NEMT billing in Virginia

Broker model on both sides. DMAS contracts with ModivCare (formerly LogistiCare) as the transportation broker for the fee-for-service NEMT program, and members who are not in fee-for-service are enrolled in one of five Cardinal Care managed care organizations, each with its own contracted transportation broker; the brokers enroll providers and drivers, train drivers, inspect vehicles, negotiate contracts and rates, assign trips and pay providers.¹ DMAS says you do not enroll with DMAS directly for either the fee-for-service or the MCO NEMT program, and that the broker preauthorizes all NEMT services for the member. A member may ask for a particular provider when booking, but the broker is under no obligation to assign the provider the member requests.

Medicaid provider enrollment in Virginia runs through the Medicaid Enterprise System (MES) Provider Services Solution (PRSS) portal⁷. Transportation providers do not enroll with DMAS for NEMT: ModivCare, the fee-for-service broker, and each Cardinal Care plan's broker enroll the providers and drivers, and the DMAS enrollment sheet says you must enroll with the brokers to transport Medicaid members¹.

Three steps, in DMAS's order. First, DMV operating authority: DMV requires NEMT providers to have proper operating authority and licensed vehicles before transporting Medicaid members, and its Non-Emergency Medical Transportation Carrier certificate covers a carrier that only transports Medicaid recipients whose trips are arranged through DMAS, a broker under contract with DMAS or a managed care organization's broker. Second, enrollment with each broker you want trips from, which goes over its own provider and driver requirements and may require more insurance than DMV does. Third, the driver, attendant and vehicle requirements DMAS publishes as the program's minimums, which every broker agreement has to include.¹ The DMV certificate comes with vehicle registration and license plates designated for NEMT carriers, a surety bond or letter of credit kept on file for three years from the date the certificate is issued, and liability insurance set by passenger capacity. DMAS's minimums, updated May 26, 2026, include drivers at least 18 with a license held for two years, no more than two chargeable accidents or moving violations in the last three years, a Virginia State Police criminal background check before the first trip, the broker's driver training program and an ID badge, vehicle inspection before service and twice a year for wheelchair and stretcher vans, the provider's name and phone number on both sides of the vehicle, and no Medicaid or FAMIS wording on the vehicle or in the business name.

• The broker's trip assignment, because the broker preauthorizes every NEMT service and assigns the trip; a member's own request for you is not an assignment
• The member's name and Medicaid identification number, the pickup and drop-off addresses, and the date and time of each legCMS 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 the service was furnished, and the number of miles traveled with the beneficiary in the vehicle.
• Loaded miles from an accurate odometer, which every vehicle must carry, and the level of assistance shown on the manifest, curb-to-curb, door-to-door or hand-to-hand
• The driver's name and NEMT Program ID badge, and the name of the attendant when the broker provided oneDrivers show the badge to the member or facility on arrival, and the broker submits attendant claims as part of its encounter data, so an attendant is billed to the broker under its own rules.
• A driver file the broker can review at its annual credentialing check: license, driving record, Virginia State Police background check, drug screen and driver training certificateThe broker credentials every driver and attendant before they transport members and reviews the credentials at least annually, and it uses DMV's Driver Alert driving record monitoring program between reviews.
• Vehicle records: the inspection before service and each semi-annual inspection, and the vehicle information packet with registration, insurance card and the broker's accident and incident forms carried in the vehicle

No HCPCS claim goes to DMAS for a brokered trip. The brokers negotiate contracts and rates with providers and pay them, so each broker's trip submission format and rate sheet decide what a provider is paid for a trip, a wait or an attendant. DMAS publishes fee schedules for ambulance services, while its transportation page lists non-emergency ambulance alongside ambulatory, wheelchair and stretcher van trips as part of the brokered NEMT benefit.¹ Because the DMAS standards treat attendant claims as part of the broker's encounter submissions, an attendant is never a separate claim to DMAS; it is a line the broker's agreement either pays or does not. For what each transport code and each origin and destination modifier means, in plain language, see the NEMT billing codes page.

The broker's agreement sets the deadline for a trip to be submitted for payment, because brokered NEMT is not billed to DMAS. For a claim that is billed to DMAS, 12VAC30-95-10 gives 12 months from the date of service, counted from DMAS's documented receipt, with the burden on the provider to show the claim was actually received; a denied claim can be reconsidered only if it was first filed within those 12 months and is resubmitted within 13 months of the original denial.⁶ When a Medicare claim was filed on time, DMAS may pay the Medicaid claim within six months after the provider receives notice of the Medicare disposition.