NEMT billing in Delaware

A single statewide broker under section 1902(a)(70). CMS's 2024 state tables show Delaware's Modivcare Non-Emergency Medical Transportation program running statewide since July 1, 2002, with mandatory enrollment for the covered groups, Modivcare listed as the enrollment broker and the non-emergency medical transportation benefit carried by the program and by PACE but not by the Diamond State Health Plan and DSHP Plus health plans. The 2024 plan file counts 236,213 members in the program, and its earlier rows show the same statewide brokerage reported as LogistiCare through 2020 and as ModivCare from 2021.¹ Modivcare's NEMT page names the Delaware Department of Health and Social Services in a case study on specialized transportation for pediatric patients with complex medical needs through its contracted providers. The Delaware Medical Assistance Portal for Providers lists Highmark Health Options, AmeriHealth Caritas Delaware and Delaware First Health as the managed care organizations and says MCO providers should look to their MCO's handbook for plan-specific information, while the state tables keep the transportation benefit out of those plans.

Medicaid provider enrollment in Delaware runs through the DMAP Provider Portal (Delaware Medical Assistance Portal for Providers)³. Delaware runs one statewide NEMT brokerage under section 1902(a)(70), Modivcare Non-Emergency Medical Transportation, started July 1, 2002 with mandatory enrollment for the covered groups, so a transportation company is paid under its Modivcare contract and the health plans do not carry the transportation benefit¹.

Join Modivcare's network, and hold a Delaware Medical Assistance Program enrollment behind it. Modivcare's transportation provider page invites companies to join its network, says it conducts field visits to confirm vehicles are up to contract standards, provides training programs specific to NEMT and keeps communicating with providers to help them achieve compliance, and gives contracted providers a Transportation Portal for billing and claims, ride reservations and driver safety training, with WellRyde offered as the dispatch platform. On the state side, the Delaware Medical Assistance Portal for Providers says CMS requires states to deny claims from providers who are not enrolled in the state's Medicaid or CHIP program, offers enrollment through the portal, and sets an enrollment fee of $750 for institutional providers at initial application, reactivation, revalidation, re-enrollment and each new location from January 1, 2026.⁴ The portal warns that CMS is requiring many Medicaid providers to revalidate within the next 24 months, that DMAP mails revalidation instructions 60 days before the due date, and that providers who fail to revalidate on time are terminated from DMAP, so the mailing address and contact information in the provider portal have to be current. Section 209 of the Consolidated Appropriations Act, 2021 sets the federal floor the state plan must apply to every transportation provider and driver: no federal exclusion, a valid driver's license, a process for state drug law violations and disclosure of employed drivers' driving history, and CMS's booklet says a transportation provider must hold a contract with the managing entity before any trip is furnished.

• The member's name and Delaware Medicaid ID, the pickup and drop-off addresses, and the date and time of each legCMS's booklet says every state requires at least the beneficiary's name and Medicaid identifier, the pickup and drop-off locations and the date and time the service was furnished on the transport record.
• Loaded miles, counted only while the member is in the vehicleCMS says drivers should document only loaded miles and that states and their contracted transportation entities pay for loaded mileage alone, with no extra payment for wait time in most states.
• The Modivcare assignment the trip was run underModivcare is the program's broker and enrollment broker under the state tables, and CMS's booklet says Medicaid payment is not available for a trip run without a contract with the managing entity, so the record ties each leg to the assignment Modivcare issued.
• Driver and vehicle identifiers that match what Modivcare inspectedModivcare conducts field visits to confirm vehicles meet contract standards and trains its providers, and Section 209 requires a valid license and a clear federal exclusion check for every driver.
• The electronic trip data from the dispatch platformModivcare's provider page says WellRyde's GPS systems automate information for claims and that online claims submission is how providers are paid, so the biller keeps the platform's trip record as the evidence of completion.

Paid under your Modivcare contract, not from a Delaware fee schedule. The state tables carry the transportation benefit in the Modivcare program alone and leave it out of the health plans, so the rate to check before each submission is the one in your contract for the level of service Modivcare assigned, and the submission goes through Modivcare's Transportation Portal or WellRyde rather than as an 837P to the Delaware Medical Assistance Program. This page lists no HCPCS codes or rates for Delaware NEMT.¹ Delaware First Health's billing manual carries an appendix of origin and destination modifiers for the transportation claims that are billed to the plan itself, with the first letter the origin and the second the destination, which is the format a company would meet only on a claim to a plan for a service the plan covers, such as an ambulance run, rather than on a brokered NEMT trip. For what each transport code and each origin and destination modifier means, in plain language, see the NEMT billing codes page.

Set by your Modivcare contract for brokered trips, because a trip in the statewide program never reaches the Delaware Medical Assistance Program or a plan as a claim. For a claim that does go to a plan directly, Delaware First Health's billing manual requires first-time claims within 120 calendar days of the date of service for participating and non-participating providers alike, with exceptions when the provider is pursuing another payer first, and it holds electronic claims to the same timely filing rule as paper. This page gives no DMAP fee-for-service day count.⁵ The portal's Manuals, Bulletins and Forms library holds the DMAP policy that governs fee-for-service claims, so a company billing the state directly for anything outside the brokerage checks that policy before a claim ages.