What is NEMT?
Expanding access to health care services is a vital component of managing care, improving outcomes and controlling costs. Non-emergency medical transportation (NEMT/NET) is a crucial benefit provided to eligible qualified Medicaid recipients throughout the U.S. and is offered to provide a way for people to get to and from their medical care when they do not have access to another form of appropriate transportation. Though all states are federally required to offer the transportation benefit to applicable beneficiaries, each state is a little different when it comes to the services covered and who may receive them. Some Medicare Advantage members may also have a voluntary transportation benefit through their health plan. To learn more about NEMT in general, you can visit Centers for Medicare and Medicaid Services website at www.cms.gov. This transportation benefit may be offered to eligible recipients by their health insurance providers such as managed care organizations, coordinated care organizations, and state agencies. These organizations then partner with Access2Care to coordinate, schedule, and deliver the transportation services to their members.
What is Access2Care’s role in NEMT delivery?
Access2Care manages the transportation experience for those receiving an NEMT benefit. We assure that those in need get the right services, at the right time, from the most appropriate transportation resources. We do not own vehicles, but instead utilize a large network of contracted and credentialed transportation providers in each service area. This network is supplemented by community transportation resources such as public transit agencies. This model allows us to work with companies and drivers who are extremely familiar with the landscape, highway and road systems, as well as traffic patterns and predictable delays. We also partner with providers and drivers who mirror the cultural landscape and speak the languages common to a given service area to help make the ride more comfortable for our riders.
How does the program generally work?
Although each NEMT program is specific to the sponsoring managed care organization or state agency, there is a general process that is followed for each program:
The member calls Access2Care’s Contact Center to schedule their ride or may access services through the internet. The Contact Center Associate uses a pre-programmed “rules” driven software system which confirms the member’s eligibility and assesses the transportation needs of that member.
Our proprietary system automatically links the member to the best fit provider based on the parameters of the benefit, the member’s needs, location, and appointment details.
Transportation provider receives and accepts the trip.
The transportation provider completes the trip for the member, either one-way or round trip.
The transportation provider submits an electronic claim with pertinent data elements to Access2Care for payment.
Access2care quickly adjudicates the claim while being attentive to fraud, waste, and abuse considerations.
Claims and/or encounter information is submitted to our client.
Remember, all transportation provider companies and their drivers are credentialed and screened before being contracted as part of our transport network. All drivers have had background checks; all drivers and transport companies are verified to be eligible to participate; and we monitor all licenses and insurance requirements so you can feel safe and relaxed while being transported to and from your healthcare appointments.