NEMT terms, in plain words.
What dispatchers, drivers, billers and payers mean by the words they use every day, and what each one means for a California provider carrying Medi-Cal riders.
32 terms. Medi-Cal rules are taken from DHCS and the Medi-Cal provider manual; each term lists its sources.
Programs and payers
NEMT (non-emergency medical transportation)
Non-emergency medical transportation (NEMT) is a ride to covered medical care for someone whose condition rules out ordinary public or private transport.
NMT (non-medical transportation)
Non-medical transportation (NMT) is a Medi-Cal ride by private or public vehicle for a member who has no other way to get to a covered appointment.
Medi-Cal managed care plan (MCP)
A Medi-Cal managed care plan (MCP) is a health plan that contracts with the state to cover Medi-Cal members.
Transportation broker
A transportation broker is a company that arranges NEMT and NMT rides on behalf of a health plan or state: it runs the call center, schedules the rides and hands them to transportation providers in its network.
Payer (funding source)
The payer, also called the funding source, is whoever pays for a trip leg: a broker, a health plan directly, Medi-Cal fee-for-service, a facility, a workers’ compensation administrator or the rider.
ADA paratransit vs NEMT
ADA paratransit is the door-to-door or curb-to-curb service a public transit agency must run alongside its buses and trains for people whose disability keeps them off fixed routes.
Trips and scheduling
Trip leg (A leg and B leg)
A trip leg is one one-way ride from a pickup to a drop-off.
Will-call
A will-call is a return leg booked without a pickup time.
Standing order
A standing order, also called a subscription or recurring trip, is a trip that repeats on a pattern, such as dialysis every Monday, Wednesday and Friday.
Pickup window
The pickup window is the span of time around a scheduled pickup that counts as on time, for example 15 minutes before to 15 minutes after.
Run (route)
A run, also called a route, is the ordered list of pickups and drop-offs one van and driver will do in a shift.
Multi-load (shared ride)
Multi-load means carrying more than one rider in the same van at the same time, for example three dialysis riders from the same building.
Vehicles and service levels
Space type (level of service)
Space type, also called level of service, says how a rider travels and so what room they take in a vehicle: ambulatory (a seat), wheelchair, stretcher or bariatric.
Ambulatory
An ambulatory rider is one who can walk, with or without a little help, and sit in a regular vehicle seat.
Wheelchair van
A wheelchair van is a vehicle with a lift or ramp and securements that carries a rider seated in their wheelchair.
Litter van (gurney or stretcher van)
A litter van, also called a gurney or stretcher van, carries a rider lying flat on a stretcher who needs no medical care on the way.
Curb-to-curb, door-to-door and door-through-door
Curb-to-curb, door-to-door, door-through-door and hand-to-hand are service levels: they say how far the driver goes with the rider, from the vehicle only to handing them to a named person inside.
Attendant (escort)
An attendant, or escort, is a person who rides with the member to help them, such as a parent, guardian, spouse or aide.
Pre-trip inspection (DVIR)
A pre-trip inspection is the driver’s check of the vehicle before the first trip of the day, recorded as a driver vehicle inspection report (DVIR).
On the road
No-show
A no-show is a pickup where the van arrives on time but the rider isn’t there or won’t ride.
Dry run
A dry run is a trip where the vehicle responds to the call but no one is transported, for example because the rider was a no-show or had already left.
Loaded miles
Loaded miles are the miles a vehicle drives with the rider on board, from pickup to drop-off.
Deadhead miles (empty miles)
Deadhead miles, or empty miles, are the miles a vehicle drives with no rider on board: from the yard to the first pickup, between a drop-off and the next pickup, and back to the yard at the end of the day.
Where’s My Ride
Where’s My Ride is how a rider or caregiver finds out where the van is and when it will arrive.
Billing and claims
Medi-Cal NEMT billing codes (HCPCS)
HCPCS codes are the billing codes for each service on a claim.
837P claim (CMS-1500)
An 837P is the standard electronic file for a professional health care claim, and the CMS-1500 is the paper form with the same content.
835 remittance (ERA)
An 835, or electronic remittance advice (ERA), is the file a payer sends back after processing claims.
Trip sheet and manifest
A trip sheet is the record of what happened on each leg that a payer asks for before it pays: times, miles, driver, vehicle and signatures.
Timely filing limit
The timely filing limit is the deadline for submitting a claim after the service date.
Working with Medi-Cal plans? NEMT in California puts these terms in order: who pays, how a ride reaches you and what billing needs.
See a day of your own trips in MileCall.
We’ll walk you through dispatch, the driver app and billing, and what moving over would take for your fleet.