When NEMT providers use them
Broker trips are usually billed through the broker’s portal or invoice process instead. Trips billed to fee-for-service Medi-Cal, or to a plan that takes claims directly, go on a CMS-1500 or as an 837P, often through a clearinghouse.
What a transportation claim carries
Beyond the member and provider details, a transportation claim carries the HCPCS codes and modifiers, the units (legs and miles), the authorization number, and the trip details the payer asks for. For fee-for-service Medi-Cal the manual puts the pickup and destination addresses, trip times for same-day repeats and night trips, and the origin of a hospital pickup in specific boxes of the CMS-1500. Claims must be filed within the payer’s timely filing limit.
The answer comes back as an 835
The payer replies to claims with a remittance: paid, partly paid or denied, with reasons. Electronically that is an 835.
Going deeper: Billing Medi-Cal NEMT trips: the codes and what a clean claim needs
Related terms
- 835 remittance (ERA)An 835, or electronic remittance advice (ERA), is the file a payer sends back after processing claims.
- Medi-Cal NEMT billing codes (HCPCS)HCPCS codes are the billing codes for each service on a claim.
- Timely filing limitThe timely filing limit is the deadline for submitting a claim after the service date.
- Trip sheet and manifestA 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.
- Treatment Authorization Request (TAR)A Treatment Authorization Request (TAR) is fee-for-service Medi-Cal’s approval for a service before it is paid.
Sources
Checked on . Rules change: check the current version with the payer before you bill.