No-shows and dry runs in NEMT: what counts, what payers pay for, how to document them

Payers and brokers use these words in slightly different ways, so always check the definitions in your contract. In general:

• Member no-show: the van arrived on time at the right place, waited as required, and the rider was not there or did not come out.
• Cancel at the door: the rider or a caregiver is there but cancels when the van arrives.
• Late cancel: the trip is cancelled after the payer's cutoff, often after the van has already left.
• Dry run: the general term for a trip where the vehicle went out and no one was transported.
• Turnback (or handback): the provider gives a trip back to the broker because it cannot do it. This is the provider's no, not the rider's.

The difference matters because a no-show or cancel at the door is the rider's doing, a turnback is yours, and a missed pickup with no record looks like yours too.

Some payers pay for certain no-shows or dry runs, usually only with proof the van was there. Others pay nothing for a trip where no one rode. The rules live in each contract and each payer's manual, and they change.

Medi-Cal fee-for-service is one example of a payer that describes billing a dry run only for specific situations, with its own codes and modifiers. Its ground transportation manual sets them out, and the billing examples section shows how a claim should look. Outside those situations, and for plans and brokers, the contract decides. Read it before you bill one, and never bill a dry run as if the rider rode.

Even when a no-show pays nothing, record it as well as a paid trip. Plans watch providers' records. Health Plan of San Joaquin's NEMT policy, for example, lists no-show rates among the measures it monitors for NEMT providers at least every quarter. An undocumented no-show is hard to tell apart from a van that never came.

The goal is a record that answers, without the driver's memory, the question a payer will ask: was the van there, on time, long enough?

1. The arrival time and the GPS position, taken when the driver taps arrive, not typed later.
2. That the position matches the pickup address. A van recorded three blocks away did not arrive.
3. How long the driver waited, measured against the payer's minimum wait. Leaving a minute early can turn a valid no-show into a missed pickup.
4. What the driver did: knocked, rang, called the rider, called dispatch. If dispatch tried the rider's phone, record that too.
5. The reason in a few plain words: no answer, refused, not ready, wrong address, rider in hospital.
6. A photo of the door or the building where the payer accepts one.
7. For a cancel at the door, who cancelled: the rider, a caregiver, facility staff.

Each of these belongs to the leg, the same way a signature does on a completed trip. Our post on trip sheets covers the rest of a leg's record.

• Deal with the return leg at once. If the rider never went, the will-call home should come off the board before a driver is sent for it. See will-call returns.
• Tell the broker or plan the way your contract asks, and within its deadline.
• Keep the driver moving. A no-show should free the van for the next pickup, so dispatch needs to know the moment it is recorded.
• Look for patterns. The same rider missing every Tuesday, or the same address with no answer, is something to raise with the plan or the facility.

Not every no-show can be prevented, but many happen because the rider did not know the time, forgot, or already cancelled with someone who did not pass it on.

• Remind riders the day before, in their language, and let them confirm or cancel by reply.
• Tell them when the van is on the way and when it is nearby, so they are at the door.
• Send the same texts to a caregiver or the facility where the rider wants it.
• Make sure a cancel request reaches dispatch, not just a voicemail box.
• Arrive inside the window. A rider who gave up after waiting 40 minutes and went back inside is recorded as a no-show, but the cause was the late van. See pickup windows and on-time performance.

In the MileCall driver app, a no-show needs proof before it is recorded: arrive at the pickup, a location check against the address, a wait timer against the payer's minimum, a reason and a photo. It is saved on the phone without signal and lands on the leg in billing. The operations dashboard shows the day's no-shows, and driver insights show the no-show rate per driver.

Rider texts send a reminder the evening before with a C to confirm, on-the-way and nearby texts, and a cancel request reaches dispatch as an alert. See rider texts and Where's My Ride.

1. Medi-Cal Provider Manual, Part 2: Medical Transportation – Ground (DHCS, Medi-Cal)
2. Medi-Cal Provider Manual, Part 2: Medical Transportation – Ground: Billing Examples (DHCS, Medi-Cal)
3. Policy UM55: Emergency Transportation, Non-Emergency Medical Transportation and Related Expenses (Health Plan of San Joaquin, a Medi-Cal plan)
4. All Plan Letter 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (DHCS)

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.