Use one copy per rider per appointment. A dispatcher fills it in during the call, or a facility, relative, or private-pay rider completes it and sends it in. For rides that repeat on a weekly pattern, use the standing order form.
- Pin down the payer before anything else. For a Medicaid member going to a covered appointment, the booking runs through the member’s broker, health plan, or state approval process. Your company drives it once the trip or authorization number arrives.
- Fill it in order. Section C picks the vehicle. Ask it every time, even for a regular rider, because needs change after a fall or a hospital stay.
- Repeat the key facts aloud. Before the call ends, read back the date, pickup time, both addresses, how the rider gets home, and the price. The phone side of booking is covered in our guide to NEMT trip intake.
- Split round trips. Each direction becomes its own leg on the driver’s daily manifest, with the needs and notes copied word for word.
- Store it with the trip record, where only booking and dispatch staff can open it.
The template
A. Request and payment
B. The rider
C. How the rider travels
The four assistance levels are explained in our glossary entry on level of service.
D. Where
E. When
F. Riding along
G. Confirmation
State manuals list what a booking has to capture. Georgia’s NEMT manual wants the rider’s name, address, phone, and Medicaid ID; the appointment date, start time, and expected end; the provider’s name, address, and phone; the type of transportation; and special needs, naming the kind of wheelchair, walkers, oxygen, escorts, car seats, and service animals. Transdev, which approves Illinois fee-for-service rides, also asks about walkers, wheelchairs, and canes, and whether the rider can go alone or needs an attendant.
Lead times and response times differ by program. Write the ones for your area on the form.
Four federal rules also affect the questions you ask:
- Attendants. Making an attendant a condition of service for a rider with a disability is barred (49 CFR 37.5(e)). Ask anyway, so the seat is held.
- Transfers. Staff can recommend that a wheelchair user move into a vehicle seat, but cannot make it a condition of the ride (49 CFR 37.165(e)).
- Oxygen and service animals. Riders may bring portable oxygen and service animals (49 CFR 37.167). Georgia puts supplying and handling the oxygen on the rider.
- Weight. A lift built to the federal standard holds at least 600 pounds (49 CFR 38.23). Get the combined weight before you promise a wheelchair van.
Mistakes that send the wrong vehicle
- Stopping at “wheelchair: yes.” A power chair, a transport chair, and a rider who can slide into a seat each call for a different plan.
- A pickup time without the appointment time. The driver cannot tell which stops have slack and which cannot slip.
- Blank entrances and stair counts. A stretcher crew at the wrong hospital door, or a chair user behind four steps, delays every stop after it.
- No plan for the ride home. Book it as a fixed time or a will-call trip on the same call.
- Card numbers written on the sheet. Card details go on their own credit card authorization form and stay in the office.
- Asking for more than the ride needs. Keep diagnoses and medical records off booking paperwork. The HIPAA minimum necessary standard limits what you use and share, and what you request from facilities, to what the job requires.
Booking rides in HealthRide
HealthRide fills in each rider’s needs from their profile when you book, and works out the pickup time from the appointment time you enter. The ride home, fixed or will-call, goes into the same booking, and wheelchair, stretcher, and oxygen needs are matched to a suitable vehicle on the dispatch board. Riders and families can also book on the web, and a texted link lets them watch the driver on the way.
Frequently asked questions
- How much notice should a NEMT ride request have?
- On Medicaid rides, the program decides. Georgia wants three business days, where the call day counts and the appointment day does not. MTM Health asks Virginia facilities for five business days on routine requests and Wisconsin facilities for two. All three accept discharges and urgent trips on shorter notice. Private rides follow whatever lead time you choose, so write yours at the top of the form.
- Can I collect money from a Medicaid rider on a broker trip?
- No. New York's Medicaid transportation manual says members never pay a copay for NEMT and providers never ask them for payment, and Georgia supplies Medicaid rides without collecting any copayment. The federal rule behind this, 42 CFR 447.15, lets Medicaid enroll only providers who take what the program pays, plus any deductible or copayment it requires, as the full amount. Also hold off driving until the trip number arrives: New York pays nothing for a non-emergency ride run without prior authorization.
- Can a child ride without a parent?
- It depends on the program, so write down the age of every child on the booking. Georgia Medicaid requires an escort for anyone under 18. MTM Health in Virginia requires an adult escort for children 12 and under and lets 13 to 17 year olds ride alone once a parent or guardian completes a minor consent form.
- Why does the form ask for rider and chair weight as one number?
- Because every lift has a rated capacity. Under federal ADA vehicle standards, a lift is built to carry at least 600 pounds. When a rider and chair are heavier than the standard, 49 CFR 37.165 still requires you to carry them if your lift and van can take the load, and lets you decline when the total is over the lift's rating. MTM Health prints the member's weight, including mobility devices, on its Virginia manifests.
- Does the form need medical information about the rider?
- Only what changes the ride. Record mobility, equipment, and the help required, and skip the diagnosis and why the rider is being seen. HIPAA's minimum necessary standard means you use, share, and request only the health details the ride calls for. A broker may ask what service the rider is getting to confirm coverage, but a provider booking the ride does not need it.
- What goes on the form when the visit has no set end time?
- Make the return a will-call with no pickup time, and note who will phone in when the rider is ready. The response clock starts with that call. MTM Health gives Virginia providers 45 minutes to arrive, while Georgia and MTM Health in Wisconsin allow up to one hour.
