Pickup windows and on-time performance: how payers measure it and how dispatch keeps it

A single leg can carry several times, and mixing them up is the most common reason a provider's own on-time number disagrees with the payer's.

• The appointment time: when the rider must be at the clinic. Outbound legs are built backwards from it.
• The requested or scheduled pickup time: when the van should be at the door.
• The pickup window: the span around the scheduled pickup that counts as on time, set in each contract, usually as minutes before and after.
• The ride-time limit: how long a rider may be on board, which caps how many stops a shared ride can make.
• The actual times: when the van arrived, when the rider boarded, when the rider was dropped off.

Ask each payer which actual time they measure (arrival at the door or the rider on board) and whether an early arrival counts as on time. The answers change how you report and how you plan.

DHCS All Plan Letter 22-008 puts on-time service at the center of NEMT for Medi-Cal managed care. Plans must meet the state's timely access standards whatever the member's need for transport. If an NEMT provider is late or does not arrive at the scheduled pickup time, the plan must authorize urgent NEMT so the member does not miss the appointment. A discharge from an acute care hospital to a skilled nursing facility or similar setting must be provided within three hours of the request. And plans must have a process to check that their brokers and providers meet these requirements.

Plans turn this into measures. Health Plan of San Joaquin's NEMT policy, for example, says it tells members they will be dropped off within 15 minutes of their scheduled appointment, and lists among its quarterly checks whether NEMT providers consistently arrive within 15 minutes of the scheduled appointment, along with no-show rates. Brokers add their own targets in their contracts. Read the numbers in yours; they are the ones your trips will be counted against.

1. Use the payer's definition, per payer. One may count arrival at the door within its window, another the drop-off before the appointment.
2. Take the actual times from the van, not from the driver's memory: the moment the driver taps arrive, with the GPS position.
3. Count every leg once. A will-call has no scheduled pickup, so measure it from activation to pickup instead. See will-call returns.
4. Keep the reason for every late leg: traffic, a previous stop that ran long, a rider not ready, a facility delay. A late leg caused by the rider is still late on the payer's report, but your notes show the cause.
5. Break it down by hour, run, driver and payer. A company-wide percentage hides the one run that is late every afternoon.

Most late pickups are decided the night before, when a run is given more than it can do. A plan that looks fine on a map can be impossible on the road.

• Use drive times for the hour of day, not an average. The same drive can take far longer at 4:30 p.m. than at 10 a.m.
• Give each stop a realistic time by space type and service level. Securing a wheelchair and walking a rider to the door take longer than a curbside pickup. See space types.
• Respect ride-time limits when you share rides. A third pickup on the way can make the first rider late for their appointment.
• Leave room for will-calls in the afternoon, near the clinics where they will come from.
• Check the plan against what actually happened. If a run is late every Tuesday, the plan for Tuesday is wrong, not the driver.

Things go wrong anyway: a breakdown, an accident on the freeway, a dialysis chair that runs long. The difference between a late pickup and an on-time one is usually how early someone noticed.

1. Watch every van's ETA against its next rider's window, not just where the van is.
2. Act while there is still time. A pickup that will miss its window in 40 minutes can be moved to another van now; in 5 minutes it cannot.
3. When you move a rider, tell them which van is coming. A rider who knows the van is late waits; one who does not often calls three times or gives up.
4. When a van goes down, put its open stops back in the queue at once and reassign them, rather than waiting for the repair.

Rider texts help the number too. A rider who gets a nearby text is at the door when the van arrives, and the minutes saved at one stop carry to every stop after it. Our post on no-shows covers the other side of that.

MileCall checks pickup windows, ride-time limits and space by type before a trip is assigned. ETAs stay current after every change on the board and while the run is moving, and they get closer to your own drive and stop times the longer you use it. A pickup about to miss its window turns amber on the board and lands in the alert centre, with the runs that can still make it. A rider moved to another van gets a text naming the new one.

The on-time report shows pickups and appointments early, on time or late, by hour, down to the day. See MileCall dispatch and rider texts.

1. All Plan Letter 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (DHCS)
2. Provider Update 22-972: Action required for NEMT requests (APL 22-008 summary and PCS form) (CalViva Health and Health Net, Medi-Cal plans)
3. Policy UM55: Emergency Transportation, Non-Emergency Medical Transportation and Related Expenses (Health Plan of San Joaquin, a Medi-Cal plan)

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.