How to Read a NEMT Broker Provider Manual in 2027: The Sections That Decide Your Pay

Your broker contract sets the rate. The provider manual decides whether each trip earns it. It holds the pickup windows your drivers are measured against, the cutoffs for handing back trips, the fields every trip log needs, the billing deadlines, and the penalties. A quick read at signing is not enough. Read it the way an auditor will, then turn it into rules your staff follow every day.

What a broker provider manual is and how it ties to your contract

Brokers must police their networks. Federal rule 42 CFR 440.170(a)(4) requires a Medicaid NEMT broker to have oversight procedures that make sure rides are timely and transport personnel are licensed, qualified, competent, and courteous. The provider manual, sometimes called a handbook or provider guidelines, is where the broker writes those standards down for you.

It is usually binding. WellTrans’s Indiana provider agreement (revised October 16, 2025) says its transportation provider manual is incorporated by reference and is part of the contract, and that you must follow it as WellTrans amends it. As of September 2026, MTM Health says its provider guidelines are made a part of each contract.

Your broker rules are spread across several documents. Read all of them together.

Document	What it usually holds	Example
Provider agreement	Term, termination, insurance limits, payment terms, and how penalties are collected	MTM Health’s standard agreement (January 1, 2023): a three-year term that either side can end on 30 days’ written notice
Appendices and schedules	The credential list, the rate sheet, and the penalty schedule	MTM’s Appendix B (credentials), Schedule A (rates), and Schedule B (performance standards and metrics)
Provider manual or handbook	Daily rules: time windows, trip handling, trip records, claims, incidents, and contacts	MTM Health’s Virginia handbook (approved August 10, 2026)
Portal guides	How to submit claims, turnbacks, and appeals in the broker’s portal	The portal guide inside MTM’s Rhode Island handbook (July 1, 2026)
The state’s rules for the broker	Program rules the broker must enforce on its network	Georgia’s NEMT policies (July 1, 2026) require the broker to inspect every vehicle every six months

The manual often points back to the contract for the money. MTM’s Virginia handbook sends you to your service agreement for liquidated damage amounts, and to its Appendix B for the full credential list. Keep the agreement, every appendix, and the manual in one folder for each broker.

Check the date, the state, and the version first

A manual only helps if it is the current one for the program you serve.

• Read the date on the cover. MTM Health’s Virginia handbook was approved August 10, 2026 and last updated July 30, 2026. Its Rhode Island handbook was approved May 15, 2023 and last updated July 1, 2026. WellTrans’s Indiana manual is revised February 17, 2023, and says it may not apply to WellTrans programs in other states.
• Match the state and program. The same broker writes different rules for each contract. MTM gives Virginia providers 6 months from the date of service to submit a clean claim, and Rhode Island providers 90 days.
• Get it from the broker. WellTrans keeps its current manual on its provider page and has you sign an acknowledgment of receipt. MediTrans offers its handbook through its provider portal or on request (September 2026).
• Watch for updates. WellTrans gives you 5 business days after receiving an updated manual to sign an acknowledgment or send a written protest. MTM’s standard agreement lets MTM amend the agreement, including rates, by written notice, and an amendment you do not reject in writing within 30 days is accepted.

Save each version with the date you received it. When a penalty or denial is disputed, you need the rule that applied on the date of service.

Trip time windows: the numbers your drivers are measured by

Time windows decide what counts as late, when a rider becomes a no-show, and how long a will-call rider waits. They differ from broker to broker.

Rule	MTM Health, Virginia (August 2026)	MTM Health, Rhode Island (July 2026)	MAS, New York (October 2023)	WellTrans, Indiana (February 2023)
On-time pickup	15 minutes before to 15 minutes after the scheduled time	More than 15 minutes off the scheduled time is not timely	The scheduled time, or up to 15 minutes before or after	A pickup from home more than 10 minutes after the scheduled time is late
Wait before a rider no-show	Until the pickup window ends, after trying the rider by phone or text	Up to 10 minutes after the scheduled time, with a call or text	At least 15 minutes. Shorter waits can lead to suspension.	At least 10 minutes after the scheduled time
Will-call return	Within 45 minutes of the call	Within 45 minutes of the call	Within 1 hour	Within 1 hour, or by the close of the medical office if that is sooner
Same-day hospital discharge	Within 3 hours of notice that the rider is ready, with liquidated damages if missed	No separate rule in the handbook	Within 3 hours of receiving the trip	Within 3 hours of accepting the trip
Ride length limit	Shared rides: no more than 45 minutes over the average direct trip	Shared rides: no more than 45 minutes over the average direct trip	Rides under 1 hour, with some exceptions	Shared rides: no more than 20 minutes longer than the same trip by public transit

Read the drop-off rule too. In Virginia the pickup window applies to the first pickup only, and the rider must still arrive by the appointment time. WellTrans wants riders at the appointment 15 minutes early but not more than an hour early, and return pickups no more than 30 minutes after the scheduled time. CareOregon’s manual (February 2024) has drivers wait at least 15 minutes and bars drop-offs more than 15 minutes before a facility opens.

See NEMT pickup window for how windows are counted, and hospital discharge transportation for the three-hour trips.

Turnbacks, refusals, and trip changes

Every broker lets you hand back a trip you cannot run, but only before a cutoff.

Broker	Deadline to hand back a trip
MTM Health, Virginia (August 2026)	At least 24 hours before the scheduled pickup time
MTM Health, Rhode Island (July 2026)	At least 24 hours before the appointment time. No turnbacks of same-day trips or of trips taken from the marketplace.
WellTrans, Indiana (agreement of October 16, 2025)	At least 12 hours before pickup, for trips sent at least 36 hours ahead. Miss it and you pay any premium cost of the replacement ride. The February 2023 manual asks for one business day’s notice instead.
MAS, New York (October 2023)	MAS says refusals within 48 hours of pickup are ten times more likely to draw a complaint, and it may change your availability profile to stop a pattern of refusals

Notice the words. Virginia counts from the pickup time and Rhode Island from the appointment time. For a 10:00 a.m. appointment with a 9:15 a.m. pickup, the Virginia cutoff is 9:15 a.m. the day before and the Rhode Island cutoff is 10:00 a.m. the day before.

Trip details are fixed too. MTM’s Rhode Island handbook allows no address changes until MTM approves them and updates the manifest. MAS warns that changes requested after the ride may not be approved. MTM’s Virginia handbook says an unapproved mode or vehicle substitution can mean no payment. See broker trip offers for accepting trips.

The trip record that gets a claim paid

One missing item on the trip record is enough to deny a claim. Read this section word by word.

• MTM Health (Virginia and Rhode Island). Each claim needs an electronic trip log with the trip ID, scheduled pickup time, actual pickup time, departure time, arrival time, and the member’s signature, and the trip must be in completed status. If any item is missing, the claim is denied. Never carry a member without MTM’s trip ID.
• MAS (New York). GPS location data must be on every trip invoice before you can attest to it. If the GPS data and the invoice do not match, you may not be able to attest. For trips on or after November 10, 2025, MAS must receive each GPS point within 30 minutes of when it was recorded, or the trip cannot be attested.
• WellTrans (Indiana agreement, October 16, 2025). Every rider signs the trip log. If a rider cannot sign, a household member, caretaker, or facility staff member signs his or her own name with the relationship. A driver never signs for the rider, and logs with initials or an “unable to sign” note are not accepted. Corrections take a single line through the old entry, dated and initialed by the driver.

Virginia also requires location tracking to stay on for the whole ride, and it scores you on it. See NEMT trip documentation for the full record, and use the trip log template where your broker accepts paper.

Billing and appeal deadlines

A late claim is usually a lost claim. Put these dates on your billing calendar, and see timely filing limits for how the clock works.

Broker document	Deadline to bill	Deadline to appeal a denial	Payment timing
MTM Health standard agreement (January 1, 2023)	90 days from the date of service, unless MTM’s client sets another limit	Through MTM’s appeals process	Within 30 days after electronic submission of an uncontested invoice
MTM Health, Virginia (August 2026)	6 months from the date of service. For trips billed to Medicare first, 6 months from the Medicare denial.	365 calendar days	See the agreement
MTM Health, Rhode Island (July 2026)	90 days from the date of service	365 calendar days in the claims section, but 90 days from the denial in the portal guide	See the agreement
WellTrans, Indiana (October 16, 2025)	60 days from the date of service. Invoices over 90 days old are disallowed. For Medicare-first trips, the clock starts at the Medicare denial.	Claims denied for missing information may be resubmitted with it	Twice a month, within 30 days of submission

Two more clauses move money after payment. MTM’s standard agreement lets it recover overpayments and liquidated damages by offsetting future payments. WellTrans’s agreement gives you 30 days to answer a written request about a rider who may have missed the appointment, and a missed answer counts as confirming the trip did not happen. See how to bill NEMT brokers and how to appeal a denied NEMT claim.

Penalties, points, and performance targets

The performance section tells you what the broker counts and what each miss costs. MTM’s Virginia handbook (August 2026) sets a target for each measure.

Measure	MTM Health Virginia standard
On-time performance	More than 95 percent
Provider no-shows	Under 0.25 percent
Substantiated complaints	Under 0.1 percent of completed trips
Denied claims	Under 0.29 percent
GPS tracking of trips	More than 90.01 percent
Trips handed back	Under 0.5 percent

Virginia also runs an infraction point system. Points last one year. At 3 points marketplace access is suspended, 5 points bring a 5-day suspension, 8 points a 10-day suspension and the loss of recurring trips, and 10 points termination. A missing name tag is 1 point, an expired driver or vehicle credential is 2 points each, and an unreported incident or a driver, attendant, or vehicle that was never credentialed is 3 points.

Other programs work differently. MTM’s Rhode Island handbook grades you green, yellow, or red on each measure and charges $500 for missing any incident reporting deadline. MediTrans in Louisiana targets on-time performance of 95 percent or higher and provider no-shows under 1 percent (September 2026). MTM’s standard agreement lets MTM withhold liquidated damages from your payments and pass through penalties its client assesses against MTM. See NEMT broker penalties and NEMT broker scorecards.

Incidents, records, and audits

Incident deadlines are short, and several brokers fine you for missing them.

Broker	First report	Written report	Follow-up
MTM Health, Rhode Island (July 2026)	By phone immediately for injuries, police or EMS calls, weapons, assaults, or a missing member	Within 24 hours	Police report within 5 business days
WellTrans, Indiana (October 16, 2025)	By phone immediately, and no later than 3 hours, for moving violations and injury accidents	Within 24 hours of any accident, incident, or moving violation	Police report within 3 business days, and drug test results within 72 hours of the test
CareOregon (February 2024)	In writing immediately for injuries, deaths, or abuse allegations	Within 24 hours for other accidents and incidents	Grievance responses within 3 business days, or 1 business day when the brokerage requires

Records rules come with inspection rights. MTM’s standard agreement requires records kept for 10 years and allows unannounced inspections and audits. WellTrans requires records for 10 years after the agreement ends and copies within three days of a request. See NEMT broker audits and the incident report form.

How to turn the manual into house rules

A rule your staff never sees protects nobody. Translate each number into a plain instruction with an owner.

The manual says	Your house rule	Who owns it
A pickup is on time from 15 minutes before to 15 minutes after (MTM Virginia)	Drivers arrive by the scheduled time, and dispatch calls any driver running more than 5 minutes behind	Dispatcher
Turnbacks at least 24 hours before pickup (MTM Virginia)	Review tomorrow’s trips by noon and hand back anything you cannot cover right away	Dispatcher
A claim needs the trip ID, four times, and a signature (MTM)	No leg is closed until every field and the signature are in	Drivers
Bill within 90 days (MTM Rhode Island)	Bill every week, and review any unbilled trip older than 30 days	Billing
Appeal within 90 days of a denial (MTM Rhode Island portal guide)	Check denials every week and appeal within 30 days	Billing
Written incident report within 24 hours (MTM Rhode Island, WellTrans)	The driver calls dispatch before leaving the scene, and the office files the report the same day	Manager
Upload renewals 10 business days before they expire (MTM Rhode Island)	Renew every credential 30 days before it expires	Office manager

Step by step

1. Collect the full set for each broker and state: the agreement, appendices, rate sheet, manual, and portal guide. Write the date received on each.
2. Build a one-page number sheet per broker. List the windows, cutoffs, deadlines, penalties, and phone numbers. MTM’s Virginia handbook (August 2026), for example, lists a 24-hour provider hotline at 866-810-8302.
3. Mark every conflict. WellTrans’s Indiana manual says vehicles are inspected at least once a year in one section, and at the start of service and monthly in another. Follow the stricter rule and ask provider relations to confirm in writing.
4. Write the house rules in plain words. Put them in your policies and procedures and your driver handbook.
5. Train staff and get signatures. Brokers ask you to acknowledge their manual. Ask the same of your drivers and dispatchers.
6. Put every deadline on a calendar. That includes billing and appeal dates, credential renewals, and the windows to accept or reject changes, such as WellTrans’s 5 business days and MTM’s 30 days. See NEMT recredentialing for the renewal side.
7. Re-read at every update. MTM’s Virginia handbook promises provider meetings at least quarterly, where program updates are shared. Compare each new version to your number sheet.
8. Keep old versions. An appeal of a penalty depends on the rule in force on the date of service.

Questions to ask provider relations

• Which version of the manual applies to my state and program, and where are updates posted?
• If the manual and the agreement differ, which one controls?
• Which claim and appeal deadlines does the portal enforce?
• How are liquidated damages calculated, and when are they taken from payments?
• Does the turnback cutoff count from the pickup time or the appointment time?

Get each answer by email and file it with the manual.