NEMT billing in Maine

Regional brokers under a 1915(b) waiver. The introduction to MaineCare Benefits Manual Chapter II, Section 113 says the state is divided into eight regions for non-emergency transportation, that brokers hold contracts with the state to provide NET services in one or more regions, and that the waiver restricts a member's choice of provider by limiting the number of brokers the state contracts with. Section 113.02 makes each broker responsible for arranging all NET for members who live in its regions, and Section 113.13 has the Department pay each broker under its contract while transporters are paid by the broker under service agreements.² CMS's 2024 state tables record the NET program as statewide since August 1, 2011 with members pre-assigned to a broker and the transportation benefit carried by the program itself, and list MidCoast Connector, Penquis CAP and Modivcare as the 2024 participants, with 218,751 members assigned to Modivcare in regions 1, 2, 6, 7 and 8, 104,618 to Penquis CAP in regions 3 and 4 and 42,945 to MidCoast Connector in region 5. On June 24, 2026 the Office of MaineCare Services announced that Modivcare would schedule NET rides for the mid-coast region, Waldo, Knox, Lincoln and Sagadahoc counties plus Brunswick and Harpswell in Cumberland County, beginning July 1, 2026, and the broker list updated that day names only Modivcare and Penquis CAP.

Medicaid provider enrollment in Maine runs through the MaineCare Health PAS Online Portal³. MaineCare NET is a regional brokerage under a 1915(b) waiver, with Modivcare and Penquis CAP holding the regions on the July 1, 2026 broker list, and Section 113.13 has the broker, not the Department, pay each transporter under a service agreement².

A service agreement with the broker for your region is the credential that produces trips. Section 113.06-2 requires each broker to hold signed service agreements with the agencies that provide transportation, to submit every agreement to the Department for review, and to build a network of transporters with enough vehicles, drivers and attendants, including wheelchair-accessible vehicles, that the failure of any one transporter does not impede service. Section 113.06-17 sets the driver floor the broker must enforce: a current valid license for the vehicle assigned, no more than two chargeable accidents or moving violations in the previous three years, no license suspension or revocation in the last five years, training in passenger assistance, defensive driving, customer service and disability sensitivity within 30 days of starting, First Aid and CPR certification within 60 days, visible identification badges naming the transporter and the driver, no hand-held phone use while driving, and the criminal conviction limits in paragraph R. Section 113.06-19 adds the wheelchair vehicle standards: a 56-inch floor-to-ceiling clearance, a lift or ramp, an engine interlock for powered lifts, and an ADA-compliant tie-down for each wheelchair position.² MaineCare enrollment itself matters for the broker, which Section 113.06-1 requires to hold a MaineCare provider agreement, a business associate agreement and a NET contract, and for any company that bills the Department directly for something outside the brokerage. Chapter I, Section 1.03-1 has providers enroll online through the Department's Health PAS portal at mainecare.maine.gov, with an executed provider agreement as a condition of participation, re-enrollment every five years for most providers and updates to NPI or enrollment information within ten days of a change; the Office of MaineCare Services describes the same steps through the Maine Integrated Health Management Solution (MIHMS), starting with an account on that system.

• Date of service, the transporter's name, the point of origin and the drop-off destinationSection 113.09 lists these among the elements the broker's monthly 837P encounter transactions to MIHMS must document for every trip, so the transporter's own record has to supply them.
• The time the driver and vehicle left the base station and the time they returned to itBoth times are required encounter elements in Section 113.09, alongside the mileage, which Section 113.13 pays per passenger mile under the S0215 and S0209 encounter codes.
• Mileage for the trip, and the authorized transporter signature the broker keeps on fileSection 113.09 requires mileage and an authorized signature of the transporter on file; CMS's booklet adds that every state requires the beneficiary's name and Medicaid identifier, the pickup and drop-off locations and the date and time of service, with only loaded miles recorded.
• Origin and destination modifiers in the HCPCS two-letter formSection 113.09 has brokers report current HCPCS modifiers when appropriate and lists the origin and destination letters, from D for a diagnostic or therapeutic site through R for a residence and X for an intermediate stop at a physician's office, with X allowed only in the destination position.
• The pickup wait, the on-time window and any no-showSection 113.06-9 has the driver wait at least 10 minutes past the scheduled pickup and contact the broker before leaving, Section 113.01-10 defines a no-show as the member not being at the point of origin within 10 minutes of the scheduled time or cancelling on the transporter's arrival, and Section 113.01-11 defines on time as 30 minutes before to 15 minutes after a scheduled pickup, so the record carries the times that show which applied.

Paid under your service agreement, tracked by the broker on encounter codes. Section 113.13 says transporters are paid by brokers under their service agreements, that transporters without an agreement such as family and friends are paid at rates the Department sets, and that brokers track trip data with NET encounter codes: T2003 per one-way trip as the provider base rate, S0215 per passenger mile in an agency-controlled vehicle with modifier TK for a shared ride, A0090 and A0080 per mile for family or volunteer vehicles, waiver-specific T2003 and S0215 modifiers for Section 18, 19, 20, 21, 29 and 32 trips, and for wheelchair van providers A0130 per trip with S0209 per mile. Section 113.09 has the broker submit those encounters to MIHMS monthly as clean 837P transactions.² The figure that governs your payment is the rate in your service agreement for the mode the broker assigned, and the codes above are how the broker reports the trip to the state. Section 113.06-8 lets a broker also operate as a transporter but caps self-referred trips at 25 percent of trips a month without Department approval, and Section 113.06-7 keeps routine trips to a provider within 30 miles in urban areas and 50 in rural areas, 15 and 30 for pharmacies, unless an exception applies. Plain-language explanations of the transport codes and the origin and destination modifiers are on the NEMT billing codes page.

One year for a claim to the Department. Chapter I, Section 1.10-2 gives providers one year from the date of service to file a claim correctly with the Department regardless of when eligibility is verified, counts the year from the date eligibility was granted when MaineCare eligibility is determined after the service, and from the date on the other carrier's explanation of benefits when another insurer or Workers' Compensation is involved, and bars billing a member for a covered service denied for exceeding the limit because the provider did not verify eligibility.³ That rule governs claims billed to MaineCare directly. Brokered trips are paid under your service agreement, which sets its own submission terms, while the broker's encounter data for the previous month is due to MIHMS by the 15th of the month under Section 113.09.