NEMT Accounts Receivable in 2027: How to Track Unpaid Trips and Match Every Payment

Every ride you finish becomes money someone owes you. Until it is paid, that money sits in your accounts receivable. In a NEMT company it is spread across the state, health plans, brokers, facilities, and private riders, each with its own deadlines and pay cycles. The way to get paid for every trip is to track it one trip at a time, every week.

What counts as NEMT accounts receivable

Your receivables are every completed trip leg you have not been fully paid for. Most owners count only claims they sent. The trips you have not billed yet are receivables too, and they are the ones most likely to be lost, because the filing clock is already running.

Status	What it means	What to do
Unbilled	The ride happened, but no claim has gone out	Bill it this week
Submitted	The payer has the claim and has not decided	Watch for acceptance and the expected pay date
Rejected	The payer refused the claim before processing	Fix and resend it. It never reaches the remittance.
Pended	The payer is holding the claim for review or more information	Track it until it pays or denies
Paid short	Paid, but for less than expected	Check whether the cut is a normal write-off or an error
Denied	Processed and refused	Correct it or appeal it before the deadline
Recouped	Paid before, now taken back	Match it to the original trip and track the balance

A trip can move through several of these. Keep one line per trip leg, and change its status as it moves. See trip leg for why the leg, not the round trip, is the unit to track.

Two clocks run on every trip

• The filing clock starts on the date of service. It decides whether a claim can still be paid at all.
• The payment clock starts when the payer receives the claim. It tells you when a payment is late.

Age your list by the filing clock, and chase payers by the payment clock. A claim sent on day 80 to a payer with a 90-day limit is on time, but a denial on day 95 may leave no room to fix it.

Filing limits and pay cycles by payer

Federal rules require every state to have providers submit all claims within 12 months of the date of service (42 CFR 447.45(d)). The federal payment standard, written for practitioners, is 90 percent of clean claims paid within 30 days of receipt and 99 percent within 90 days. Medicaid health plans must meet the same standard unless the plan and its providers agree to a different schedule in the contract (42 CFR 447.46). Most NEMT payers set shorter filing limits.

Payer	File by	Fix or appeal by	When it pays
New York Medicaid (billing guidelines, August 5, 2026)	90 days after the date of service, unless an acceptable delay is documented	See the state’s general billing rules	Weekly remittance cycles
Arizona AHCCCS fee-for-service (Chapter 4, revised November 3, 2025)	6 months after the date of service, or after eligibility is posted for a retroactive period	Clean claim status within 12 months of the date of service	Check your remittance schedule
Medi-Cal fee-for-service (manual pages updated through May 2025)	Six months following the month of service. Claims in months 7 to 9 pay 75 percent, months 10 to 12 pay 50 percent, later claims deny.	A Claims Inquiry Form within six months of the remittance, or an appeal within 90 days	Check your remittance schedule
MTM Health, standard agreement (January 1, 2023 version Pennsylvania posts)	90 days after the date of service, or the limit MTM’s client sets	Through MTM’s process	Uncontested invoices within 30 days after online submission
MTM Health, Virginia fee-for-service (handbook approved August 10, 2026)	A clean claim within 6 months of the date of service	Appeal within 365 calendar days	Check your MTM agreement
WellTrans, Indiana (agreement revised October 16, 2025)	Within 60 days. Invoices more than 90 days after the ride are disallowed.	Resubmit claims returned for missing information	Twice a month, within 30 days after submission
Verida, Indiana fee-for-service (state module, August 19, 2025)	Set by your Verida agreement	Set by your Verida agreement	Clean claims received by Wednesday are paid within 14 days

Two rules in that table catch owners off guard. First, filing on time is not enough. Arizona pays only claims that reach clean claim status within 12 months, and a replacement claim must carry the original AHCCCS claim reference number, or it is treated as a new claim and can deny as late. Second, lateness can cost money before it costs the whole claim, as Medi-Cal’s 75 and 50 percent payments show.

When a rider also has Medicare, the clock can start later. WellTrans and MTM Health’s Virginia program start their deadlines at the Medicare denial. See Medicaid timely filing limits for more payers, and the timely filing calculator to find the last day for any trip.

Set up your receivables list

You can keep receivables in billing software, a spreadsheet, or a printed payment log. What matters is one row per trip leg with the same columns every time.

Column	Why it matters
Your trip number	Ties the row to the trip log and the claim
Rider and date of service	Starts the filing clock
Payer	Sets the filing limit and pay cycle
Last day to file or fix	The date you cannot miss
Date sent and payer claim number	Starts the payment clock and finds the claim in the payer’s system
Amount billed and amount expected	Shows a short payment at a glance
Amount paid, date, and deposit	Proves the money arrived
Adjustment codes	Says why any amount was cut or denied
Status and next step	What happens next, and when

Put your own trip number on every claim. On the CMS-1500 it goes in item 26, the patient account number, which holds 14 characters. It is required in the 837P, and the national claim form manual (version 13, July 2025) says payers report it back on the 835 remittance. Each remittance line then points straight to one row on your list. New York’s transportation claim calls it the office account number, holds up to 20 characters, and returns it on the remittance advice. Broker claims carry the broker’s trip ID, which does the same job.

The weekly receivables routine

Pick one morning a week. With a few vans, an owner or office manager can do this in a sitting.

1. Bill every trip from last week

Compare the trip legs your drivers finished with the legs on the claims you sent. Every finished leg should be on a claim. Any trip without a claim goes out now, with a complete trip log behind it. An unbilled trip earns nothing, and its filing clock is already running.

2. Check what the payers accepted

A claim the payer rejects never shows up on your remittance, so a missing payment can look like a slow one. New York reports rejected electronic claims on its front-end report, called a 277CA, and says providers must correct and resubmit them in a timely manner. For broker trips, check each claim’s status in the broker’s portal. Resend every rejection this week.

3. Post every remittance and match the deposit

Mark each trip paid, paid short, denied, or pended from the remittance. Then tie the remittance to the bank. New York’s rule is the one to copy: the net financial transactions plus the claim total must equal the check or electronic deposit. When a deposit is smaller than the claims paid, look for a recoupment or offset in the remittance’s financial section. How to read a remittance advice walks through every line.

4. Work denials in deadline order

Sort denials by the last day to fix them, not by size. A small claim that expires Friday comes before a large one with months left. Correct your own mistakes with a corrected claim that carries the original claim number. Appeal the payer’s mistakes, with the trip record attached. See NEMT claim denials.

5. Chase claims past their expected pay date

Add the payer’s pay cycle to the date sent. Any claim past that date with no decision gets a claim status check. HIPAA has a standard transaction for this, the X12 276/277 claim status inquiry and response (45 CFR 162.1402). New York providers can send claim inquiries through ePACES. For broker claims, use the broker’s claims portal or provider line. Check before you resend anything, so you do not create a duplicate.

Pended claims need patience with a limit. New York recycles a claim pended because the rider was not eligible on the date of service for 30 days, then denies it if nothing changes. It also lists a pended claim on the remittance for the first week it pends, so write it on your list that week.

6. Review the aging and set next week’s priorities

Look at every trip older than half its payer’s filing limit. Those are next week’s first tasks.

How to age receivables by payer

An aging report groups what you are owed by how old it is. Age each trip from its date of service, and split the report by payer, because a 45-day-old trip is fine with one payer and nearly lost with another.

Here is an example aging report for a small company. The payers and amounts are made up to show how to read one.

Example payer	Filing limit	0 to 30 days	31 to 60 days	61 to 90 days	Over 90 days	Total
State Medicaid	90 days	$6,200	$1,900	$450	$120	$8,670
Broker A	60 days	$9,800	$700	$0	$0	$10,500
Health plan B	6 months	$2,400	$1,100	$800	$600	$4,900
Facility contracts	Invoice terms	$3,000	$900	$0	$0	$3,900
Total		$21,400	$4,600	$1,250	$720	$27,970

Read it against the limits, not just the totals:

• State Medicaid, $120 over 90 days. Past the 90-day filing limit. If it was never billed on time, plan to write it off unless a documented delay reason applies. If it was, find out today why it is still unpaid.
• State Medicaid, $450 at 61 to 90 days. Bill or fix it this week.
• Broker A, $700 at 31 to 60 days. Close to a 60-day limit. Find out why it is unpaid today.
• Health plan B, $600 over 90 days. Still inside a 6-month limit, but old enough to need a status check.

Two numbers sum up the report. Track them monthly.

Days in receivables = total owed ÷ average billed per day

Share over 60 days = amount older than 60 days ÷ total owed

In the example, the company billed $63,000 over the last 90 days, or $700 a day. $27,970 ÷ $700 = about 40 days of billing waiting to be paid. The share over 60 days is $1,970 ÷ $27,970, about 7 percent. What matters is the trend. If either number climbs for two months in a row, find the payer driving it. The NEMT payer mix guide shows how to see which payers carry your revenue, and NEMT cash flow shows how receivables turn into payroll money.

The adjustment codes you will see most

Every cut or denial on a remittance carries a group code and a reason code from X12. The group code says who carries the amount: CO is contractual obligation, PR is patient responsibility, OA is other adjustment, and PI is payor initiated reduction. The reason code says why.

Reason code	What X12 says	What to do with the trip
45	Charge exceeds fee schedule or maximum allowable	Normal. Write off the difference between your charge and the rate.
16	Claim or service lacks information or has billing errors	Read the remark code, fix the claim, and resend it
197	Precertification or authorization absent	Find the authorization or trip number and correct the claim
27	Expenses incurred after coverage terminated	Recheck eligibility for the date of service. Look for another payer.
109	Not covered by this payer	Send the claim to the right payer, such as the rider’s health plan
18	Exact duplicate claim or service	Check the original claim’s status before doing anything
29	The time limit for filing has expired	Appeal only with proof of timely filing. Otherwise write it off.

The full list is on the X12 claim adjustment reason code page. See claim adjustment reason codes for how each one shows up on NEMT claims.

When a trip will not be paid

Some trips will never be paid, and the rules on what happens next are strict.

Do not bill the rider. Federal rule 42 CFR 447.15 limits Medicaid to providers who accept its payment as payment in full, apart from allowed cost sharing. Read your broker contracts too. MTM Health’s standard agreement bars billing a member even when MTM or its client does not pay. WellTrans’s Indiana agreement allows it only where the law permits, when a trip is denied because the rider did not attend the medical visit.

Watch for pay-when-paid terms. WellTrans’s Indiana agreement lets it delay your payments when its client, the state or a health plan, does not pay WellTrans what is due. Money held that way is still yours to track, so keep those trips on your list with a note.

Write off on purpose. When a trip is truly lost, record the amount, the reason code, and who approved the write-off. A monthly write-off list shows patterns, such as one driver’s missing signatures or one payer’s authorization rules. For taxes, the IRS says in Topic 453, reviewed September 24, 2026, that a business on the cash method generally cannot deduct unpaid fees as a bad debt, because they were never counted as income. Ask your tax preparer how your books handle it.

Borrowing against receivables has limits. Federal rule 42 CFR 447.10(h) bars Medicaid from paying for a service to or through a factor, directly or by power of attorney. MTM Health’s standard agreement requires 30 days’ written notice before you assign your right to its payments to a third party. See NEMT factoring.

Overpayments, recoupments, and credit balances

Receivables run in both directions. When a payer pays you twice, pays for more than you gave, or pays for a trip you did not run, you hold its money.

• Return overpayments within 60 days. Federal law requires you to report and return an overpayment, with a written reason, by 60 days after you identify it. Money kept past that date becomes an obligation under the False Claims Act (42 U.S.C. 1320a-7k(d)). See the 60-day overpayment rule.
• Track recoupments as negative lines. Payers take money back by holding it from later payments. New York’s remittance has an accounts receivable section showing each outstanding amount and its balance after that cycle’s recoupments. WellTrans’s agreement lets it offset overpayments from future payments. Match each one to the original trip. See Medicaid recoupment.
• Clear credit balances. A credit balance is a trip where the payments, allowances, or charge reversals posted add up to more than the charge. HHS OIG’s 1998 guidance for billing companies says providers and their billers should set policies, and assign responsibility, for finding and resolving these overpayments on time.

A weekly routine is also your best audit defense. When every payment ties to a trip and every trip ties to a log, questions from a broker or the state take minutes, not weeks. If you use an outside biller, demand these same reports from it. See NEMT billing service.