What is a claim in NEMT?
A claim is the itemized bill a provider submits to a payer for a completed service. In NEMT a claim identifies the member, the trip date, the authorization number, the level-of-service code, the mileage, pickup and drop-off locations and the charge. Broker-managed trips are usually "claimed" by confirming trip completion in the broker portal or by file upload; fee-for-service Medicaid uses the standard CMS-1500 or 837P electronic claim.
Why claims matter for NEMT
Cash flow in NEMT is claim discipline. Submit daily, not weekly. Reconcile every trip on the manifest against a submitted claim, and every submitted claim against a remittance. Clean-claim rates above 95 percent are achievable with GPS-verified trip logs and electronic signatures; anything below 90 percent means you are financing the payer's float.
Related: best practices for NEMT revenue auditing.
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