What is a denial?

A denial is a payer's decision not to pay a claim. Common NEMT denial reasons include no authorization on file, trip details that do not match the authorization, mileage over the approved amount, duplicate billing, missing rider signature, member ineligible on the date of service, and claims filed after the timely-filing window (often 90 to 180 days for brokers, up to a year for some states).

Why denials matter for NEMT

Every denial is unpaid work you already paid a driver and fuel for. Track denials by reason code and fix the root cause upstream: if signatures are missing, enforce signature capture in the driver app; if mileage is disputed, use GPS-recorded odometer readings. Most denials can be appealed, but appeals cost staff time, so prevention beats recovery. Aim for a first-pass denial rate under 5 percent.