NEMT billing in Ohio

Split by benefit, with no statewide broker named in the state plan. Necessary transportation by ambulance or wheelchair van is covered under the general Medicaid benefit, administered by ODM or by a managed care organization. For managed care members, non-emergency transportation by other means (taxicab, van, sedan) may be covered under the managed care benefit. For anyone whose necessary transportation is not explicitly covered elsewhere, the county department of job and family services (CDJFS), acting on ODM's behalf, may provide NEMT assistance ranging from actual rides to fuel subsidy, depending on local resources.¹ Payment for NEMT rides furnished by a vendor under contract with a CDJFS is negotiated under standard county procurement practices, while wheelchair van payment amounts are set by the State and reviewed periodically. Transportation related to a hospice enrollee's terminal illness sits under the hospice benefit, and a long-term care facility resident's transportation by means other than ambulance or wheelchair van sits under the long-term care benefit. The state plan amendment took effect December 27, 2021.

Medicaid provider enrollment in Ohio runs through the Provider Network Management (PNM) module¹⁰. With no statewide NEMT broker in Ohio, ODM or the member's managed care organization covers ambulance and wheelchair van trips, and the county department of job and family services provides NEMT assistance to riders whose trip no other Medicaid benefit covers¹.

Three set-ups, one per lane. Wheelchair van providers enroll with ODM as Medicaid providers, county NEMT vendors contract with the CDJFS under county procurement, and plan vendors contract with the MCO. Ohio's state plan attests that each Medicaid-enrolled wheelchair van provider and each CDJFS vendor is not excluded from any federal health care program or listed on the OIG's List of Excluded Individuals and Entities, that each driver has a valid driver's license, that the provider has a process complying with Ohio Medicaid rules for identifying and handling disqualifying offenses by drivers, particularly state drug law and traffic violations, and that a certified driving record history is obtained from the Ohio Bureau of Motor Vehicles for each driver employed or applying for employment.¹ Those four attestations mirror the federal minimums that section 209 of the Consolidated Appropriations Act, 2021 added for NEMT providers and drivers. Keep the BMV record, the license copy and the exclusion check date in each driver's file from the hire date, because a county or plan audit will ask for them trip by trip.

• 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.
• Pickup and drop-off locations with the date and time the service was furnished
• Loaded miles only, meaning miles with the beneficiary in the vehicle; a no-show cannot be billed as a trip
• The beneficiary's signature on the transport record where the county or plan requires it, plus management's own check that documented trips were furnished
• A driver and vehicle file that an auditor can read against the trip: license, exclusion check, driving record, vehicle ownership and insuranceODM's transportation rules, each county contract and each MCO vendor agreement add Ohio-specific fields, so confirm the current list with each payer before the first batch.

No Ohio code table is quoted on this page. The state plan sets wheelchair van payment amounts at the State level and reviews them periodically, county NEMT vendors are paid amounts negotiated under county procurement, and plan vendors are paid under the MCO's contract, so the codes and modifiers on a claim depend on which lane the trip is in, and this page lists no HCPCS codes or rates.¹ The NEMT billing codes page walks through the transport codes and the origin and destination modifiers in plain language.

365 days from the date of service for fee-for-service claims submitted to ODM. A denied fee-for-service claim may be resubmitted within 180 days of the denial date, as long as the original submission was received timely, even when the resubmission falls past the 365-day mark, under OAC 5160-1-19(C)(2)(ii).⁴ County vendor contracts and MCO vendor agreements set their own submission deadlines, which are usually shorter; the biller tracks each contract's window separately.