NEMT billing in Utah

Single statewide broker for brokered rides, with transit and mileage lanes beside it. Utah Medicaid may reimburse non-emergency medical transportation for a member who is currently eligible for Traditional Medicaid and has no transportation to get medical care, and ModivCare Services is the contractor that provides door-to-door service in areas without bus or paratransit coverage. A Traditional Medicaid member who lives in an area served by UTA may receive a UTA Transit Card for local bus, bus rapid transit, TRAX and streetcar routes, and where public transportation is not available or does not meet the member's needs, personal mileage may be reimbursed at 18 cents per mile up to $300 a month.¹ Children's Health Insurance Program members, members in the Qualified Medicare Beneficiaries, Specified Low-Income Medicare Beneficiaries and Qualifying Individual Medicare cost-sharing programs, and Emergency Medicaid recipients are not eligible. Members contact ModivCare at least three business days before the appointment, on weekdays between 8:30am and 5:30pm.

Medicaid provider enrollment in Utah runs through PRISM⁴. Utah Medicaid's brokered rides run through ModivCare Services for Traditional Medicaid members in areas without bus or paratransit coverage, so a transportation company contracts with ModivCare rather than billing Utah Medicaid for trips¹.

Two set-ups, and the broker's is the one that brings trips. Modivcare's join page lists what its credentialing covers: for each driver a PASS wheelchair certificate, first aid and CPR certification, a defensive driving certificate, drug screening, a motor vehicle report and a background check; for each vehicle current registration, state inspection compliance and insurance that meets minimum coverage; and for the company general liability, sexual abuse and molestation coverage, auto liability at the state minimum and workers' compensation where state law requires it. Modivcare conducts field visits to confirm vehicles are up to contract standards and gives providers access to training specific to NEMT for Medicaid and Medicare members.³ Utah Medicaid provider enrollment, for any lane you bill the state directly, runs through PRISM, the Provider Reimbursement Information System for Medicaid: the provider creates a Utah-ID account, logs in to the PRISM portal with multi-factor authentication, required since April 1, 2021, and completes the online application, which is purged after 90 days if it is not completed and submitted. PRISM replaced the previous Medicaid Management Information System in April 2023 and no longer accepts paper claims. Federal law also asks every state to ensure each NEMT provider and driver is not on the OIG exclusion list and that each driver holds a valid license.

• The member's name and Utah Medicaid identifier, the pickup and drop-off locations, and the date and time of serviceCMS states that at a minimum all states require these elements plus the number of miles traveled with the beneficiary in the vehicle.
• Loaded miles onlyCMS says a provider cannot bill Medicaid for a no-show, and that claiming loaded mileage when the beneficiary was a no-show is billing for services not rendered.
• ModivCare's trip assignment and the real-time ride events for each legWellRyde captures real-time ride events, and Modivcare's GPS systems automate the information that goes onto a claim, so the ride events are the proof the submission rests on.
• The ModivCare booking, made at least three business days before the appointment, for a member on Traditional MedicaidCHIP members, members in the QMB, SLMB and QI Medicare cost-sharing programs and Emergency Medicaid recipients are not eligible for the benefit.
• Driver and vehicle identifiers that tie to the credentialing file ModivCare approvedThat file holds each driver's PASS wheelchair certificate, first aid and CPR, defensive driving certificate, drug screen, motor vehicle report and background check, and each vehicle's registration, inspection and insurance.

Rates from your ModivCare agreement, not a Utah Medicaid fee schedule. Modivcare takes provider claims through web-based billing and offers WellRyde as the dispatch platform that feeds them, so the figure to check before each submission is the rate line in that agreement for the mode delivered. This page lists no HCPCS codes or rates.² Utah Medicaid's own transportation lanes are the UTA Transit Card for Traditional Medicaid members in UTA's service area and personal mileage reimbursement of 18 cents per mile up to $300 a month where public transportation is not available or does not meet the member's needs; neither is billed by a transportation company. Utah Medicaid also publishes a Medical Transportation provider manual, dated July 2026 in its manual index, alongside the All Providers General Information Section I manual. Plain-language explanations of the transport codes and the origin and destination modifiers are on the NEMT billing codes page.

The ModivCare provider agreement sets the submission terms for brokered trips, and Modivcare's web-based billing is where they go. A trip ModivCare arranged is paid under that agreement, so the record that gets it paid is the ride event and the claim in Modivcare's system, submitted inside the agreement's terms, rather than a claim on a state deadline.² Utah Medicaid's own fee-for-service claim rules apply only to claims a provider sends to the state through PRISM, which accepts no paper claims; the state's All Providers General Information Section I manual is dated September 2026 in its manual index.