D-2026-001, D-2026-002) so gaps are obvious.
- Copy the codes exactly. Write the group code and reason code together (CO-197), then every remark code. The reason code says what happened; the remark code usually says what was missing.
- Translate it. Write one plain sentence a dispatcher would understand, and pick a root cause from the list below.
- Write the deadline before anything else. Take it from the payer’s rules for corrections or appeals, counted from the date on the remittance.
- Fix it and send it. Record the action, the date sent, and any reference number the payer gives back.
- Follow up. Put a check date on every resubmission. A resubmitted claim that never appears on a later remittance is still open.
- Close it. Record the amount paid or written off and the date.
The common causes are covered in depth in our guide to NEMT claim denials. This log is where you keep score.
The template
Part A: Denial register
| No. | Date received | Payer or program | Payer claim number | Rider and trip ID | Date of service | Codes and modifiers billed | Amount billed | Group and reason code | Remark codes | Denial in plain words | Root cause | Owner |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Example: D-2026-014 | 10/05 | State Medicaid fee-for-service | (from remittance) | Trip 4471 | 09/28 | Wheelchair van base and mileage | (billed amount) | CO-197 | N54 | Billed trip did not match the authorized trip | AUTH | Billing lead |
Part B: Fix and outcome
Match each row to its Part A number.
| No. | Action (correct and resend, new claim, appeal, bill another payer, write off) | Deadline to act | Date sent | Payer reference | Check again on | Result (paid, partly paid, upheld) | Amount recovered | Amount written off | Closed (date and initials) |
|---|---|---|---|---|---|---|---|---|---|
Root cause codes
| Code | What went wrong | Codes that often point here |
|---|---|---|
| AUTH | No authorization or trip ID, or the trip billed differs from the trip authorized | 197, 198; remarks M62, N54 |
| ELIG | Rider not covered on the date of service, or ID and name do not match | 27, 31, 140, 177; remark N30 |
| DOC | Miles, pickup address, trip log, or signature missing or wrong | 16, 226, 252; remarks M22, N53 |
| CODE | Procedure code or modifier not valid on the date of service | 181, 182; remark M51 |
| DUP | Same trip billed twice | 18 |
| LATE | Filed after the payer’s deadline | 29 |
| PAYER | Sent to the wrong payer or vendor, or another payer should pay first | 22, 109; remark N904 |
| PROV | Enrollment, NPI, taxonomy, or rendering provider problem | 185, 206, B7; remarks N255, N767 |
| COVER | Trip or destination not covered, or medical necessity not shown | 50, 96, 204; remark N157 |
| OTHER | Anything else (describe) | A1 plus its remark code |
Both code lists are published by X12. X12 requires a remark code alongside reason codes 16, 96, 226, 252, and A1, so a denial that shows one of them with no remark code is incomplete and worth a call to the payer.
Part C: Weekly review
| Measure | This week |
|---|---|
| Open denials (count and dollars) | |
| Deadlines in the next 14 days | |
| Oldest open denial (days) | |
| Resubmissions with no payer answer after 30 days | |
| Resubmissions and appeals decided this week: paid, or denied again | |
| New denials this week, by root cause | |
| Closed this week: recovered and written off | |
| Reviewed by and date |
Part D: Monthly root-cause tally
| Root cause | Denials | Dollars | Most common reason code | Fix put in place (training, intake script, credential update, billing edit) |
|---|---|---|---|---|
| AUTH | ||||
| ELIG | ||||
| DOC | ||||
| CODE | ||||
| DUP | ||||
| LATE | ||||
| PAYER | ||||
| PROV | ||||
| COVER | ||||
| OTHER |
Add a line for your denial rate: denied claims divided by all claims the payers processed that month. Track it per payer, since each program denies for different reasons.
Deadlines that drive the log
The deadline column matters more than any other. Every payer sets its own window for first claims and a second window for fixing or appealing a denial.
| Payer or program | First claim due | After a denial |
|---|---|---|
| Any state Medicaid program | 12 months from the date of service at most, the federal ceiling (42 CFR 447.45); states can set a shorter limit, as Texas and New York do | Set by the state |
| Texas Medicaid (TMHP) | 95 days from each date of service | Appeals of denials and adjustment requests: 120 days from the disposition date (the date of the R&S report showing the claim); a deadline landing on a weekend or listed holiday moves to the next business day |
| New York Medicaid (eMedNY) | Within 90 days of the service date | Corrected claims within 60 days of notification, which is the remittance date; every claim finally submitted within 2 years |
| MTM Health for Virginia fee-for-service Medicaid, starting with October 1, 2026 trips | Clean claim due 6 months after the trip date; when Medicare was billed first, the 6 months run from Medicare’s denial | Appeal within 365 calendar days, through MTM Health’s online claims portal |
Texas adds a rule worth copying for every payer. If a claim has not shown up as in process, paid, denied, or incomplete within 30 days, resubmit it while the 95-day window is still open. That is the “no payer answer” line in Part C. For more filing limits by state, see our entry on the timely filing limit.
Choosing the fix
The code tells you which path to take.
- Billing errors you caused (wrong code, missing modifier, typo in the rider ID) go back as a corrected or new claim, not an appeal. Our guide to corrected NEMT claims explains replacement and void claims.
- Denials you think are wrong (the trip was authorized and completed as billed) go to appeal with the trip record attached. See our guide to appealing a denied NEMT claim.
- Wrong payer denials go to the right payer. Remark N904 says the transportation vendor is responsible for the claim, so it belongs with the vendor that arranged the trip.
- Write-offs are a decision, not a default. Record who approved it and why. A Medicaid provider must treat the agency’s payment plus any plan cost sharing as the whole fee (42 CFR 447.15), so the rider is not a fallback for a denied Medicaid trip.
Sometimes the review runs the other way and shows a trip was paid when it should not have been, such as a duplicate that slipped through. An overpayment must be reported and returned within 60 days after it is identified, with a written reason. Our guide to the 60-day overpayment rule walks through the steps.
Turning the tally into fewer denials
The monthly tally points to the step that failed. AUTH denials start at intake and dispatch: the trip ID was never captured, or the van that went did not match the authorized level of service. ELIG denials start at booking. DOC denials start in the van, when miles, times, or a signature were not recorded. MTM Health’s Virginia handbook shows how strict this can be. Its claims deny when the electronic trip log lacks one of the required items: the trip ID, the scheduled pickup, the actual pickup, the departure time, the arrival time, or the member signature. A trip not in completed status denies too.
Assign each recurring cause to the person who owns that step, and check the next month’s tally to see whether the fix worked.
Where the proof comes from
Most DOC and AUTH denials are settled with the trip record. For each trip, HealthRide keeps GPS-recorded miles, a time for every step, the signature captured on screen, and the recorded wait on a no-show. From reports, the full trip log exports to CSV or PDF. When your biller needs to show what happened on a trip, the record is already there, with no call to the driver.
Frequently asked questions
- Is a rejected claim the same as a denied claim?
- No. Rejection happens before processing: the payer's system turns the claim away, usually over missing or invalid data, and you correct it and send it again. When a payer returns an unprocessable claim on a remittance, remark code MA130 says so: no appeal rights, and a new claim with correct information is needed. A denial means the payer processed the claim and refused to pay, with a reason code on the remittance. Track denials in this log and rejections on a separate tab.
- What deadline applies to fixing or appealing a denial?
- Each payer sets its own clock, and some are short. In New York Medicaid, a corrected claim is due 60 days after notification, which eMedNY treats as the remittance date. Texas Medicaid's window is 120 days, starting on the date of the remittance and status (R&S) report that lists the denial. For Virginia fee-for-service trips that MTM Health handles starting October 1, 2026, a denied claim can be appealed for up to 365 calendar days. Federal rules cap every state's first-claim deadline at 12 months after the trip date.
- Which reason codes need a remark code to make sense?
- Some broad reason codes are only valid with a remark code beside them, including 16 (a billing error or missing information), 96 (charge not covered), 226 (information the payer asked for never arrived), 252 (needs an attachment), and A1 (general denial, for use only when no more specific code fits). The remark code carries the detail, such as M22 for missing miles or N53 for a missing pickup address.
- Can the company charge the rider when Medicaid denies a trip?
- Generally no. Medicaid pays only providers that accept the agency's rate, plus any plan copay, as the entire payment (42 CFR 447.15). A denial caused by a missing authorization, a late filing, or a billing error is the company's loss to fix or write off, not a balance to pass to the rider.
- How often should the denial log be reviewed?
- Weekly for open items and monthly for patterns. The weekly pass catches deadlines inside the next two weeks and claims still waiting on a payer answer. The monthly pass tallies denials by root cause, so the fix happens at intake, dispatch, or billing instead of one claim at a time.
- Do brokers watch a provider's denial rate?
- Some score it. MTM Health's Virginia fee-for-service handbook lists denied claims below 0.29% of claims as a provider performance standard, next to on-time performance and complaint rates. Missing these standards puts a provider at risk of a performance improvement plan, liquidated damages, or losing its place in the network.
