What a broker does, and doesn’t
DHCS defines brokers as entities that “conduct administrative activities on behalf of the MCP such as maintaining a call center for the members to request NEMT or NMT rides, scheduling, and arranging rides.” A broker may keep its own network of providers, but the plan must be able to add providers if that network falls short.
In Medi-Cal a broker cannot triage a member to a different level of service, cannot downgrade NEMT to NMT, and cannot approve PCS forms. It must be able to name the provider and the driver for any ride by date, time, pickup and drop-off place and member.
Brokers in California
Brokers active in California include ModivCare, MTM Health, SafeRide Health, Call The Car, American Logistics and Ventura Transit System. Which plan uses which broker changes over time; California NEMT by plan lists what we have checked.
What it means for the provider
Trips usually arrive as a file or a portal download from each broker, in that broker’s own columns. Brokers check what comes back: pickup and drop-off times against the window, signatures, miles and the driver who did the leg. Billing goes back through the broker’s portal or invoice process, under its own timely filing limit.
Going deeper: Starting an NEMT business in California: licences, insurance and getting on Medi-Cal plans
Related terms
- 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.
- 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.
- 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.
- Timely filing limitThe timely filing limit is the deadline for submitting a claim after the service date.
- Pickup windowThe 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.
Sources
Checked on . Rules change: check the current version with the payer before you bill.