Prior Authorization for NEMT Trips: Who Approves Rides and How It Goes on the Claim

What prior authorization means for a ride

Prior authorization is the payer’s approval of a ride before you give it. It confirms the rider may use Medicaid transportation for that appointment, at a set level of service, on set dates. The approval carries a number, and that number goes on your claim.

It does not guarantee payment. New York’s policy manual (effective August 25, 2023) and Illinois’s handbook (March 11, 2024) both say an approved ride can still be denied when eligibility rules are not met, and Illinois tells you to verify eligibility on the day of the trip.

Federal rules let states control how rides are used. Under 42 CFR 440.230(d), a state may limit a service by medical necessity or utilization control procedures, and prior authorization is the usual tool for rides. Since January 1, 2026, 42 CFR 440.230(e) requires state Medicaid agencies to decide standard prior authorization requests for items and services within 7 calendar days, and expedited ones within 72 hours. Each state must also post a yearly list of the items and services that need prior authorization.

Who issues the number

The number comes from whoever manages rides for that rider. For a broker trip, the broker’s trip number is the approval. Health plans approve rides for their own members: the Texas program’s handbook (September 2026) says Medicaid health plans approve managed care rides and that it covers fee-for-service riders only.

Program	Who approves the ride	What you receive
New York Medicaid	The state’s prior authorization official, the broker Medical Answering Services	An 11-digit prior authorization number, after you attest the trip was completed
Texas fee-for-service	The Medical Transportation Program, which issues every authorization	A prior authorization number for each authorized ride
Illinois fee-for-service	Transdev, the state’s contracted vendor, named in the handbook of March 11, 2024	A request tracking number and a notice of approval
Medi-Cal fee-for-service	The TAR Processing Center	An 11-digit TAR control number
North Dakota	The human services zone or tribal office	An approved SFN 1507, given to you before the trip
Oregon Health Plan fee-for-service	The local transportation brokerage	An authorization before the ride
Arizona AHCCCS fee-for-service	The AHCCCS prior authorization department, only for trips over 100 miles	A prior authorization for the base and mileage codes
MTM Health, Virginia fee-for-service	MTM Health	A unique trip ID assigned to your company

Who may ask for the approval varies too. New York calls it inappropriate for a transportation provider to request prior authorization: the rider, a representative, or the ordering practitioner asks. Illinois lets the customer, the transportation provider, or the medical provider call its vendor. See the Medical Answering Services and MTM Health broker guides.

Which rides need approval first

Some programs approve every ride. Others approve only the rides that cost the most or leave the state.

Kind of ride	What the rules say
Every non-emergency ride	New York, Texas, Illinois, Oregon, North Dakota, and Medi-Cal fee-for-service require an approval for each ride. North Dakota exempts rides a hospital arranges at discharge, which use its Medical Certificate of Transportation Services instead.
Long-distance rides	Arizona fee-for-service needs prior authorization when one member’s trips on one date total more than 100 miles, one way, round trip, or several trips. Ohio limits mileage to 50 miles from the pickup unless your records justify more.
Wheelchair and stretcher rides	North Dakota requires a mobility impairment that prevents safe use of a bus, taxi, or car, plus an approved SFN 1507. Medi-Cal requires a treatment authorization request with a prescription for wheelchair and litter van rides.
Out-of-state rides	North Dakota needs its own service authorization for travel to a provider more than 50 miles past the state border. Louisiana requires out-of-state medical care to be prior approved, and commercial air travel needs prior approval too. Ohio sends claims for trips outside Ohio and its neighboring states to manual review.
Repeat rides	New York may grant a standing order for regular treatment such as dialysis at the same place with the same provider. Illinois grants a standing authorization for trips to the same place more than three times a month.

Medi-Cal’s only exception to its authorization rule is a ride from an acute care hospital to a nursing facility, level A or B. For a rider who needs a lift, a stretcher, or a trip across a state line, see out-of-state NEMT trips and long-distance medical transport.

How to get a ride approved

The steps below follow the Illinois handbook, the most detailed of these manuals. Other programs follow the same pattern.

1. Ask early. Illinois wants requests at least seven business days before the ride, by phone, fax, or its online portal.
2. Give the details. Its vendor asks for the rider’s ID number, pickup address, appointment date and time, the doctor and the reason for the visit, the destination, why the rider cannot use public or other transportation, and whether the rider uses a walker, wheelchair, or cane or needs an attendant.
3. Attach the medical necessity form. Rides from a hospital or nursing facility need the HFS 2270 Physician Certification Statement, and rides from home should have the HFS 2271 Certificate of Transportation Services. See NEMT medical necessity form.
4. Wait for the approval notice before you bill. Check that the approved dates, level, and trips match what you will drive.
5. Request a standing authorization for repeat trips. Illinois does not take these by phone. Send them at least seven business days before care begins, with the medical records that justify the level of transportation.

See NEMT standing orders for dialysis and other repeat rides.

Rides given after hours

Urgent rides sometimes happen when no one can approve them. Most programs allow approval afterward, inside a short window.

Program	Window to ask after the ride
North Dakota	Within 72 hours of the urgent ride, for weekends, evenings, or holidays when the office is closed. The office has five business days to approve or deny it.
Oregon	Within 30 days of the after-hours transport, from the local brokerage
Illinois	Within 30 calendar days at the vendor. After that, the state considers two exceptions: an application still pending on the date of service, due within 90 days of the approval notice, or a rider who did not disclose Medicaid, due within 6 months of the ride with monthly private pay bills attached.
New York	For retroactive eligibility, a trip attestation up to 120 days after eligibility is established

If an authorization is approved late, the filing clock may move with it. Indiana extends its limit to 180 days from the date a retroactive prior authorization was approved. See timely filing limits.

How the number goes on the claim

1. Match the claim to the approval. Medi-Cal says the codes, modifiers, and dates on the claim must match the approved authorization exactly, and the units billed may not exceed the units approved. Illinois rejects a claim that does not match its authorization. New York denies claims with more daily units than the authorization allows.
2. Enter the number in box 23 of the CMS-1500. Texas and Medi-Cal both put the prior authorization number there. Medi-Cal says not to attach a copy of the authorization as proof.
3. On an electronic claim, use loop 2300. New York’s billing guidelines (August 5, 2026) put the number in a REF segment with the G1 qualifier in loop 2300 of the 837P.
4. Send one claim per authorization. New York needs a separate claim for each prior approval, and Medi-Cal bills services on separate authorizations on separate claims.
5. Bill broker trips against the trip number. MTM Health’s Virginia handbook says to use the trip ID to seek payment.

For the whole form, see the CMS-1500 for NEMT.

Mistakes that cost you the trip

• Driving without the number. MTM Health’s Virginia handbook says not to transport a member without its trip ID and does not guarantee payment for trips done without approval.
• Changing the ride without approval. New York wants changes to location or day approved before the ride. MTM Health’s Virginia handbook says an unapproved change of mode can mean no payment.
• Sending a different level of service. The approval covers one level. See NEMT level of service.
• Billing more units than approved. The extra units are denied.
• Rebilling trips already paid under an old number. Illinois says trips paid on the original authorization should not be billed again when a new number replaces it.
• Missing the attestation or post-approval window. New York expects trip attestations within 30 days of the ride.

For how to fix and resubmit, see NEMT claim denials.