NEMT Broker Trip Offers in 2027: How to Accept, Decline, and Turn Back Trips

A broker trip offer is the moment a ride becomes your job. The broker books the member, checks that the trip qualifies, and then picks a provider. How that choice reaches you, how fast you must answer, and what it costs to hand a trip back all depend on the broker. This guide walks through each step, with the rules brokers and states have set in writing.

How a trip gets from the broker to you

Every brokered trip starts the same way. A member or a health care provider asks the broker for a ride. The broker checks the member’s eligibility and that the trip goes to a covered service, then gives it a trip or job number. Louisiana, for example, requires its broker to confirm eligibility and that the pickup or drop-off is a medical facility before it schedules the trip (Chapter 10, Section 10.2, issued July 14, 2025).

Only then does the trip go to a provider. Brokers use five routes, and most use more than one:

How it reaches you	How it works	Examples
Automatic assignment	The trip goes straight to a named provider, and no one else sees it	MTM Health in Virginia assigns standing orders set to a provider, members with a required provider, and facilities with a sole source provider this way (handbook approved August 10, 2026)
Assignment by the broker’s system	The broker picks an eligible provider and puts the trip on your list or manifest. You keep it or hand it back.	MTM Virginia sends trips to eligible providers 7 days before the appointment. WellTrans (agreement revised October 16, 2025) sends a manifest each day, and you confirm you received it.
Open marketplace	Unclaimed trips in your area are posted for any credentialed provider to take	In Virginia, MTM’s Marketplace shows the open trips in your service area 5 days before the appointment. Modivcare’s marketplace lets providers pick up extra trips to fill gaps left by cancellations and no-shows.
Priced offer or bid	Each trip comes with its miles and pay, and you choose	American Logistics offers show the pickup city, mileage, vehicle type, and payment. MART in Massachusetts assigns trips through a low-cost bid system built on the rates you submit for each town.
Phone call	Dispatch calls with a short-notice trip	WellTrans sends same-day, urgent, and hospital discharge trips by phone, and you must be able to take them that way. MTM Virginia will not assign an urgent trip without your OK.

Standing orders are most of the work in some programs. In Wisconsin in May 2026, 203,022 of the 301,246 trip legs MTM Health completed were tied to recurring appointments, and 36,143 were booked with less than 24 hours’ notice, according to the state’s monthly report. See NEMT standing orders and advance notice.

A trip on your list may already be yours, even if you never clicked accept. In Rhode Island, MTM’s dispatch team sends some trips marked “Unassigned,” which means the trip is assigned to your company and you must place it on a driver’s run so it is not missed (handbook, July 1, 2026). If trips flow into your own dispatch system through a file or a connection, check each day’s load the same day. See broker trip imports.

Who gets the offer

Brokers do not choose at random, and some states write down the order. Rhode Island’s contract with MTM Health (effective July 1, 2025) requires its trip assignment system to weigh these, in this order:

1. The right vehicle for the member’s needs.
2. The member’s preferred provider, or a request not to use one.
3. A facility’s request for a provider it has worked with.
4. Your capacity: vehicles in service and drivers available.
5. Geography, including terrain, so each run can be driven safely.
6. Your quality of service, including complaints, on-time record, and driving safety.
7. A fair spread of the remaining trips, with random assignment among providers in a region.

The same contract bars MTM from cutting a provider’s trips because the provider filed a grievance against MTM.

Other programs name similar factors:

• New York. The broker assigns trips first by the medically appropriate mode, then by the member’s choice among participating companies, then at its own discretion. It may use each company in its network to whatever extent it decides (Medicaid Transportation Policy Manual, effective August 25, 2023).
• Louisiana. The broker assigns the least costly provider that fits the level of service. When costs are equal, the member may choose, and the broker should favor a provider based in the member’s region that can meet time standards.
• Oregon. CareOregon’s manual (version 1.3, February 2024) says trips go out by stated availability by service area and hours, vehicle types, level of service, rates, and performance.
• Georgia. Each broker’s orientation for providers must cover its criteria for trip assignment (DCH NEMT manual, section 917.1.10, version dated July 1, 2026). Ask for them in writing.

None of these promise you a number of trips. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, leaves trip volume to MTM’s sole discretion and lets it reassign any trip, recurring trips included. CareOregon’s manual says contracted providers are not guaranteed a specific volume of trips. For the levers that raise your share, see how to get more NEMT broker trips.

What a trip offer shows

Read the whole trip before you take it. MTM Health’s Virginia handbook lists what its manifests carry:

• A unique trip number for billing.
• The member’s full name and phone number.
• The pickup and appointment addresses, with times.
• The name and phone number of the doctor or other provider.
• The approved mode and level of service: curb-to-curb, door-to-door, or hand-to-hand.
• Whether an escort rides along, or you must supply an attendant.
• The member’s weight, including any wheelchair or equipment.
• Special needs and pickup details, such as which entrance to use.

Many offers add the money. MTM’s portal shows the estimated miles and claim amount for each trip (Rhode Island handbook). American Logistics shows the payment for completing the trip before you take it. MART stamps each trip with its loaded miles and fare when it posts the trip. Any dispute over those numbers must be raised before you accept, because MART accepts no increase at invoice time (Attachment H, amendment effective July 1, 2025).

Check these before you accept

1. Level of service. Your van and driver match the mode and the help the member needs. WellTrans charges $200 each time a provider sends a lower class of vehicle than it asked for. If the member seems booked at the wrong level, tell the broker, as WellTrans’s agreement requires.
2. The pickup time. You can reach the pickup inside the window with your other trips that day. MediTrans tells providers to accept only trips they can complete on time.
3. The return. A will-call return has its own clock: 45 minutes from the call with MTM Health in Virginia and Rhode Island, and 60 minutes with WellTrans and with MAS in New York.
4. Ride time on shared rides. MTM Health in Virginia and Rhode Island allows no member to ride more than 45 minutes longer than the average direct trip. See maximum ride time.
5. Pay against cost. Count the empty miles to the pickup and back, not only the paid miles. The deadhead cost calculator and trip profit calculator do the math.
6. A credentialed driver and van. MTM’s standard agreement allows it to withhold pay for trips run with drivers or vehicles it has not credentialed. In Rhode Island, trips can come off your manifest when a credential is not submitted at least 5 days before it expires.
7. Special equipment. MTM’s Virginia handbook says some hospital discharges need a wheelchair supplied by the provider.

Take the short trips along with the long ones. Louisiana tells its broker to watch for providers who reject local trips in favor of long ones, and a pattern can bring fewer trips or other sanctions. CareOregon lists “cherry-picking” the highest paying trip types as an unacceptable reason to hand trips back.

Deadlines to accept or decline

Broker or program	When you must answer	What else applies
MediTrans, Louisiana (September 2026)	Decline within 30 minutes if you cannot complete the trip	No penalty for a timely decline. Never reroute a trip without dispatch approval.
SafeRide Health (June 2023 guide, standards as of September 2026)	Confirm the rides you can run by 2 p.m. local time, and look 5 days ahead	A 100 percent ride response rate, 95 percent acceptance, and half of same-day bookings accepted
MART, Massachusetts (July 1, 2025)	Accept or decline in the Vendor Portal every day, on MART’s schedule	Work left unaccepted is removed at a set time, and not answering can cut the trips MART offers you
MTM Health, Virginia (August 10, 2026)	Dispatchers call about offers still pending 4 to 5 days before the appointment	The Marketplace opens 5 days before
CareOregon (February 2024)	Accept or reject assignments in a timely manner	Next-day and same-day requests get shorter windows set by the brokerage

Where no window is written down, ask your broker contact for it in writing. CareOregon’s manual says brokerages will set clear timeframes for accepting extra trips or returning them.

Some trips cannot be declined at all:

• New York Preferred Provider Opportunities. Trips under these facility partnerships cannot be refused or reassigned.
• New York ambulettes. An ambulette in the Medicaid program may not refuse Medicaid transportation within its state operating area, which the manual says would violate New York Transportation Law section 146.
• MTM Health agreements. You agree to accept the trips MTM assigns and to give accepted trips equal priority with your other work, with a backup plan for each one (standard agreement, January 1, 2023 version).

Turnbacks: handing back a trip you already have

A turnback hands a trip that is already yours back to the broker so it can go to someone else. Brokers call it a turnback, reroute, sendback, kickback, or reassignment. Rhode Island’s contract with MTM defines a turn-back as a provider refusing to run the trip within the broker’s timeframe, and says it is not counted as a provider no-show. That is why an on-time turnback always beats a trip you keep and miss.

Broker	Deadline to hand a trip back	Other rules
MTM Health, Virginia	At least 24 hours before the scheduled pickup	Trip re-routes are scored, with a standard under 0.5 percent
MTM Health, Rhode Island	At least 24 hours before the member’s appointment	None for same-day trips, and none for trips taken from the Marketplace
WellTrans, Indiana	At least 12 hours before pickup, for trips assigned 36 or more hours ahead	No more than 15 percent of your trips in a month
MediTrans, Louisiana	Only with dispatch approval	Call dispatch at once
MART, Massachusetts	Returning work you accepted can bring fines or less work	Closing your office for a time needs written notice at least one week ahead

How to turn back a trip

1. Decide early. Review the next several days every morning, so you find the trips you cannot cover while there is still time.
2. Use the broker’s own tool. In MTM’s portal, open the Trips tab, choose the Turnback tab, pick a reason from the list, and save (Rhode Island handbook). MediTrans handles reroutes through dispatch at 1-844-349-4326.
3. Give a real reason. CareOregon’s manual lists the reasons it accepts: the trip is outside your service area or hours, you do not have the vehicle type, a vehicle is out for repair, a driver is sick, on vacation, or off shift, bad weather or a disaster, a safety concern, a lawsuit between the member and your company, or a cultural or religious holiday.
4. Avoid the reasons that count against you. CareOregon names discriminatory reasons, cherry-picking, a pattern of last-minute handbacks, and dropping a critical same-day trip you already agreed to run.
5. Keep proof. Save the confirmation, the time you sent it, and the reason, so you can check your turnback count against the broker’s.
6. Fix the cause. If the same kind of trip keeps coming back, change your profile. CareOregon’s manual asks you to tell the brokerage right away when you cannot handle the volume assigned or your hours or area change, and MART lets you change your capacity in its scheduling grid.

How turnbacks and late handbacks hurt your standing

An on-time turnback is a normal part of the work. A pattern of them, or one sent too late, is what costs you.

Brokers score the rate. MTM Health in Virginia holds re-routes under 0.5 percent. In Rhode Island, MTM rates turnbacks green under 3.99 percent, yellow from 4 to 6.99 percent, and red at 7 percent or more. WellTrans allows up to 15 percent a month and charges $200 for each percentage point above that. SafeRide Health holds its kickback rate under 5 percent. For how each is counted, see NEMT broker scorecards.

Late handbacks cost money. When a WellTrans trip comes back less than 12 hours before pickup, WellTrans can charge the difference between your trip price and what the replacement ride cost, or $100 if no one covered it. If you give MTM notice that you are leaving, you must still run the trips already assigned to you during the 30-day notice period, or MTM can charge liquidated damages and deduct the cost of rescheduling them.

Late handbacks are harder to cover. In May 2026, providers in Indiana’s fee-for-service program sent back 1,965 of the 17,080 trips Verida assigned them, according to the state’s monthly report. Of the 1,546 sent back more than 48 hours ahead, 89.46 percent found another provider. Of the 419 sent back within 48 hours, only 77.33 percent did.

Late handbacks bring complaints. MAS, New York’s Medicaid transportation broker, says trips refused within 48 hours of pickup are ten times more likely to draw a complaint (network manual, October 1, 2023).

Patterns shrink your offers. For example:

• WellTrans can cut your trip volume, suspend you, or end your contract as a corrective action.
• CareOregon can put a provider on a corrective action plan that cuts the rides offered or changes the hours and area it serves.
• MART can remove your rates for a town where you keep turning trips down.
• MAS can change your provider profile on its own to stop a pattern of refusals.

A kept trip you never run is worse. MTM’s Virginia handbook counts a failure or refusal to complete an assigned trip as a vendor no-show, held under 0.25 percent. WellTrans charges $100 for each provider no-show. CMS says federal Medicaid funds do not pay for a no-show provider (SMD 23-006, September 28, 2023). See missed trip and NEMT broker penalties.

Not every handback trend is your fault. CareOregon says its brokerage first checks for a flaw in trip assignment or in your capacity information before it considers penalties. A trend caused by trips sent outside your service area or hours is not penalized, as long as you report the recurring problem.

Same-day, urgent, and hospital discharge offers

Short-notice trips arrive by phone or alert, and they need a fast yes or no.

Routine rides are booked ahead. Louisiana expects 48 hours’ notice, except for urgent trips and discharges, and its broker must still try to schedule shorter-notice requests. Rhode Island’s contract requires MTM to accept routine requests made at least 48 hours ahead and to complete valid urgent trips within 3 hours of the request.

What brokers expect from you:

• MTM Health, Virginia. Keep enough drivers and vans for short-notice trips. Urgent trips come by dispatch call or system alert, need a prompt answer, and are never assigned without your OK.
• SafeRide Health. Accept at least half of same-day bookings (June 2023 guide).
• WellTrans. Be ready to take same-day, urgent, and discharge trips by phone.

Hospital discharges run on their own clocks:

Program	Pickup deadline for a discharge
MTM Health, Virginia	Within 3 hours of notice, with liquidated damages if missed
Louisiana Medicaid	The later of 3 hours after notice or 2 hours after the scheduled discharge
MAS, New York	Within 3 hours of receiving the trip

CareOregon adds one protection. When the brokerage asks you to take a same-day trip that is already late, the pickup time stays the same, but you are not penalized for the late pickup, and the brokerage records that it assigned the trip late. Once you agree to cover a critical same-day trip, though, handing it back is an unacceptable reason. See same-day NEMT trips and hospital discharge transportation.

Standing orders: the offers you keep

A standing order is a recurring trip, such as dialysis three days a week. Once it is set to your company, you do not win it again each week.

• MTM Health, Virginia. Standing orders set to a provider are assigned automatically. MTM asks you to keep the same driver when you can and to note when someone else drives.
• Louisiana. When several providers meet the least costly standard, a standing order should stay with the same provider. The broker reviews every standing order at least once a month for cost.
• MART, Massachusetts. Each standing order trip is stamped with its miles and fare when it is assigned and keeps them for the life of the order. Rate changes you submit later do not apply to existing standing orders.

You can still lose them. MediTrans says a provider that falls out of compliance will lose its standing orders. MTM’s Virginia infraction system takes away all assigned recurring trips at 8 points, along with a 10-day suspension. And MTM’s standard agreement says you have no right to carry any particular member.

A daily routine for broker offers

1. Each morning, open every broker portal. Answer each new offer inside its window and read every manifest change.
2. Look 5 days ahead. SafeRide asks for it, and MTM’s Marketplace opens 5 days before the appointment. Hand back anything you cannot cover before the deadline.
3. Put every trip on a driver’s run, including trips that arrive marked unassigned.
4. Confirm tomorrow’s riders. MTM’s Rhode Island handbook asks providers to contact members 24 hours before the ride to confirm the pickup time.
5. Keep each profile current: service area, hours, vehicle types, seats, and holidays. MAS asks providers to keep their profile updated for holidays and closures.
6. Log each turnback with its reason and the time you sent it.
7. Once a month, compare your numbers for response, acceptance, and turnbacks with each broker’s standard.

If you work with several brokers, keep all of their trips on one schedule so no van is booked twice. See working with multiple NEMT brokers.