How NEMT broker contracting works

Who arranges the trips

In most markets, a state Medicaid program or a managed-care plan contracts a transportation broker to arrange non-emergency trips. The broker takes member requests, assigns them to network providers, verifies the trips and pays the providers.

That means the provider's commercial relationship is with the broker, and the broker's requirements, not the provider's preferences, define what it takes to participate.

What credentialing usually asks for

Each network publishes its own requirements, but the categories are consistent enough that a provider can prepare in advance.

• Corporate, tax and ownership documentation
• Insurance at the network's stated limits and endorsements
• Vehicle documentation, inspections and accessibility equipment
• Driver qualification files, screening and training records
• Written policies: safety, HIPAA, complaints, no-shows, refusals
• Evidence of operating capacity and coverage area

Understand the economics before you sign

Network rates are what they are. The provider's control is over cost per trip, trip mix, deadhead miles and documentation quality. Model those honestly against the published rates before you commit capacity.

Clean trip verification also determines whether you get paid. GPS records, signatures and timestamps are not paperwork; they are the payment file.

Before you apply

Assemble the packet to the network's checklist rather than sending what you happen to have. Incomplete submissions are the most common reason a capable provider waits months to be onboarded.

Regulatory requirements differ by state and county and change over time. This article is general information about consulting topics, not legal advice, and not a substitute for the current published requirements of the agency with jurisdiction over your operation.