NEMT trip sheets: what payers and brokers ask for, and how to keep them complete

Each leg of a trip, one way from pickup to drop-off, needs its own record. The trip sheet ties that leg to four things: the authorization the payer gave, the driver and vehicle that did it, the times and places, and proof that the rider was really on board.

Payers need this because they pay for rides they did not see. California's rules for managed care plans show why the detail matters. Under DHCS All Plan Letter 22-008, a plan must require its transportation brokers to be able to identify the specific provider, including the driver's name, from the service date, time, pickup and drop-off locations and the member's name. A plan can only do that if its providers' records carry those fields for every leg.

Formats differ from broker to broker, but the content is close to the same everywhere. A trip sheet that will hold up has, for every leg:

• The rider's name and Medi-Cal ID (or the payer's member ID).
• The trip or authorization number the payer issued.
• The space type: ambulatory, wheelchair, stretcher.
• The driver's name and the vehicle, by number or plate.
• The full pickup and drop-off addresses, with city and ZIP code.
• The scheduled pickup time or appointment time, and the actual times the van arrived, picked up and dropped off.
• Loaded miles, and odometer readings where the payer wants them.
• Signatures where the payer asks for them: the rider's, and sometimes the facility staff member who took the rider in.
• Any exception, with its reason: a no-show, a cancel at the door, a refused ride, a wait.

The addresses and times matter on the claim too. Health Plan of San Joaquin, for example, wants the complete origin and destination addresses with city and ZIP on every transportation claim, and the time of day and destinations for a second trip on the same day, or that trip may be denied as a duplicate. A trip sheet that already holds those fields makes the claim a copy job. See Medi-Cal NEMT billing codes for the claim side.

Incomplete trip sheets are rarely about bad drivers. They come from how the record is made.

• Times written down after the fact. A driver who fills in the sheet at lunch rounds to the quarter hour, and the times stop matching the GPS.
• A signature skipped because the rider was in a hurry or the facility was busy, with no note saying why.
• Odometer readings taken at the start and end of the day, not at each stop, so loaded miles have to be guessed.
• A trip changed by dispatch mid-day, with the paper sheet still showing the old pickup.
• No-shows recorded as a word on the sheet, with no time of arrival, no wait and no proof the van was at the address.

Each of these turns into a denial, a request for records or a write-off. The fix is the same for all of them: capture the fact at the stop, at the moment it happens, with the time and place attached by the device rather than typed by a person.

1. Set each payer's rules once. Which signatures, which odometer readings, how long the driver must wait before a no-show counts. Write it down per payer, not per driver.
2. Have the driver collect exactly that at the stop, in order: arrive, sign, pick up. If the payer needs a signature, the pickup should not be recorded without one or a written reason.
3. Let the phone stamp the time and location on every step, so the record is the same whether the driver is careful or rushed.
4. Check legs every day, not at month end. A leg missing a signature or a reading is easy to fix the next morning and hard to fix three weeks later.
5. Hold incomplete legs out of billing, each with the reason, and bill the rest. One missing signature should not stop a whole batch.
6. Export in the payer's own layout. Re-typing a trip sheet into a broker's columns is where new mistakes come from.

Signal is the hidden problem. Drivers go into parking garages, dialysis basements and rural roads. If the app needs signal to save a signature, the driver will skip it. Whatever you use has to save every step on the phone and send it when the signal comes back.

The legs most likely to be questioned are the ones that did not go to plan: the rider who was not there, the trip cancelled at the door, the return that waited an hour. These need the most detail: when the van arrived, how long it waited, where it was, and what the driver saw. Our post on no-shows and dry runs covers what to record.

Keep the original record when something changes. If dispatch moves a pickup or a biller corrects a mileage, the change and who made it should stay visible. An edited trip sheet with no trail is weaker in an audit than an honest one with a correction on it.

Each payer's rules are set once in MileCall. The driver app asks for exactly what that payer needs before a stop counts: the rider's signature, a facility staff member's name and signature at a clinic drop-off, odometer readings, with the time and GPS fix on each. Every step is saved on the phone without signal and sent when it returns.

In billing, each leg gets a proof-of-service page: times against the window, GPS, odometers, signatures and the trail on a map. A leg missing a piece is held with the reason, and trip sheets export in each payer's own columns as CSV or Excel. See MileCall billing.

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. Ground emergency transportation and non-emergency transportation billing and documentation requirements (June 2024) (Health Plan of San Joaquin, a Medi-Cal plan)
4. Medi-Cal Provider Manual, Part 2: Medical Transportation – Ground (DHCS, Medi-Cal)

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.