Subcontractor agreement checklist for NEMT companies that hand trips to another carrier

Who this checklist is for

This checklist is for the company that holds the payer contract and wants another carrier to run some of its trips, such as overflow on a heavy morning or a county it cannot cover. If you are the carrier on the receiving end, working as a subcontractor for another NEMT provider explains your side and compares which brokers allow it. For a joint bid, the teaming agreements guide covers the agreement between the bidders.

Fill it in with your payer contract open. Where the payer sets a number, such as an insurance limit or a deadline to report a breach, the subcontract has to meet it, because the payer’s contract binds you and not the carrier you hand the trip to.

Can you hand trips to another carrier at all?

Not unless your payer’s contract says so, and the contracts differ.

• Verida (Tennessee) and Medi Trans (Louisiana). Both limit a provider to its own owned or leased vehicles. Verida’s manual bars subletting or arranging transportation under the agreement from any third party, and Medi Trans’s manual adds that the provider may not subcontract.
• MART (Massachusetts human service transportation). A provider may hire subcontractors. It has to sign a written agreement with each one, keep it, and carry the relevant privacy and security terms of its own contract into it.
• MTM and WellTrans. Both require written consent first. The guide for subcontractors quotes each contract.

Record the permission in Part A before any trip moves. Without it, trips run by another carrier’s unapproved drivers and vehicles go unpaid at both MTM and WellTrans, as the credentialing part below explains.

The checklist

Check each box when the term is agreed and written down. Fill each blank from your payer contract, not from memory.

Part A: Permission and parties

• Payer permission to subcontract: contract section ____, or consent letter dated ____ and signed by ____
• Trips, counties, and service levels the permission covers: ____
• Subcontractor’s legal name, address, NPI, state Medicaid ID, and tax ID: ____
• Signed IRS Form W-9 from the subcontractor on file
• Authorized signer for each company, with name and title: ____
• Start date ____, end date ____, and notice to end early ____ days

Part B: Drivers and vehicles

• Each driver and attendant approved by the payer in writing before the first trip, with dates: ____
• Each vehicle approved or inspected by the payer, with dates: ____, and listed on your driver and vehicle roster
• Subcontractor company and every driver screened against the federal and state exclusion lists before the first trip and monthly after, with dated results in your exclusion screening log
• Subcontractor tells you within ____ hours of a driver’s arrest, charge, or loss of license and removes that driver from your trips at once
• Training your payer requires, completed and dated for each driver: ____

Part C: Insurance

• Auto liability of at least ____, the highest limit any of your payer contracts requires
• General liability of ____, and professional liability of ____ where wheelchair vehicles are used
• Workers’ compensation as your state requires, or proof of exemption: ____
• You and the payer named as additional insured, with the certificate received on ____
• Subcontractor’s coverage primary and non-contributory
• Written notice to you ____ days before any cancellation or change
• Every vehicle on your trips listed on the subcontractor’s policy: ____

Part D: Rider information

• Business associate agreement signed and dated (see the template): ____
• Subcontractor reports any privacy or security incident within ____ hours (shortest deadline you owe a payer: ____)
• Rider details used only to run your trips
• Anyone the subcontractor brings in, such as a dispatch service, bound by the same terms in writing
• At the end, rider information returned or destroyed only with your approval, with a written certificate within ____ days

Part E: Money

• Rates by service level: ____; waiting time: ____; no-show: ____
• Trip records due to you within ____ days of each trip (your payer’s shortest filing window: ____ days)
• Records that go with every invoice: pickup and drop-off times, miles, rider signature, driver, and vehicle
• You pay within ____ days of a clean invoice, or after the payer pays you: ____
• Who absorbs a denied trip, a recouped payment, or a payer penalty: ____
• How a pay dispute is raised and settled, within ____ days

Part F: Records and audits

• Subcontractor keeps trip, driver, and vehicle records for ____ years, at least your longest payer period
• Copies delivered within ____ days of a request (your payer’s shortest turnaround: ____ days)
• Payer, state Medicaid agency, CMS, and HHS inspector general may inspect the subcontractor’s records and premises
• No destroying records that are under audit, review, or investigation
• Where the records are kept and who to contact: ____

Part G: Riders and conduct

• No billing or collecting from riders, except a copayment the payer authorizes
• No questions to riders about illness beyond what the trip needs
• No soliciting your riders, facilities, or staff outside the agreement: area ____, length ____ months
• Complaints and incidents reported to you within ____ hours, and full help with any investigation
• Conduct, seat belt, and securement standards your payer sets: ____

Part H: Liability, performance, and ending

• Subcontractor defends and indemnifies you, the payer, and the payer’s client for claims, penalties, and liquidated damages from its trips
• On-time standard ____ percent (your payer’s standard: ____ percent) and what happens below it: ____
• Subcontractor takes part in any corrective action plan the payer requires
• You may pull trips back at once for a safety problem, an expired credential, or lost payer consent
• The agreement ends the day your payer contract ends or the payer’s consent is withdrawn
• Assigned trips run through the notice period of ____ days
• Final payment and return of rider information at the end: ____

What your payer contracts require you to pass down

The blanks above come from your own payer contracts. These are the numbers and rules that decide what to write in them.

Insurance limits

Match the highest limit among your payer contracts, since one subcontractor may cover trips for several of them. WellTrans’s Indiana agreement sets $1,500,000 per accident for vans, or the local taxi ordinance amount if that is higher, on a policy showing “Any Auto” or symbols 2, 8, and 9. It also requires $1,000,000 of general liability, $1,000,000 of professional liability for providers with wheelchair vehicles, and 30 days’ written notice of any change in coverage. Verida’s Tennessee network asks for at least $1,000,000 combined single occurrence. MTM’s standard agreement sits lower, at $500,000 for general liability per occurrence and $500,000 combined single limit for auto. A carrier insured to MTM’s minimum does not meet WellTrans’s.

MTM and WellTrans both require the provider’s insurance to be primary, which is why Part C asks for the same from the subcontractor.

Credentials before the first trip

Under MTM’s agreement, trips by uncredentialed drivers or in uncredentialed vehicles are not paid. WellTrans pays for no trip run by a driver or vehicle it did not pre-approve. Medi Trans likewise reimburses only drivers and vehicles it approved. For a subcontractor’s driver, the question to settle with your payer is whether that driver can be credentialed at all, so get the answer in writing in Part B.

Exclusion checks

Medicaid pays nothing for a service furnished by an excluded individual or entity (42 CFR 1001.1901(b)(1)). OIG may also impose a penalty, an exclusion, or an assessment on anyone who arranges or contracts with an individual or entity it knows, or should know, is excluded to provide services a federal program pays for (42 CFR 1003.200(b)(4)). Modivcare tells providers to confirm each driver is not excluded on hire and monthly after, using the OIG exclusion list and the federal SAM exclusion list. Verida treats any provider, driver, attendant, or subcontractor found on those lists, or on its other screening lists, as ineligible to serve its members. Screen the subcontractor as a company, not only its drivers. The OIG exclusion list entry explains how to run the check.

Reporting a privacy incident

Federal rules put the chain in writing: a business associate may share rider information with a subcontractor only under a written contract that carries the same terms as its own (45 CFR 164.502(e)(1)(ii) and 164.504(e)(5)). The required terms are in the business associate agreement template, and the subcontractor guide explains how the chain runs.

The deadlines you owe vary a lot by payer:

• WellTrans. 48 hours for a known breach under the provider agreement, and one business day under the business associate exhibit. The exhibit treats a breach as discovered on the first day it is known, or with reasonable diligence would have been known, and counts what your workforce members and agents know, other than the person who caused it, as known to you.
• MART. A verbal report to the state within two business days of becoming aware of an event, then a written report within five business days.
• Verida. Five calendar days for any use or disclosure of rider information that breaks the agreement.

Assume a subcontractor could count as your agent, and set its reporting deadline well inside the shortest of these.

Records and audit access

Payers want trip, driver, and vehicle records kept for a long time and handed over fast. MTM’s agreement asks for 10 years. WellTrans asks for the agreement’s full term plus 10 years and copies within three days. Modivcare asks for 10 years and delivery within 3 business days. Where the payer is a Medicaid managed care plan, 42 CFR 438.230(c)(3) has each subcontractor agree that the state, CMS, HHS’s inspector general, and the Comptroller General may audit the books, records, and systems of the subcontractor or the subcontractor’s contractor. The clock on that right runs 10 years, counted from whichever comes later: the last day of the contract period or the close of an audit. A carrier you hand trips to can fall inside it. Set the subcontractor’s period from your record retention schedule and its turnaround shorter than your payer’s.

Getting paid and paying

Your own payment clock decides how fast the subcontractor’s records must reach you.

• MTM. Pays a clean invoice within 30 days of online submission, and a claim filed after 90 days from the ride is ineligible unless MTM’s client allows more time.
• WellTrans. Requires invoices with completed trip logs within 60 days of the date of service and disallows any filed after 90 days. It pays properly submitted uncontested invoices twice a month, within 30 days of submission, and may delay paying you until its own client pays it.
• Verida. Requires trip forms weekly, gives 120 calendar days from the date of service to file, pays within 30 days of a clean invoice, and wants a denied claim resubmitted within 10 days of the denial.

Pick the subcontractor’s records deadline well inside your shortest window. Decide, and write down, whether you pay it a fixed number of days after a clean invoice or only after the payer pays you.

Riders, liability, and the end of the agreement

MTM’s agreement has the provider look solely to MTM for payment and bars it from billing a member, even if MTM never pays, except for a copayment MTM authorizes. It also bars drivers from asking about a member’s illness beyond what the trip needs. WellTrans lets a provider bill a participant directly only where it denied payment because the participant skipped the covered appointment. Copy whichever rule your payer uses into Part G.

On liability, MTM’s agreement makes the provider defend MTM and its client and cover their losses, including claims and any assessments, penalties, and liquidated damages that trace back to the provider’s actions. MART’s indemnity names the provider’s subcontractors and makes the provider liable for a failure by a subcontractor of any tier. Part H asks the subcontractor for the same, so what flows up to your payer can flow down to the carrier that caused it. The NEMT liability guide covers the claims a company faces.

On ending the agreement, MTM may end its contract at once if its own client contract ends, and a provider that gives notice must run its assigned trips through the notice period. Tie your subcontract to your payer contract the same way.

Signing and keeping the agreement

Sign before the first trip, with both signers’ names and titles, and keep the payer’s consent letter with it. Put your payer contract’s end date on the calendar, since MTM’s standard agreement runs three years and renews only by written agreement, and a subcontract that outlasts the payer contract has nothing under it.

File the signed agreement, the consent, the insurance certificates, the business associate agreement, and the exclusion checks together. Keep them for as long as your retention schedule says for contracts.

Using the same trip record in HealthRide

Ask the subcontractor for the same trip record you keep on your own vans. HealthRide records, for every ride, the actual pickup and drop-off times, GPS-recorded miles, the rider’s on-screen signature, and the recorded wait on a no-show, and the trip log exports to a spreadsheet or PDF. That is a ready list of what to require in Part E. HealthRide also tracks expiration dates for your own drivers and vehicles and sends reminders before they lapse. See reports and fleet and credentials.