How to Bill Medicaid for NEMT?

Medicaid for NEMT

Providing transportation for Medicaid patients to and from their medical appointments can be a great way for transportation companies to generate revenue. However, the process for billing Medicaid for non-emergency medical transportation (NEMT) can be complex. In this article, we’ll walk through the key steps transportation companies like NYBillPro need to take to successfully bill Medicaid for NEMT services.

Get Authorized as a Medicaid NEMT Provider

The first step is to get authorized by your state’s Medicaid program as an NEMT provider. Each state has its own requirements and application process. Often this involves obtaining required licenses and permits, undergoing background checks, providing proof of insurance, and signing provider agreements. Make sure you understand and meet all requirements outlined by your state. Companies like NYBillPro can help provide guidance on becoming an authorized NEMT provider.

Verify Patient Eligibility and Get Prior Authorization

Before providing each NEMT trip, verify that the patient is eligible for Medicaid and that the trip is medically necessary. Medicaid NEMT services require prior authorization. Contact the patient’s Medicaid plan to obtain approval and get any necessary documentation. Authorization must be granted before transporting the patient.

Maintain Detailed Trip Records

Medicaid requires extensive documentation for NEMT claims. For each trip, keep detailed records including date, passenger name, pickup/drop-off locations, mileage, and trip purpose. Get copies of medical appointment documentation from providers. Track driver logs, vehicle inspection reports, waiting times, and assistance provided to passengers. Thorough records are key for successful claims. 

Submit Claims with Necessary Codes

To get reimbursed by Medicaid, claims must be submitted accurately and timely using the right procedure codes. Codes distinguish the type of NEMT service provided (taxi, wheelchair van, etc). Carefully read billing guidance from your state’s Medicaid program. Submit claims electronically along with supporting documentation.

Appeal Denied Claims

It’s not uncommon for Medicaid NEMT claims to be denied initially. Don’t let denied claims go unpursued. Evaluate the reason for the denial and follow the appeal instructions provided in the rejection notice. With persistence and proper documentation, many denied claims can eventually get paid. Companies like NYBillPro can provide assistance with appealing denied NEMT claims.

Providing NEMT services to Medicaid patients can be a valuable business opportunity, but the claims process requires knowledge of billing rules and close attention to detail. Follow these tips to successfully navigate Medicaid reimbursement for NEMT. With careful recordkeeping and diligent follow-up, transportation companies can get paid for serving this important patient population.