NEMT billing in Mississippi

Single statewide NET coordinator. Modivcare states that it serves as Mississippi's coordinator for non-emergency transportation and coordinates rides for eligible fee-for-service Medicaid beneficiaries across the state. Rides are requested at least three business days in advance unless the trip is urgent, and a non-urgent request made with less notice may have to be moved to a different date.² The Mississippi Division of Medicaid's frequently used links page carries a card for Modivcare under non-emergency transportation next to the MESA portals for providers and members and links to the health plans Magnolia Health Plan, Molina Healthcare and TrueCare. MTM Health, the previous contractor, states on its Mississippi page that as of June 8, 2024 the Mississippi NEMT program is operated by Modivcare, with MTM handling only questions about mileage reimbursement trips that took place on or before June 7, 2024.

Medicaid provider enrollment in Mississippi runs through the MESA provider portal¹. Mississippi Medicaid's non-emergency transportation runs through Modivcare as the statewide NET coordinator for fee-for-service beneficiaries, so a transportation company contracts with Modivcare rather than billing the Division of Medicaid for trips².

Modivcare's network credentialing first. Its join page asks for six things per driver: hands-on wheelchair transport training with a PASS certificate, a current first aid and CPR certificate, defensive driving certification, a passed drug screen, a motor vehicle report showing a clean record, and a completed background check. Each vehicle needs current registration, a passed inspection where the state requires one, and proof of insurance meeting the minimum coverage, and the company carries general liability coverage for bodily injury, property damage and personal injury, sexual abuse and molestation coverage, auto liability, and workers' compensation where it has employees. Once contracted, Modivcare runs field visits to confirm vehicles meet contract standards and gives providers training built for Medicaid and Medicare NEMT.⁴ Enrollment with the Division of Medicaid itself, for any service billed to the state directly, runs through the MESA Portal for Providers that the Division links from its frequently used links page, and the Division's resources page carries the Medical Assistance Participation Agreement, the Provider Disclosure Form, the electronic funds transfer authorization, and six-month due lists for revalidation, license renewal and recredentialing, so a provider enrolled there tracks those dates as well.

• The beneficiary's name and Mississippi Medicaid identifier, the pickup and drop-off addresses, the trip date and time, and the loaded milesCMS states that at a minimum all states require the beneficiary's name and Medicaid identifier, the pickup and drop-off locations, the date and time of service and the number of miles traveled with the beneficiary in the vehicle, and that drivers document only loaded miles.
• Modivcare's trip assignment, booked at least three business days before the appointment or flagged urgentModivcare's Mississippi page requires three business days' notice unless the trip is urgent, so the assignment is the proof that the ride was coordinated rather than arranged with the beneficiary directly.
• The GPS ride events for each legModivcare's transportation provider page says its GPS systems automate the information that goes onto a claim and that real-time ride events reduce cancel-at-door trips and no-shows, so the recorded pickup and drop-off are what the submission rests on.
• Confirmation that the rider is a fee-for-service beneficiaryModivcare coordinates rides for eligible fee-for-service Medicaid beneficiaries; for a member of one of the health plans the Division links, the plan's own arrangement for rides is the one to confirm before the trip is run.
• Driver and vehicle identifiers that tie to the credentialing file Modivcare approvedThat file holds each driver's PASS certificate, first aid and CPR, defensive driving certificate, drug screen, motor vehicle report and background check, and each vehicle's registration, inspection and insurance; Section 209 of the Consolidated Appropriations Act, 2021 also requires a valid license for every driver and a clear federal exclusion check for every provider and driver.

Trips are paid under your Modivcare agreement through its web-based billing, not from a Division of Medicaid fee schedule. Modivcare's Mississippi provider page points providers to its provider portal, promises faster payment via web-based billing and describes GPS systems that automate the information for claims, so the figure to check before each submission is the rate line in that agreement for the level of service delivered. This page lists no HCPCS codes or rates.³ A claim sent to the Division of Medicaid directly follows the Gainwell EDI companion guides the Division publishes on its resources page, including the 837P professional claim, the 835 remittance advice and the 276/277 claim status transactions. A transportation company meets those only for a service it bills the state itself, not for a coordinated NET trip. For what each transport code and each origin and destination modifier means, in plain language, see the NEMT billing codes page.

Your Modivcare agreement sets the submission terms for coordinated trips. A trip Modivcare arranged is paid under that agreement through its web-based billing, backed by the GPS ride events its systems capture, so the record that gets it paid is the trip in Modivcare's portal submitted inside the agreement's terms rather than a claim against a Division of Medicaid deadline.³ The Division of Medicaid's own claim rules apply only to claims a provider sends to the state through the MESA Portal for Providers; this page states no state deadline, so a biller working a direct lane confirms the current rule in the Division's provider materials before the first submission.