Why the payer decides so much
Every payer has its own contract. It sets the rate per leg and per loaded mile, whether wait time or an attendant is paid, how miles are measured and rounded, which signatures are needed, which space types it covers, its pickup window and its timely filing limit. Broker rate sheets are usually confidential, so no two providers’ numbers look the same.
In California a provider often works for several payers at once: more than one broker, a plan billed directly, facilities such as dialysis centers, and private pay. Workers’ compensation transport runs through third-party administrators and is billed like private pay.
What it means for the provider
Getting the payer right on each leg is what makes billing work. A leg booked under the wrong payer is priced wrong, held for the wrong paperwork and sent to the wrong place.
Related terms
- Transportation brokerA 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.
- 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.
- 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.
- Loaded milesLoaded miles are the miles a vehicle drives with the rider on board, from pickup to drop-off.
- Timely filing limitThe timely filing limit is the deadline for submitting a claim after the service date.