What is fee-for-service Medicaid?

Fee-for-service (FFS) Medicaid pays providers a set rate for each covered service they deliver, billed directly to the state Medicaid agency or its fiscal agent. In NEMT, FFS means the transportation provider enrolls as a Medicaid provider, obtains prior authorization where required, transports the member and submits a claim to the state, with no broker in between.

Why fee-for-service matters for NEMT

FFS states, and the FFS populations that remain in managed-care states, give providers a direct relationship with the payer and often better published rates, but they also shift administrative work onto the provider: enrollment, authorizations, claim submission, denials and audits all land on you. Providers in FFS states need billing discipline and clean trip documentation, because the state, not a broker, is the auditor.