NEMT billing in Nevada

Single statewide broker, with a rural MCO lane beside it. Medicaid Services Manual Chapter 1900 states that Nevada Medicaid contracts with a single NEMT broker to provide transportation to and from medically necessary covered services for fee-for-service recipients in urban or rural counties and for MCO members in urban counties, while in the 15 rural counties the rural MCOs are responsible for providing NEMT to their enrolled recipients. All NEMT, including out-of-state and long-distance transport, requires prior authorization by the NEMT broker, except services provided by Indian Health Programs, and the broker must authorize the least expensive mode consistent with the recipient's condition.² Nevada Medicaid's Transportation Services page says there are two NEMT brokers serving Medicaid recipients, MTM and SafeRide: all recipients in an urban county have their NEMT authorized by MTM, and rural MCO recipients call their plan first and are routed to SafeRide, with CareSource and SilverSummit Healthplan listed. Recipients give at least three business days' notice, with urgent and same-day trips accommodated for hospital discharges and medically necessary urgent care. Modes range from public bus passes and paratransit to transportation network companies, gas mileage reimbursement and commercial flights for out-of-state travel.

Medicaid provider enrollment in Nevada runs through the Nevada Medicaid Provider Web Portal⁴. Nevada Medicaid contracts with a single statewide NEMT broker, MTM, for fee-for-service recipients and urban MCO members, and the rural MCOs route their members' rides to SafeRide, so a transportation company subcontracts with the broker rather than billing Nevada Medicaid for trips¹.

Through the broker's subcontract, with Nevada Medicaid approving the terms. Under Chapter 1900 section 1903.3C the NEMT broker provides transportation only through subcontracting or non-contract arrangements with third parties, submits every subcontract to Nevada Medicaid for approval, and may not own any provider it subcontracts with. The broker has to verify that each provider maintains insurance meeting 49 CFR 387 subpart B and NAC 706.191, an alcohol and substance testing program meeting 49 CFR Part 382, and periodic criminal background checks. Drivers must be at least 18 with a current valid Nevada license, no more than one chargeable accident and two moving violations in the last three years, no suspension or revocation in the previous five years, and classroom and behind-the-wheel training within 30 days of starting, covering defensive driving, wheelchair securement and lift operation, sensitivity, passenger assistance and first aid. Vehicles need a two-way communication system linked to the provider's main office, ADA compliance, a first aid kit, a vehicle information packet, at least $1,500,000 combined single limit insurance, and an annual broker inspection on top of the state inspection; a driver or vehicle found out of compliance is removed from service immediately.² Nevada Medicaid's own enrollment matters only for lanes billed to the fiscal agent, such as emergency transport or non-emergency secure behavioral health transport, which Chapter 1900 has providers enroll for with the fiscal agent or the MCOs. The Providers page says Nevada Medicaid's Provider Enrollment Unit oversees enrollment and revalidation with the contracted fiscal agent, Gainwell Technologies, and links the Provider Web Portal and the online provider enrollment site.

• The recipient's name and Nevada Medicaid ID, the pickup and drop-off addresses, the date and time of the trip, 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.
• The broker's prior authorization and the level of service it assessedSection 1903.3B has the broker assess every recipient for the proper level of transportation before authorizing NEMT, starting with mileage reimbursement or fixed-route bus and moving up only when a lower level is not acceptable or sufficient for the recipient's condition.
• The scheduled pickup time, the arrival time, and the 15-minute wait before any no-showSection 1903.3C requires a transportation provider to wait at least 15 minutes after the scheduled pickup time before no-showing a recipient, and neither the broker nor its providers may charge recipients for rides or for no-shows.
• Driver and vehicle identifiers that tie to the file the broker certifiedThe broker certifies insurance, vehicle safety standards and driver background and drug tests, verifies each driver's license and training dates, and inspects vehicles annually; Section 209 of the Consolidated Appropriations Act, 2021 also requires every driver to hold a valid license and every provider and driver to be clear of the federal exclusion list.
• Attendant authorization when someone rides with the recipientChapter 1900 requires the broker to allow at least one attendant aged 18 or older, or a parent of any age for a minor, when attendant services are medically necessary, and the broker covers the attendant's transportation cost only while the recipient is being transported.

Trips are paid under your subcontract with the broker, not from a Nevada Medicaid fee schedule. Chapter 1900 has the broker submit all subcontracts, and the terms and conditions under which third parties provide NEMT, to Nevada Medicaid for approval, and it refers to the broker's capitation payment, which the broker may be required to refund for a recipient who was transported to a geographically inappropriate provider without documented justification. The figure to check before each submission is the rate in your subcontract for the level of service the broker authorized. This page lists no HCPCS codes or rates.² The only transportation lanes that produce a claim to Nevada Medicaid's fiscal agent are outside the NEMT broker's scope: emergency medical transportation, non-immediate medically necessary transports by an enrolled emergency transportation provider when a recipient's in-transit care needs exceed the broker's capability, and non-emergency secure behavioral health transports, for which Chapter 1900 says claims must be submitted to the fiscal agent. The NEMT billing codes page walks through the transport codes and the origin and destination modifiers in plain language.

180 days for a claim to Nevada Medicaid's fiscal agent. Medicaid Services Manual Chapter 100 section 105.2B says that to be considered timely a claim must be received by the fiscal agent within 180 days from the date of service or the date of the eligibility decision, whichever is later; out-of-state providers and claims where a third-party liability resource exists get 365 days, and any claim submitted after the stale date is denied, with a right to appeal. A provider that delayed billing while pursuing a third-party payer has 60 days from that payer's reimbursement or denial notice to submit, with the EOB, and no more than two years from the end date of service.³ Brokered NEMT trips never reach the fiscal agent: they are submitted to MTM or SafeRide under your subcontract, which sets its own submission terms. The stale-date rule governs the emergency and secure behavioral health transports billed to Nevada Medicaid directly.