# NEMT KPIs in 2027: The Eight Numbers to Check Every Week

Canonical URL: https://nemtguide.com/guides/nemt-kpis/ · Updated 2026-09-29

The NEMT KPIs worth checking every week are on-time pickups, trips per vehicle hour, revenue per vehicle hour, empty-mile share, rider no-shows and late cancellations, turnbacks, claim denials, and days to pay. Each one is a simple fraction from your trip logs, timesheets, odometer readings, and remittances. Brokers grade several. MTM Health's 2026 Virginia handbook wants more than 95 percent on time and under 0.5 percent turnbacks.

- Every KPI is a fraction. Write down what goes on top and what goes on the bottom, and keep it the same every week.
- Brokers grade on-time pickups, turnbacks, and claim denials. MTM Health in Virginia wants above 95 percent, under 0.5 percent, and under 0.29 percent.
- Trips and revenue per vehicle hour show whether the day pays for the driver and the van. Count every hour a driver is on the clock.
- Days to pay has two halves: days until you bill and days until the money lands. Indiana's broker averaged 11 and then 36 days in May 2026.
- Judge the trend over four to eight weeks, not one bad day, and fix the number furthest from its target first.

A small NEMT company can feel busy and still lose money, or run on time and still run out of cash. Eight numbers, checked once a week, show which one is happening. None of them needs special tools: your trip logs, driver timesheets, odometer readings, broker portal, and bank deposits hold everything.

## The eight NEMT KPIs at a glance

Each KPI is a fraction. Decide once what goes on top and what goes on the bottom, write it down, and use the same rule every week. A number that changes definition every month tells you nothing.

| KPI | Formula | Where the data comes from | What to aim for |
|---|---|---|---|
| 1. On-time pickup rate | Pickups inside the window ÷ pickups made | Trip log: scheduled and actual pickup times | Above 95% (MTM Health, Virginia) |
| 2. Rider no-show and late-cancel rate | Rider no-shows, and late cancellations, ÷ trips on your schedule | Trip log statuses and dispatch notes | Lower each month, counted separately |
| 3. Turnback rate | Trips you handed back ÷ trips assigned to you | Broker portal | Under 0.5% (MTM Health, Virginia) |
| 4. Trips per vehicle hour | Completed one-way trips ÷ hours vans were on the road with a driver | Trip log and driver timesheets | Higher each month. Public dial-a-ride averaged about 1.9 boardings per revenue hour in 2024. |
| 5. Revenue per vehicle hour | Revenue billed ÷ vehicle hours | Claims and invoices, timesheets | More than an hour of that van costs you |
| 6. Empty-mile share | Miles with no rider ÷ all miles driven | Odometer at shift start and end, and at every pickup and drop-off | Lower each month |
| 7. Claim denial rate | Claims denied ÷ claims decided | Remittance advice | Under 0.29% (MTM Health, Virginia) |
| 8. Days to pay | Days to bill, plus days from claim to deposit | Claim dates and bank deposits | Inside each payer's terms |

The targets above come from MTM Health's Virginia handbook (approved August 10, 2026). Your own broker may use other targets and other definitions. The [NEMT broker scorecard guide](https://nemtguide.com/guides/nemt-broker-scorecards/) shows how brokers count each one.

## Service KPIs: on time, no-shows, and turnbacks

### 1. On-time pickup rate

**On-time pickup rate = pickups inside the window ÷ pickups made × 100**

Learn the window first. MTM Health's Virginia handbook counts a pickup on time when the driver arrives no more than 15 minutes before or 15 minutes after the scheduled time. That window applies only to the first pickup of the trip. The rider must also be dropped off no later than the appointment time. Florida's Medicaid health plans must meet these monthly standards (contract update July 1, 2026):

| Florida standard | Level |
|---|---|
| Riders arriving on time for scheduled appointments | At least 90% |
| First-leg pickups within 15 minutes of the scheduled time | At least 90% |
| Return pickups within 30 minutes of the scheduled time | At least 90% |
| Transportation requests that end in a missed trip | No more than 0.2% |
| Unscheduled trips fulfilled within 3 hours of the request | At least 85% |

Track three on-time numbers, not one: first pickups, appointment arrivals, and returns. A company can pick up on time and still deliver riders late. MTM Health pays a quarterly on-time bonus in Virginia, but only to providers at 95 percent or better for the quarter. See [how to improve on-time performance](https://nemtguide.com/guides/improve-nemt-on-time-performance/) and [pickup window](https://nemtguide.com/glossary/pickup-window/).

### 2. Rider no-show and late-cancel rate

**No-show rate = rider no-shows ÷ trips on your schedule × 100**

**Late-cancel rate = cancellations after your cutoff ÷ trips on your schedule × 100**

Count them separately. A no-show means the van arrived and waited and the rider did not come out. A late cancellation means the ride was called off after your broker's cutoff, often when the van is already on its way. Use your broker's definitions and cutoffs when it has them. MTM Health's Virginia handbook has the driver document a member no-show and try to reach the rider by phone or text before leaving.

State reports show how much the counting method changes the result:

| Program, May 2026 | Rider no-shows | Rider cancellations |
|---|---|---|
| Indiana fee-for-service (Verida) | 234 legs, 0.7% of scheduled rides | 2,561 legs, 7.6% of scheduled rides |
| Wisconsin statewide (MTM Health) | 8,566 legs | 104,602 canceled legs |

Wisconsin completed 301,246 legs that month, so its canceled legs were about a third as many as its completed ones. The report's definition is simply canceled trip legs, with no cutoff. The cancellations that cost you money are the late ones, so track them on their own.

A no-show still costs you the drive. CMS says the miles driven with no rider, including the drive back from a no-show, generally cannot be paid as a service, though states may build their cost into the rate (SMD 23-006, September 28, 2023). CMS also says neither states nor providers may charge a rider for a no-show. See [how to reduce no-shows](https://nemtguide.com/guides/how-to-reduce-nemt-no-shows/) and price your own with the [no-show cost calculator](https://nemtguide.com/tools/nemt-no-show-cost-calculator/).

### 3. Turnback rate

**Turnback rate = trips handed back ÷ trips assigned to you × 100**

A turnback is a trip you accepted and then returned to the broker. MTM Health's Virginia handbook calls it a trip re-route, holds it under 0.5 percent, and expects any turnback at least 24 hours before the scheduled pickup. Across Indiana's fee-for-service program in May 2026, providers sent back 1,965 of 17,080 assigned trips, or 11.50 percent, and 419 of those came within 48 hours of the trip.

Record the time you sent each turnback. A trip handed back at 4:00 p.m. for a 7:00 a.m. pickup is the one that hurts your score and the rider. See [NEMT broker trip offers](https://nemtguide.com/guides/broker-trip-offers/).

## Productivity KPIs that decide your profit

### 4. Trips per vehicle hour

**Trips per vehicle hour = completed one-way trips ÷ vehicle hours**

Count a vehicle hour as every hour a van is on the road with a driver on the clock, from clock-in to clock-out. That includes waiting, driving to the first pickup, and lunch in the van. You pay the driver for those hours, so they belong on the bottom.

For comparison, the public dial-a-ride and ADA paratransit services that report to the National Transit Database carried 139,745,774 boardings in 72,645,000 vehicle revenue hours in 2024, about 1.9 per hour. Two things make that number higher than most NEMT vans. Those services share rides by design, and the database counts every passenger who boards, so a shared ride with three riders counts three. The database also leaves trips to and from the garage out of revenue hours. A van carrying one wheelchair rider at a time will usually run lower. What matters is your own trend. See trips per vehicle hour and the [trips per day calculator](https://nemtguide.com/tools/nemt-trips-per-day-calculator/).

### 5. Revenue per vehicle hour

**Revenue per vehicle hour = revenue billed ÷ vehicle hours**

**Profit per vehicle hour = revenue per vehicle hour − cost per vehicle hour**

Cost per vehicle hour is a month of that van's costs divided by its vehicle hours: driver pay and payroll taxes, fuel, insurance, the van payment, and repairs. Revenue per vehicle hour tells you what trips per hour cannot: whether the hours you pay for carry trips that pay enough. Two vans with the same trips per hour can earn very different amounts if one runs short in-town trips and the other runs long loaded miles or stretcher trips. See revenue per vehicle hour and [NEMT cost per trip](https://nemtguide.com/guides/nemt-cost-per-trip/).

### 6. Empty-mile share

**Empty-mile share = miles with no rider ÷ all miles driven × 100**

Empty miles, also called [deadhead miles](https://nemtguide.com/glossary/deadhead-miles/), are the drive to the first pickup, between drop-offs and the next pickups, back from no-shows, and home at night. Medicaid generally pays only loaded miles, so every empty mile is fuel and wear with nothing to bill (SMD 23-006). Get the numbers from odometer readings: at the start and end of each shift, and at every pickup and drop-off. The difference between all miles and loaded miles is your empty miles.

Transit uses a narrower definition. The National Transit Database counts as deadhead only the miles a vehicle travels out of revenue service, such as leaving or returning to the garage. So its deadhead figures are not comparable with an NEMT empty-mile share. Price your own with the [deadhead cost calculator](https://nemtguide.com/tools/nemt-deadhead-cost-calculator/).

## Money KPIs: denials and days to pay

### 7. Claim denial rate

**Denial rate = claims denied ÷ claims decided × 100**

Federal rules define a clean claim as one that can be processed without getting more information from the provider or a third party ([42 CFR 447.45(b)](https://www.ecfr.gov/current/title-42/section-447.45)). Every denial is a trip you ran and still have to fight for. MTM Health's Virginia handbook holds denied claims under 0.29 percent, and claims with missing or incorrect information under 0.99 percent of claims paid.

Indiana's fee-for-service broker decided 22,268 clean claims in May 2026: it paid 21,178 and denied 1,090. That is about 4.9 percent of claims decided, or 5.15 percent of claims paid, the way the report counts it. The top reasons show where the paperwork breaks:

| Denial reason in Indiana's May 2026 report | Claims |
|---|---|
| Space distance variance | 391 |
| Incorrect mobility type | 117 |
| Service not provided to member | 78 |
| Unauthorized vehicle | 67 |
| Unauthorized driver | 51 |
| Missing signatures | 49 |
| Altered document | 47 |
| Missing or invalid time | 46 |
| Missing or invalid odometer reading | 43 |

Most of these start at the door, not in the billing office: the wrong level of service, an uncredentialed driver or van, a missing signature, or a blank time or odometer box. See [NEMT claim denials](https://nemtguide.com/guides/nemt-claim-denials/) and [clean claim](https://nemtguide.com/glossary/clean-claim/).

### 8. Days to pay

**Days to bill = claim submitted date − ride date**

**Days to get paid = deposit date − claim submitted date**

Split it in two, because you control the first half. Indiana's broker report for May 2026 shows both halves: an average of 11 days from the date of service to the broker's receipt of the claim, 18 days from receipt to a decision, and 18 more from the decision to payment. That is about 47 days from ride to money.

Filing limits make days to bill a hard deadline, not only a cash question:

| Payer | Filing limit | Payment terms |
|---|---|---|
| State Medicaid, fee-for-service (42 CFR 447.45) | No later than 12 months from the date of service, unless the state sets a shorter one | Set by the state's payment cycle |
| New York Medicaid (policy manual, August 25, 2023) | 90 days from the date of service | Set by eMedNY's cycle |
| MTM Health, standard agreement (January 1, 2023 version Pennsylvania posts) | 90 days, or what MTM's client requires | Uncontested invoices within 30 days after online submission |
| MTM Health, Virginia (handbook approved August 10, 2026) | 6 months to submit a clean claim, and 365 days to appeal a denial | See your agreement |
| Brokers in Georgia (DCH manual, July 1, 2026) | See your agreement | As the agreement says, or within 15 business days of an undisputed invoice |

A payment can arrive on time and still come up short. MTM Health's standard agreement lets it withhold or offset liquidated damages from what it owes you, so match every remittance to its trips. See [NEMT accounts receivable](https://nemtguide.com/guides/nemt-accounts-receivable/) and [how long Medicaid takes to pay](https://nemtguide.com/guides/how-long-medicaid-takes-to-pay/).

## Score one week: a worked example

Here is one week for a hypothetical company with two wheelchair vans, each on the road 10 hours a day, 5 days a week. The counts, the $40 average revenue per trip, and the payment dates are example numbers, not rates from any payer.

| KPI | The week's counts | Result | Against MTM Health's Virginia standard |
|---|---|---|---|
| Turnback rate | 2 handed back of 112 assigned | 1.8% | Misses under 0.5% |
| Rider no-show rate | 3 of the 110 trips kept | 2.7% | No broker standard. Watch the trend. |
| Late-cancel rate | 4 of the 110 trips kept | 3.6% | No broker standard. Watch the trend. |
| On-time pickup rate | 99 of 103 pickups made | 96.1% | Meets above 95% |
| Trips per vehicle hour | 103 completed trips ÷ 100 vehicle hours | 1.03 | No broker standard |
| Revenue per vehicle hour | $4,120 billed ÷ 100 vehicle hours | $41.20 | Compare with your cost per hour |
| Empty-mile share | 575 empty miles of 1,480 driven | 38.9% | No broker standard |
| Claim denial rate | 3 denied of 96 claims decided | 3.1% | Misses under 0.29% |
| Days to pay | 5 days to bill, plus 26 days to deposit | 31 days | Check against your agreement |

This company runs on time, but two numbers need work first. The turnbacks are almost four times MTM's limit, and the denials are over ten times its limit. Both fixes cost little: accept only trips you can staff, and check every trip record before it is billed. Then look at empty miles, because 575 empty miles is about 5.6 miles for every completed trip.

## How to collect the numbers in 20 minutes a week

1. **Close out every trip the same day.** Each leg gets a status: completed, rider no-show, late cancellation, or turned back. Use the [trip log template](https://nemtguide.com/templates/nemt-trip-log-template/) or your scheduling system.
2. **Record the four times on every trip.** Scheduled pickup, actual arrival, pickup, and drop-off. MTM Health's Virginia handbook requires the trip ID, the scheduled and actual pickup times, departure and arrival times, and the member's signature on the electronic trip log, or the claim is denied.
3. **Write down the odometer** at the start and end of each shift and at every pickup and drop-off.
4. **Pull the week's timesheets** for vehicle hours.
5. **Export the broker's turnback list** with the time each one was sent.
6. **Match each deposit to its remittance advice,** then note the ride date and claim date of every trip it paid.
7. **Fill in the week's row** on one sheet with the eight KPIs, and keep the last eight weeks side by side.
8. **Compare with the broker's own report** when it arrives, and dispute any number that does not match your records.

## What to do when a KPI slips

| KPI that slips | Where it usually starts | First fix |
|---|---|---|
| On-time pickup rate | Pickup times with no room for boarding, first runs that leave late, drivers waiting outside the window | Rebuild tomorrow's pickup times. See [NEMT scheduling](https://nemtguide.com/guides/nemt-scheduling/). |
| Trips per vehicle hour | Gaps between legs, vans sent home early, too few trips near where vans already are | Group trips by area and time, and fill the gap during long appointments |
| Revenue per vehicle hour | Low-paying trips in expensive hours, long waits that are not paid | Check which payer and which trip type fill your worst hours. See [NEMT payer mix](https://nemtguide.com/guides/nemt-payer-mix/). |
| Empty-mile share | Trips far from your garage, returns that pull a van across town | Take trips near your vans, and plan will-call returns before the day starts |
| No-shows and late cancellations | Wrong phone numbers, canceled appointments nobody told you about, standing orders out of date | Confirm every ride the day before. See [NEMT standing orders](https://nemtguide.com/guides/nemt-standing-orders/). |
| Turnback rate | Accepting trips before a driver is on them | Accept only what you can staff, and hand back at least 24 hours ahead |
| Claim denial rate | Missing signatures, times, or odometer readings, and uncredentialed drivers or vans | Check every trip record before billing, and renew credentials early |
| Days to pay | Billing once a month, and denials left sitting | Bill every week, and work denials the week they arrive |

## Numbers worth a monthly look

Four more numbers change slowly, so a monthly check is enough.

- **Complaints per 1,000 trips.** MTM Health's Virginia standard is substantiated complaints on under 0.1 percent of completed trips, which is fewer than 1 per 1,000. Wisconsin's May 2026 report counted 481 substantiated complaints against 301,246 completed legs, about 1.6 per 1,000. In Philadelphia County, rider complaints about Modivcare's service ran from 1.76 to 2.08 per 1,000 trips a year from 2023 to 2025 (Pennsylvania DHS study, June 25, 2026). See [broker rider complaints](https://nemtguide.com/guides/broker-rider-complaints/).
- **GPS-tracked trips.** MTM Health's Virginia handbook wants more than 90.01 percent of trips tracked by compatible GPS.
- **Credentials expiring in the next 30 days.** MTM Health warns that trips run by drivers with expired documents can go unpaid.
- **Cost per trip and revenue by payer.** One payer that pays slowly or denies often can hide inside good totals. See [NEMT cost per trip](https://nemtguide.com/guides/nemt-cost-per-trip/) and the [profit per vehicle calculator](https://nemtguide.com/tools/nemt-profit-per-vehicle-calculator/).

For the full list of levers behind these numbers, see [how to increase NEMT profit](https://nemtguide.com/guides/increase-nemt-profit/).

## Frequently asked questions

### What are the most important KPIs for a NEMT company?

For a small company, eight numbers cover most of it: on-time pickup rate, trips per vehicle hour, revenue per vehicle hour, empty-mile share, rider no-show and late-cancel rate, turnback rate, claim denial rate, and days to pay. The first and the turnback and denial rates are the ones brokers grade. The rest decide whether each van makes money.

### What is a good on-time percentage for NEMT?

Aim above 95 percent. MTM Health's Virginia handbook (approved August 10, 2026) sets its standard above 95 percent, counting a first pickup on time from 15 minutes before to 15 minutes after the scheduled time, and pays a quarterly bonus only at 95 percent or better. Florida holds its Medicaid health plans to 90 percent of first pickups within 15 minutes and 90 percent of returns within 30 minutes (July 1, 2026).

### How many trips per hour should a NEMT van do?

There is no official NEMT standard, because distance, level of service, and shared-ride rules change it. For comparison, public dial-a-ride and ADA paratransit services reported about 1.9 boardings per vehicle revenue hour to the National Transit Database for 2024. Those systems share rides by design and count every passenger who boards, so a van that carries one rider at a time will usually run lower. Track your own number and push it up week by week.

### What is a normal NEMT no-show rate?

It depends on how the program counts. In May 2026, Indiana's fee-for-service broker recorded member no-shows on 0.7 percent of scheduled rides and member cancellations on 7.6 percent. Wisconsin's broker recorded 8,566 member no-show legs that month against 301,246 completed legs. Count your own no-shows and late cancellations separately, against the trips on your schedule, so the trend means something.

### How do I calculate days to pay?

Take each payment and match it to its trips. Days to bill is the claim date minus the ride date. Days to get paid is the deposit date minus the claim date. Average both for each payer. In May 2026, Indiana's fee-for-service broker averaged 11 days from ride to claim receipt, 18 days to decide the claim, and 18 more to pay it.

### Which numbers do NEMT brokers track on my company?

MTM Health's Virginia handbook (approved August 10, 2026) lists on-time performance, vendor no-shows, substantiated complaints, miles against minutes, overlapping claims, incorrect claim information, denied claims, GPS tracking, and trip re-routes. A field monitor reviews each one with you regularly. Other brokers use their own lists and definitions, so ask each broker for its measures in writing.

### How often should I review NEMT KPIs?

Weekly for the service and productivity numbers, because a slipping on-time rate or a rising no-show rate needs a fix before the month closes. Monthly for claim denials, days to pay, complaints, and cost per trip, because claims take weeks to come back. Look at four to eight weeks together before you change how you schedule.

## Official resources

- [MTM Health: Virginia transportation provider handbook (performance metrics)](https://www.mtm-inc.net/wp-content/uploads/2018/12/VA-Provider-Handbook-2026.pdf)
- [Indiana FSSA: Monthly NEMT broker reports (SEA 480)](https://www.in.gov/fssa/ompp/non-emergency-medical-transportation/sea-480-data-reports/)
- [Wisconsin DHS: NEMT monthly performance reports](https://www.dhs.wisconsin.gov/nemt/reports.htm)
- [FTA National Transit Database: service data by mode](https://data.transportation.gov/Public-Transit/2022-2024-NTD-Annual-Data-Service-by-Mode-and-Time/wwdp-t4re)
- [eCFR: 42 CFR 447.45, Timely claims payment](https://www.ecfr.gov/current/title-42/section-447.45)
- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)