How to Reduce NEMT No-Shows in 2027: Confirmation Calls, a Timed Door Procedure, and Proof

A no-show hurts a small NEMT company twice. The trip usually goes unpaid, and the miles and driver time it took to reach the door are already spent. You cannot stop every one. You can stop most of the ones caused by wrong details, forgotten rides, and canceled appointments, and you can record every real no-show so it never counts against you.

What a no-show costs you

Most programs pay nothing for a rider who does not come out. CMS says federal Medicaid funds are not available for transportation to a member who does not appear for the ride (SMD 23-006, September 28, 2023). MTM Health’s Wisconsin and Missouri provider pages say it does not pay providers for no-shows, including a rider who cancels at the door. CMS lets states build the cost of no-shows into their payment rates instead, so any allowance for them comes through the rates on the trips you do run.

A few programs pay something:

Program	What it pays on a rider no-show
Georgia Medicaid (DCH manual, July 1, 2026)	The broker pays the first leg, the “A” leg, if you arrived on time and the rider did not board within the wait
Medi-Cal fee-for-service (provider manual, as of September 2026)	A dry run: the trip code, such as A0130 or T2005, billed with modifiers DS and then QN
Private pay and facility contracts	Whatever fee the rider or facility signed for

Here is one example at Arizona’s fee-for-service rates effective October 1, 2026, for a wheelchair van trip that starts in the Phoenix or Tucson metro area. The distance and the running cost are example numbers. Your broker rates will differ.

Example: a round trip of 10 miles each way	Amount
A0130 wheelchair van base rate, 2 legs × $11.15	$22.30
S0209 wheelchair van mileage, 20 loaded miles × $1.54	$30.80
Pay you planned on	$53.10
Fuel and wear you did not spend on those 20 miles, at an example $0.30 a mile	−$6.00
What the no-show takes	$47.10

The driver’s paid time and the drive to the door are spent either way. The no-show turns them into cost with nothing to bill.

Monthly no-show cost = no-shows a month × (pay for the legs you planned − running cost of the loaded miles you skipped)

At an example 3 no-shows a week, about 13 a month, this trip comes to $612.30 a month. Put your own numbers into the no-show cost calculator.

There is a second cost if you cannot prove the no-show. Rider no-shows are not supposed to count against you. CareOregon’s manual says providers are not held accountable for member no-shows, and Texas leaves member no-shows out of its trip completion standard. A no-show you cannot back up can look like a missed trip, though, and those limits are tight. MTM Health’s handbook for Virginia’s fee-for-service program holds vendor no-shows under 0.25 percent of trips, and MediTrans in Louisiana holds provider-caused no-shows under 1 percent. See NEMT broker scorecards.

Where preventable no-shows come from

A no-show is not always a rider ignoring the ride. CMS notes that rescheduling is a normal part of care, driven by illness, other life events, or a provider’s scheduling conflict. The ones you can prevent usually come from a short list:

• The ride was forgotten, or the time changed and the rider was told a different time.
• The appointment was canceled or moved, and nobody told transportation.
• The driver could not find the rider: a wrong unit number, a locked gate, or the wrong entrance of a large building.
• The rider was not ready or waited at a different door.
• The rider is in the hospital, and nobody told you.
• A child’s car seat is missing. In Texas, a child who needs a car seat that is not there, or that the parent cannot install, is canceled and recorded as a member no-show.
• The van was late, and the rider gave up or found another ride.

Every item on that list can be caught before the driver leaves the garage, or at the door.

Step 1: Confirm every ride the day before

Some programs make the confirmation call a rule. Where it is not required, make it anyway.

Program	Confirmation rule	Source and date
Texas Medicaid health plans	Confirm with the member 24 hours before pickup, by phone, text, or another platform. No contact after 9 p.m. local time. Keep a record of each contact. Add-on trips and hospital discharges are exempt.	HHSC UMCM 16.4, version 2.0.1, effective August 1, 2021
MTM Health, Rhode Island	Contact members 24 hours before the ride to confirm the pickup time	Provider handbook, updated July 1, 2026
MTM Health, Wisconsin	After MTM confirms the trip, confirm the ride and pickup time with the member the day before. Confirm pickup and drop-off places and times on that call.	Wisconsin provider page, September 2026
MTM Health, Missouri	Confirm the ride and pickup time the day before, and cancel the trip if the rider will not be going	Missouri provider page, September 2026

On each call, cover the details that cause misses:

1. The pickup time and how early to be ready. MTM Health’s Virginia handbook asks members to be ready at least 15 minutes before the pickup time and to wait at the main entrance or door.
2. The exact pickup spot. Confirm the unit number, gate code, and which door. MediTrans asks drivers to verify the address and any gate codes or access instructions before each pickup.
3. The appointment. Ask whether it is still on, and check the destination and time against the trip.
4. What rides along. A wheelchair or walker, an escort, and a child’s car seat. In Virginia, parents supply car seats.
5. The return. A set pickup time or a will-call return.
6. A cancellation. If the rider will not go, have the rider cancel with the broker. MTM Health’s Wisconsin page says that if the member has not canceled by the pickup time, you cancel the trip in the MTM Link Provider Portal.
7. The result. Write down confirmed, canceled, or no answer, with the time. Texas requires the record.

An unanswered call is not a cancellation. Run the trip, and try again the morning of the ride.

Keep messages short and private. CareOregon’s manual says drivers never reveal a member’s appointment information to anyone outside the care team, and dispatchers share trip details only with the member, a caregiver, or the member’s health care provider after verifying who is calling. In a voicemail or text, give your company name, the pickup date and time, and a callback number. Leave out where the rider is going and why. See HIPAA for NEMT providers.

Step 2: Keep standing orders and facility schedules current

Recurring riders cause recurring no-shows when their schedule changes and the trip does not. Georgia’s manual has its broker update or confirm each standing order every 30 days. Louisiana’s manual (issued July 14, 2025) lets the rider or the treating facility change pickup and drop-off times on a standing order, and the broker must update it on request.

• Ask your dialysis and therapy centers to tell the broker, and you, about schedule changes, holidays, and hospital admissions.
• Move changes through the broker. Modivcare’s Kansas and Oklahoma facility pages ask facilities to report a canceled appointment as soon as possible, with 24 hours’ notice when they can.
• Keep the same driver on the same riders. MTM Health’s Virginia handbook asks providers to make a best-faith effort to use the same driver for recurring trips, and to document when they cannot.

The standing orders guide covers setup and holidays.

Step 3: Get the driver to the right door on time

A late van causes no-shows that are not the rider’s fault. MTM Health’s Virginia handbook counts a pickup as on time from 15 minutes before to 15 minutes after the scheduled time, and Modivcare’s Kansas and Oklahoma pages use the same window. The rider does not have to board before the scheduled time in Virginia, Rhode Island, Georgia, or CareOregon.

Lateness can cost you the trip. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, says that if a late pickup or drop-off means the member cannot be seen, you may get a provider no-show penalty or no pay for the trip.

When a driver will be late, dispatch calls the rider or facility with a new arrival time and tells the broker. Virginia’s and Rhode Island’s handbooks require both steps. See what to do when a driver is running late and pickup window.

The door procedure, minute by minute

Count every wait from the scheduled pickup time. Call it T. Georgia’s manual says that when the driver arrives early, the 10-minute wait still starts at the scheduled pickup time.

Time	What the driver does	The rule behind it
Before T	Arrive inside the pickup window. Mark “Arrived” in the driver app. Make your arrival known at the door, lobby, or front desk.	Virginia’s window runs from 15 minutes before to 15 minutes after. Texas requires drivers to announce their arrival, and Virginia requires it on pickups that are not curbside.
T	The wait starts. Call or text the rider: your company name, that you are outside, and a callback number.	MTM Health Rhode Island asks drivers to tell the rider by call or text that they are outside. Virginia requires reasonable attempts by phone or text before leaving.
T + 5	At a clinic, hospital, or nursing home, ask staff whether the rider is still inside.	Staff can tell you if the rider already left or was admitted.
T + 10	Call or text again. This is the earliest a driver may leave in Georgia, in Texas, and for MTM Health in Rhode Island.	Georgia and Rhode Island: no duty to wait more than 10 minutes. Texas: at least 10 minutes.
T + 15	Earliest a driver may leave in New York, the CareOregon network, Modivcare Kansas and Oklahoma, and a MediTrans home pickup.	New York and CareOregon: at least 15 minutes. Modivcare: up to 15 minutes from the pickup time. MediTrans: 15 minutes at a home.
T + 20	Earliest a driver may leave a MediTrans facility pickup.	MediTrans: 15 minutes at a home, 20 at a facility.
End of the wait	Call dispatch. Do not leave until dispatch clears you.	CareOregon bars leaving without telling dispatch. MediTrans requires the call.
Leaving	Mark the no-show in the broker’s app or portal with the time, then drive off so GPS records the departure.	MediTrans wants a timestamped entry. MTM Health Rhode Island takes no-shows only in its driver app.

If a driver is unsure which rule applies, wait the longer time. A few extra minutes cost less than a disputed no-show.

Dispatch has its part. It tries the rider once more, checks whether the broker or facility logged a cancellation, and reports the no-show the way the broker requires. CareOregon requires a report to the brokerage for every no-show. Ask the broker what to do with the rider’s return leg rather than dropping it on your own.

The full wait table by program is on the no-show glossary page. The no-show policy template turns this procedure into a printable policy your drivers sign.

The proof brokers accept

A no-show is only yours to keep off your record if you can prove it. The best proof is recorded by machines at the moment it happens.

What to keep	Why it counts	Where the rule comes from
GPS arrival, wait, and departure	Shows the van was at the door, on time, for the full wait	Virginia requires vehicle location tracking for the full ride and scores providers on GPS tracking above 90.01 percent of trips. New York has required GPS trail data for every trip since April 3, 2023, unless the state grants an exemption.
The no-show entry in the broker’s app or portal	The broker’s own timestamp	MediTrans wants the no-show marked with a timestamp. MTM Health Wisconsin requires every trip tracked electronically as proof of completion or member cancellation.
Call and text log with times	Shows you tried to reach the rider	Virginia requires reasonable attempts by phone or text. MediTrans asks for a call to the number on file.
The dispatcher’s name and the time they cleared the driver	Shows the driver did not leave early	CareOregon requires the driver to tell dispatch before leaving
The driver’s attestation on the trip record	The driver’s own statement of what happened	New York’s trip record includes a driver attestation that shows a no-show when the trip did not happen
The confirmation call from the day before	Shows the rider knew the time	Texas requires providers to keep a record of each confirmation

A printed schedule is not enough on its own. New York’s manual says a driver or vehicle manifest or a dispatch sheet can only supplement the required trip records.

Keep no-show records as long as your longest rule. New York requires records for six years from the date of service. MTM Health’s standard agreement, in the version Pennsylvania posts, requires full records for 10 years. See NEMT trip documentation and GPS tracking for NEMT vans.

When the same rider keeps missing rides

Your job is the record. The decision belongs to the broker or state. CMS says states may not deny transportation because of no-shows or lateness, even frequent ones. It lets states add steps for those riders:

• counseling the rider,
• requiring the rider to confirm the night before or the morning of, or the ride will not be provided,
• assigning one provider and requiring a confirmation shortly before each ride, or
• offering, never forcing, a ride the rider arranges and the state pays back.

CMS says the state should send the rider a letter describing its efforts before it limits rides in any way. Programs apply this differently:

• Georgia. After at least two no-shows, late arrivals for pickup, or cancellations at pickup, the broker sends a warning letter by certified mail.
• Oklahoma. Modivcare’s SoonerRide page says a member with three no-shows in 90 days risks mileage reimbursement only.
• CareOregon. Brokerages may assign a specific provider, require an attendant, or have the member confirm on the date of service. Providers help carry out these changes but do not make them, and a change may never be a denial of service.

Report every no-show, with your notes on when and why, so the broker sees the pattern.

Two things are never part of the fix. First, never charge a Medicaid rider. CMS bars no-show charges, and a Medicaid provider accepts the Medicaid payment as payment in full under 42 CFR 447.15. Second, never reward a rider for showing up. New York’s manual says it is illegal to pay, or offer to pay, a Medicaid enrollee to use your services, and pay includes anything of value. Federal rule 42 CFR 1003.1000(a) lets HHS OIG fine or exclude anyone who offers a Medicaid member something likely to steer them to a particular provider. For fees on private-pay trips, see billing for NEMT no-shows.

A monthly no-show review

Once a month, pull every no-show from the month before and look for the cause you can fix.

1. Find your rate. Divide rider no-shows by scheduled trips.
2. Check the confirmation result for each one. A no-show after a confirmed call points to the door or the timing. One after no answer points to the phone number.
3. Group them by rider, address, and facility. Repeat addresses usually mean a wrong door or a gate code.
4. Flag any where the van arrived late. Those are yours to fix with scheduling, not the rider’s.
5. Check the proof. Every one should have GPS times, call times, the dispatcher’s name, and the broker entry.
6. Fix one cause before the next review, and send the broker your list of repeat riders.

Your dispatcher runs most of this. See NEMT dispatch for how confirmations fit into the day.