How to Provide NEMT Rides for Health Plan of San Joaquin (2027)

Health Plan of San Joaquin is a not-for-profit Medi-Cal plan created for San Joaquin County, serving members since 1996. It also serves Stanislaus County, and since January 1, 2024 it has served El Dorado and Alpine counties under the name Mountain Valley Health Plan. Its documents call the two together “Health Plan.”

The plan runs its own ride benefit. Members ask its Customer Service Department for a ride, the plan approves and arranges it with a company in its network, and that company bills the plan directly. There is no broker in between, so your contract, credentialing, and claims all go to the plan. For how a plan contract differs from broker work, see contracting with Medicaid health plans.

Where Health Plan of San Joaquin members live

In August 2026, the plan had about 380,000 Medi-Cal members across its four counties, according to the state’s managed care enrollment report. It is by far the largest plan in San Joaquin and Stanislaus, while in El Dorado and Alpine more members are in Anthem Blue Cross. Each county also has at least one other plan, so a company that wants every Medi-Cal rider in the area needs more than one contract.

County	Plan members, August 2026	Other Medi-Cal plans there
San Joaquin	214,891	Kaiser 37,536; Health Net 31,661
Stanislaus	157,558	Health Net 56,433; Kaiser 15,138
El Dorado	7,237 (Mountain Valley)	Anthem Blue Cross 24,438; Kaiser 4,092
Alpine	40 (Mountain Valley)	Anthem Blue Cross 203

Health Net sends its Medi-Cal rides through Modivcare for members of its direct network and shared-risk medical groups, and Anthem Blue Cross sends all of its Medi-Cal rides through Modivcare. Those trips come from Modivcare’s network, not from a contract with Health Plan of San Joaquin.

Since January 1, 2026, the plan also runs Advantage D-SNP, a dual special needs plan for residents of the four counties who have both Medicare and Medi-Cal. Its 2026 provider manual says the D-SNP arranges medical transportation and non-medical rides for its members through its own Customer Services line, 1-888-361-7526.

How members get rides

The 2026 member handbook splits rides into two kinds:

• Medical transportation. Ambulance, litter van, wheelchair van, or air transport for members who cannot use a car, bus, train, or taxi, or who need the driver’s help between home, vehicle, and treatment because of a disability. The member’s provider prescribes it on a form sent to the plan, and an approval lasts up to 12 months, with as many covered trips as needed.
• Non-medical transportation. A car, taxi, or bus for members with no other way to reach a covered visit or pick up prescriptions. The plan’s transportation page, last updated January 22, 2025, says it mails public bus vouchers for scheduled visits. Members cannot drive themselves, and a private vehicle ride is paid back only when approved first, with the driver’s license, registration, and insurance on file.

Members call 1-888-936-7526 (TTY 711), weekdays 8 a.m. to 5 p.m., at least 7 to 10 business days before a routine appointment, and as soon as possible for an urgent one. The plan covers the lowest cost ride that meets the member’s needs, to the closest provider with an opening, and it does not cover rides outside its network or service area unless it approves them first.

The PCS form and authorizations

The plan requires its Physician Certification Statement (PCS) form for non-emergency medical transport, showing the level of service the member needs. The plan’s form, revised October 23, 2023, asks for:

1. The member’s limits. The specific physical, medical, or mental limits that keep the member from walking unassisted or riding in a public or private vehicle, with ICD-10 codes. Forms missing this part are sent back.
2. Equipment. Whether the member uses a wheelchair, walker, or cane during transport.
3. One mode. Wheelchair, air transport, or BLS ambulance.
4. Duration. A number of trips, or 30, 60, or 90 days, 6 months, or 12 months.
5. The signer. A physician, dentist, podiatrist, mental health or substance use disorder provider, or a physician extender at the treating office or facility, who certifies that medical necessity decided the mode.

The office faxes it to the plan at 209-942-6302. The plan approves the lowest level of transport that is adequate and available, and once the treating physician prescribes a mode, the plan cannot change the authorization (alert of May 11, 2022). Its Medical Management Department decides authorizations, and only the Medical Director or a designee can deny one.

Authorization is required for NEMT, and its number goes in box 23 of the claim. The only exception, under the plan’s alert of June 26, 2024, is a ride from an acute care hospital to a long-term care facility, which needs no authorization, prescription, or signature. If a ride happens before the approval, a network company can ask for retrospective authorization within 30 calendar days of the ride, with a completed PCS form, through the provider portal or by fax (protocol of October 30, 2024). Out-of-network companies cannot. For discharge rides, see hospital discharge transportation.

How to join the plan’s network

The plan’s January 2026 provider manual and its Join Our Network page lay out the order:

1. Enroll in Medi-Cal fee-for-service. DHCS requires every Medi-Cal plan provider, including facility and ancillary providers, to be enrolled in Medi-Cal fee-for-service through PAVE unless its type is exempt. The plan’s contracting staff check that enrollment, or your submitted application, before credentialing sends you an application. The California guide covers PAVE.
2. Send the Join Our Network form. It asks for your company name, specialty, address, hours, languages, NPI, tax ID, whether you are enrolled in Medi-Cal fee-for-service, whether you accept 100% of the Medi-Cal fee schedule, and whether you have offices in its counties. The form only shows interest. A contract coordinator reaches out within about 5 to 10 business days.
3. Meet the ancillary criteria. A valid business license, current general and professional liability insurance in amounts the plan accepts, Medi-Cal certification or participation, and no OIG exclusions. Applying does not guarantee a contract, and the criteria depend on network need.
4. Wait for two approvals. In the manual’s credentialing process, the Peer Review and Credentialing Committee reviews files every other month, and the San Joaquin County Health Commission gives final approval at its monthly meeting. The manual says credentialing usually takes 60 to 90 days, with a written decision within 120 days of the application.
5. Start only after approval. You cannot take the plan’s members until credentialing and Commission approval are done and documented.

Keep your file ready with the NEMT credentialing checklist.

How the plan pays NEMT claims

Your contract sets your rate, and the network form asks whether you accept 100% of the Medi-Cal fee schedule. That makes the fee-for-service maximums the number to know: $20.30 for a wheelchair van pickup (A0130), $26.43 at night, $26.29 for a litter van pickup (T2005), $32.42 at night, and $1.50 a mile (A0380), in Medi-Cal manual pages updated September 2023.

Bill on a CMS-1500. The plan lists A0130, A0380, A0422, A0425, A0426, A0428, T2001, and T2005 as its NEMT codes, with place of service 41. Its alerts of August 10, 2021, June 26, 2024, and June 6, 2025 say where each detail goes:

Claim box	What the plan wants
17 and 17b	Referring provider’s name and NPI, when a prescription is required
19	Full pickup and drop-off addresses with city and ZIP, the drop-off name, and trip times
23	The NEMT authorization number
24E	Diagnosis pointer to a valid diagnosis code
24G	Total miles from pickup to destination, plus return miles on a round trip

The same alerts add four rules:

• Addresses. Since June 18, 2025, claims missing full pickup and drop-off addresses or the drop-off name reject at the clearinghouse. Electronic claims carry them in field 2310E.
• Second trips. Several trips for one member on one day need the time of day and destinations in box 19, or later trips deny as duplicates.
• Night calls. Trips between 7 p.m. and 7 a.m. take the UJ modifier, with start and stop times in box 19 or an attachment. See U modifiers.
• Mileage. Wheelchair and litter vans bill miles on A0380, and ambulances on A0425.

Send paper claims to Health Plan of San Joaquin/Mountain Valley Health Plan, Paper Processing Facility, P.O. Box 211395, Eagan, MN 55121. For electronic claims, open an account with a clearinghouse and ask it for the plan’s payer ID, since the manual lists a different ID for each of the three clearinghouses it names. The timely filing limit is 365 days from the date of service, and corrections are due within 365 days of the payment or denial. From January 1, 2026, the plan pays or denies a complete claim within 30 calendar days. For the rest of the process, see how to bill Medicaid for NEMT.

The January 2027 change

From January 1, 2027, plan members with unsatisfactory immigration status, including dual eligible members, move to fee-for-service Medi-Cal, the plan told providers on August 12, 2026. Their rides will no longer come through the plan. Companies already enrolled through PAVE can keep serving them and bill DHCS, while companies that are not must apply and be approved by January 1, 2027 to be paid. The California guide explains fee-for-service billing and TARs.

Who to contact at Health Plan of San Joaquin

For	Contact
Contracting, provider services, and member rides	1-888-936-7526 (TTY 711), weekdays 8 a.m. to 5 p.m.
PCS forms	Fax 209-942-6302
Advantage D-SNP members’ rides	1-888-361-7526 (TTY 711)
Paper claims	P.O. Box 211395, Eagan, MN 55121
Offices	7751 S. Manthey Road, French Camp; 1025 J Street, Modesto; 4327 Golden Center Drive, Placerville

Before you call, have your PAVE approval or application number, NPI, tax ID, business license, insurance certificates, vehicle list by type, and the counties you cover ready.