NEMT billing in Missouri

One statewide, at-risk broker. Missouri's state plan pays for NEMT through a state-awarded broker contract: the Office of Administration issues a request for proposals, the successful bidder is selected for the entire state, and the MO HealthNet Division pays the broker an actuarially sound rate per participant per month for each fee-for-service participant eligible for NEMT, regardless of the length of the transport, the type of vehicle required or the number of transports. The capitation is the only payment made to the broker, the broker is at risk for the cost of NEMT, and it subcontracts with transportation providers under a reimbursement methodology the State does not prescribe. MTM Health manages MO HealthNet's NEMT program today.¹ CMS lists Missouri's NEMT program as a statewide section 1902(a)(70) brokerage that began October 1, 2006, running alongside the MO HealthNet Managed Care program, whose plans in 2021 were Home State Health, Healthy Blue and UnitedHealthcare. Those plans cover NEMT for their members too: Home State Health's provider flyer says almost all MO HealthNet Managed Care members receive NEMT as part of their covered benefits and that the driver calls the number the member has on file with MTM, and UnitedHealthcare's 2026 Missouri provider manual directs non-emergent transportation to MTM with at least three business days' notice.

Missouri pays one statewide, at-risk NEMT broker, selected through a competitive bid and paid a fixed amount per eligible fee-for-service participant per month, and the broker subcontracts with the transportation providers that run the trips¹.

Network membership with the broker, not a state fee schedule enrollment. The state plan leaves the broker to subcontract with transportation providers and to track and report all trip information and provider adequacy to the Medicaid agency, without prescribing a reimbursement methodology for those subcontracts. MTM's provider onboarding runs in six steps: a provider application, an interview with a network representative, contracting, credentialing with all necessary documents submitted, training on the trip process, and the first trip. MTM monitors licensure, background checks, certifications, insurance requirements and vehicle inspections, and requires fraud, waste and abuse training and HIPAA training annually.³ MTM's Missouri page is written for riders and sets the scheduling rules a provider's trips will follow: two days' advance notice in urban counties and three in basic or rural counties, with pharmacy trips other than scheduled vaccination appointments, certain durable medical equipment services, some CSTAR services, Developmental Disability Waiver services, some Community Psychiatric Rehabilitation (CPR) services, adult day care and services provided in the member's home excluded from the program. MTM's dispatching platform is MTM Link, with a driver portal and mobile app, and it also lists third-party routing, scheduling and dispatching integrations.

• The beneficiary's name and Medicaid identifier on every trip recordCMS states that at a minimum all states require providers to document the beneficiary's name and Medicaid identifier, the pickup and drop-off locations, the date and time the service was furnished, and the number of miles traveled with the beneficiary in the vehicle; the broker's agreement adds its own fields.
• Pickup and drop-off locations with the date and time the service was furnished
• Loaded miles only, meaning miles traveled with the beneficiary in the vehicleCMS says a beneficiary who does not show up is a no-show, the provider generally cannot bill for the trip, and claiming loaded mileage for a no-show is a common form of fraud.
• The broker's or plan's trip assignment behind each rideThe state plan makes the broker responsible for tracking and reporting all trip information to the Medicaid agency, so a ride outside its record has no payer.
• Driver and vehicle credentials the broker monitors, with licensure, background checks, certifications, insurance and vehicle inspections, plus the annual fraud, waste and abuse and HIPAA training recordCMS also advises screening employees and contractors against the OIG exclusion list monthly.

Your MTM agreement sets what each brokered trip pays. The State pays the broker a per-participant monthly capitation that is the only payment made for NEMT, and it does not require a specific reimbursement methodology when the broker subcontracts with transportation providers, so a Missouri trip is submitted to MTM in the format its agreement specifies rather than by HCPCS code against a MO HealthNet fee schedule.¹ The managed care plans arrange their members' NEMT through MTM under their own contracts, and the same principle applies: the agreement, not a state fee schedule, sets the rate and the claim format for a plan member's ride. The NEMT billing codes page walks through the transport codes and the origin and destination modifiers in plain language.

Twelve months from the date of service for a claim to the MO HealthNet agency under 13 CSR 70-3.100, counted from the date of service to the date of receipt. A claim first received within twelve months and denied or returned may be resubmitted within twenty-four months of the date of service, nothing is paid when a claim is received beyond twenty-four months, and a third-party payer that reverses a payment decision after the twelve months lets the provider file late, still inside the twenty-four-month outer limit.⁵ Trips arranged by MTM are submitted to MTM under its provider agreement, which sets its own submission window; the state rule governs claims that go to MO HealthNet itself.