NEMT no-show policy template: fill-in-the-blank wording
A NEMT no-show policy defines when a rider counts as a no-show, how long the driver waits, what the driver and dispatch do before leaving, and what it costs. CareOregon, for example, has drivers wait at least 15 minutes after the scheduled pickup time. Fees can apply to private-pay and facility accounts. Providers may not bill Medicaid members for missed appointments, a CMS policy North Carolina Medicaid restates.
On this page
How to use this template
The owner fills in every bracket, has an attorney review the final wording, and then puts the policy in three places: the booking confirmation for private-pay riders, every facility contract, and driver training. Review it once a year and whenever your rates change.
- Who it covers. Private-pay riders, facilities, and other accounts that pay you directly.
- Who it does not cover. Trips booked through a Medicaid broker or health plan follow that program’s rules on wait times, no-shows, and payment. Your drivers still follow the same steps below, because the broker will ask for the same proof.
- Medicaid members. North Carolina Medicaid, restating CMS policy, says providers may not bill Medicaid beneficiaries for missed appointments. This template exempts Medicaid members from every fee, which is the safe default. Ask your attorney before you change it.
The fee amounts belong on your rate sheet too, so the two documents always match.
The template
[Company name] no-show and late cancellation policy
Effective date: [date]
Applies to: trips paid by riders, families, facilities, and other accounts billed directly by [Company name]. Trips arranged by a Medicaid broker or health plan follow that program’s rules.
1. Definitions
- Scheduled pickup time. The pickup time or pickup window confirmed when the trip was booked: [for example, a window from 15 minutes before to 15 minutes after the stated time].
- No-show. The rider is not at the pickup location and ready to travel by the end of the wait time, cannot be reached, and did not cancel. A rider who refuses the ride when the driver arrives is also counted as a no-show.
- Late cancellation. A cancellation made less than [number] hours before the scheduled pickup time.
- Our late arrival. If our driver arrives after the end of the pickup window, the trip is not a no-show, even if the rider has already left.
2. How long the driver waits
The driver waits [number] minutes after the scheduled pickup time. If the driver arrives early, the wait starts at the scheduled pickup time, not at the driver’s arrival.
3. What happens before the driver leaves
- The driver announces their arrival at [the curb, the door, or the front desk, based on the level of service booked].
- The driver calls the rider’s phone number on file.
- Dispatch calls the rider and [the facility or emergency contact on file].
- The driver records their arrival time, departure time, and location.
- The driver leaves only after dispatch approves the no-show.
4. Return trips
If the rider misses the first leg, [Company name] contacts the rider or their contact before canceling the return trip. The return trip is not canceled automatically.
5. Fees
- Late cancellation: [amount] per trip.
- No-show: [amount] per trip, or [percentage] of the scheduled fare.
- Facility accounts: billed as set out in the facility agreement.
- Medicaid members: no fee is charged.
- How fees are charged: [to the card on file, or on the next invoice].
6. When fees are waived
- A medical emergency or hospital admission
- The appointment was canceled by the clinic with less notice than this policy requires
- Severe weather or road closures
- Our vehicle arrived after the pickup window
- [Other reasons your company allows]
7. Repeated no-shows
After [number] no-shows within [number] days, [Company name] may require [a confirmation call the day before, or payment in advance] for future private-pay trips. For trips arranged by a broker or health plan, we report each no-show to the program and follow its instructions.
8. How to cancel
Call [phone number], or [text, email, or use the online portal at address], at least [number] hours before the scheduled pickup time. Cancellations are accepted [hours and days].
9. Acknowledgment
| Field | Entry | Field | Entry |
|---|---|---|---|
| Rider or responsible party | Account or facility | ||
| Signature | Date |
What brokers and auditors look for
On broker trips, the question is always whether the driver followed the program’s steps and can prove it. CareOregon’s rules are a clear example:
- Drivers make their presence known and wait at least 15 minutes after the scheduled pickup time.
- Drivers make reasonable efforts to contact the rider and call their dispatch for more information.
- Drivers may not leave without notifying dispatch of the no-show.
- Providers report every no-show to the broker in the way the broker requires.
- At stops where wait time is authorized, the wait is capped at 15 minutes unless the broker approves more.
Payment and accountability are the other half, and they vary by program:
| Program | What happens on a no-show |
|---|---|
| MTM Health (Minnesota, Missouri, Nevada, Rhode Island) | MTM does not reimburse providers for no-shows or cancellations at the door, and tells providers to confirm the pickup time with the rider the day before |
| Virginia Medicaid (Modivcare) | Members are asked for 24 hours’ notice to cancel. If the member does not cancel in time, the provider is not paid, but can file a rider no-show complaint |
| CareOregon | Brokers separate member no-shows from provider no-shows and handle member no-shows in their own process. Providers are not held accountable for member no-shows |
Private billing has one hard limit. North Carolina Medicaid, restating CMS policy, says providers may not bill Medicaid beneficiaries for missed appointments. That rule is why this template exempts Medicaid members from every fee.
Repeat no-shows are the broker’s to manage. CareOregon lets brokers modify a member’s service after recurring no-shows or late cancellations, for example by requiring the member to confirm the trip on the day of service. Providers help carry out the change but do not make it.
A provider no-show is a different problem. CareOregon counts it when a verified report shows the provider never arrived, and it requires a full incident report. Use the incident report template for those.
Common mistakes
- Leaving early. A driver who leaves at minute 12, or without dispatch approval, turns a defensible no-show into a complaint.
- Counting the wait from an early arrival. Arriving 10 minutes early does not start the clock early.
- Charging Medicaid members for missed trips. CMS policy, as North Carolina Medicaid states it, does not allow billing Medicaid beneficiaries for missed appointments.
- Canceling the return leg automatically. The rider may have gotten a ride to the appointment and still need to get home.
- A policy without numbers. “Reasonable notice” and “a short wait” cannot be enforced. Put the hours, minutes, and dollar amounts in writing.
- Fees nobody was told about. Share the policy at booking and in facility contracts before you ever charge it.
Most no-shows are cheaper to prevent than to bill. Our guide to reducing NEMT no-shows covers reminders, confirmations, and facility coordination.
Recording the wait
In HealthRide, no-shows are recorded on the trip with the driver’s wait time, so each one has a time-stamped record behind it. Riders can get text reminders 24 hours and 15 minutes before pickup. Private-pay fees can go on an invoice or a card on file through payments.
Frequently asked questions
- How long should a NEMT driver wait before calling a no-show?
- On broker trips, the broker sets the wait. CareOregon requires drivers to make their presence known and wait at least 15 minutes after the scheduled pickup time, then notify dispatch before leaving. For private-pay trips you set the wait in your own policy. Count it from the scheduled pickup time, not from an early arrival.
- Can I charge a Medicaid rider a no-show fee?
- Not for a Medicaid trip. CMS policy, as stated by North Carolina Medicaid, is that providers may not bill Medicaid beneficiaries for missed appointments, because a missed appointment is not a separate Medicaid service but part of the cost of doing business. Providers also may not bill Medicaid beneficiaries for covered services beyond allowed copays.
- Do brokers pay for no-shows?
- Often not. MTM does not reimburse transportation providers for no-shows or cancellations at the door in states such as Minnesota, Missouri, Nevada, and Rhode Island. Virginia's member handbook says a provider will not be paid for a trip the member did not cancel in time, although the provider can file a rider no-show complaint. Check your own contract.
- What is a late cancellation?
- A late cancellation is a trip canceled with too little notice to reassign the vehicle. Your policy sets the cutoff. For comparison, Modivcare asks Virginia Medicaid members for 24 hours' notice to cancel a ride, and to cancel as soon as possible when they cannot give 24 hours.
- What proof should I keep for each no-show?
- Record the driver's arrival time, how long they waited, every attempt to reach the rider, the time dispatch approved the departure, and the vehicle's location. A no-show with no times and no contact attempts is easy for a broker or payer to dispute.
