How to choose NEMT software: a checklist for California providers

Write down three things first, so every vendor is judged on the same day.

1. A real day of trips, exported from your current system or your broker files, with the riders' names removed if you prefer.
2. Your payers and how each pays: per leg, per mile, wait time, by space type, and what proof each wants.
3. The five things that go wrong most in your week. Late afternoons, will-calls, missing signatures, a broker that changes trips at night, whatever yours are.

Ask each vendor to run that day, not theirs. A vendor who cannot load your file in a demo will find it harder after you sign.

• Can it import your broker files as they arrive, in CSV or Excel, and remember the column layout for next time?
• Does it match imported trips to existing riders and flag duplicates, or create a new rider each time?
• Can an import be undone if the broker sends a corrected file?
• Standing orders: can it hold a dialysis schedule with holidays and exceptions, and roll it forward on its own?
• Will-calls: can a return be booked without a time and activated later?
• Authorizations: can it keep each rider's authorization with units and dates, warn before it runs out, and stop a trip without one?

• Does it know each vehicle's capacity by space type, wheelchair positions apart from seats? See space types.
• Does it check pickup windows, ride-time limits and space before it lets a trip onto a run, and tell you which rule a trip would break?
• Can it plan the whole day, and does it show you the plan before applying it?
• During the day, does it warn you before a pickup misses its window, early enough to move it? See pickup windows.
• When a van breaks down, how many clicks to move its stops to other vans?
• Does the live map show where each van is now, and how old that position is?

Drivers are where your records come from, so test the app on a phone yourself.

• Does it keep working without signal, saving each step and sending it later? Turn on airplane mode in the demo and try.
• Does it ask for each payer's proof at the stop: signatures, odometer readings, a facility staff signature?
• Does a no-show need proof before it is recorded: arrival at the address, the wait, a reason?
• Does it include a pre-trip vehicle inspection, and what happens when an item fails?
• Can each driver use it in Spanish? Spanish is the most common second language among California riders and drivers.
• Which phones does it run on, and how do your drivers get it?

• Does it remind riders the day before, in English and Spanish, and let them confirm or cancel by reply?
• Can a rider or a caregiver see where the van is without installing an app?
• Do those texts and pages carry your company's name?

• Can each payer's rates be set the way that payer pays, including mileage rules and rounding?
• Does it hold back a leg that is missing proof or authorization, with the reason, and bill the rest?
• How do claims leave the system: broker portals, trip sheets in the payer's own columns, invoices, CMS-1500 or 837P? Ask to see one for your biggest payer. See Medi-Cal NEMT billing codes.
• Can it take the payer's 835 remittance and post it leg by leg, with the reasons? See posting an 835.
• Does it export to your accounting system?

NEMT software holds health information: who goes to dialysis, who goes to a psychiatric appointment. Under HIPAA, a covered entity must have a business associate agreement with a vendor that handles protected health information on its behalf. Ask for the agreement before any real data goes in.

• Is each company's data kept apart from other customers' data, and how?
• Is two-step sign-in available, and can you require it?
• Can you limit what each role sees and does, and is that checked on the server?
• Is there an audit log of who changed what?
• Does it track driver and vehicle credentials and stop an expired driver from being assigned?

• How does your current data come in: riders, rates, vehicles, drivers, standing orders, history? See switching NEMT software.
• Can you run it beside your current system for a week before going live?
• If you leave, can you take everything out, including signatures and documents, without asking for it?
• What are the contract length, notice period and price, in writing?

The last question matters most. Software you can leave easily is software that has to keep earning its place.

MileCall is scheduling, dispatch and billing software for NEMT providers, with a driver app that works without signal, in English and Spanish. It is built for California and Medi-Cal first. It imports broker files with a saved mapping, checks windows, ride time and space before assigning, warns before a pickup misses its window, prices legs from each payer's rates, holds legs missing proof, exports trip sheets in each payer's columns and posts 835 remittances. Claims go out as trip sheets or invoices today. Every company's rows are kept apart in the database, with two-step sign-in, server-checked roles and an audit log. See dispatch, billing, the driver app and switching, and bring this checklist to the demo.

1. Business associates (U.S. Department of Health and Human Services)
2. 45 CFR 164.504(e): business associate contracts (Electronic Code of Federal Regulations)
3. All Plan Letter 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (DHCS)
4. Claim Adjustment Reason Codes (X12)

This post explains how things work in general; it is not legal, medical or billing advice. Rules change and differ by payer, so check your payer’s current manual and your contract before you rely on any detail here.