North Carolina Medicaid Transportation Forms in 2027: DHB-5048, DHB-5118, and What Each Office Signs

North Carolina’s county social services offices use a set of statewide DHB forms to decide who gets a Medicaid ride, to approve or deny it, and to prove the rider got care. A private company that drives county trips meets a few of them directly and works around the rest. This page lists each form, who completes it, and what it means for your paperwork. For how to enroll and contract, see the North Carolina state guide.

Which North Carolina rides use these forms

County DSS offices arrange rides for NC Medicaid Direct and EBCI Tribal Option members. NC Medicaid’s ride page (modified September 28, 2026) sends those members to their local DSS, and sends members of each health plan to the plan’s own ride line.

The county forms come from two state manual sections with the same text: MA-2910 for the Aged, Blind and Disabled manual, and MA-3550 for the Family and Children’s manual. Both were revised March 16, 2026 (change notice 04-26). NC Medicaid’s provider forms page still links the May 2022 reissue of MA-2910, so open the current one from the state policies site.

Health plan rides run differently. The managed care NEMT policy (amended January 1, 2025) has each plan keep its own NEMT policy, including its process for assessing a member’s transportation needs, and lets it use equivalent forms or system interfaces that capture all required data. That covers the four Standard Plans and the Tailored Plans. The one form number the policy names is the notice of rights (printed there as DMA-5046, now the DHB-5046), which the county gives at each Medicaid application and recertification. The November 2025 version tells county riders to call their DSS and plan members to call their plan’s Member Services.

The statewide forms in the order a rider meets them

Counties complete most of these forms. The ones most likely to reach you are the DHB-5118, the DHB-2056 log in some contracts, and the no-show reports behind the DHB-5125 notices.

Form	What it records	Who completes it
DHB-5046	Notice of rights and responsibilities	County DSS, at each application and recertification
DHB-5047	Assessment of need, special needs, and mode	County DSS or an agency it hires
DHB-5048	Exception: distance, special mode, or lodging	DSS, the rider, and the medical provider
DHB-5024	Approval or denial, with dates and hearing rights	County DSS
DHB-5119	Denial of a trip request	County DSS
DHB-5118A and 5118B	Proof the rider received a covered service	Medical provider’s office
DHB-5125, 5125A, 5125B	No-show notice, final notice, 30-day suspension	County DSS
DHB-2056	Log of each trip request, start to finish	County, or a vendor that runs the county’s NEMT

The DHB-5047 is the starting point. Its Section C lists the rider’s special needs: an attendant, a wheelchair, a cane, crutches or walker, a scooter, a portable oxygen tank, a service animal, or disorientation, hearing, or sight limits. A star beside each says to complete the DHB-5048 unless the need is obvious. MA-2910 requires a new assessment at the first request, at least once a year, when something changes, and at each Medicaid recertification.

The county keeps the DHB-5046, DHB-5047, DHB-5024, and any no-show notices in a transportation file for each rider, along with the DHB-5048 and the DHB-5118A or 5118B when they were used. The county also samples 2% of its trips, or 200 trips, whichever is less, each calendar quarter, and records what it finds on the DHB-5078, which asks whether those forms are in the file.

DHB-5048: the exception form and who signs each part

The DHB-5048 is not for every rider. The form says to complete it only if an exception is required. MA-2910 names two situations: a rider says a physical or mental impediment keeps them from using an available resource and the impediment is not obvious, or a rider needs a provider at a significantly greater distance. The state defines that as a one-way trip of more than 30 miles from the pickup location, or from the nearest provider if none is in the community.

The form has a part for each person:

1. County DSS fills in Section 1: the DSS name, the date, the rider’s identifying information, and the caseworker.
2. The rider signs Section 2, a consent to release information. It is valid for up to one year, and the rider can revoke it in writing to the county.
3. The medical provider completes Section 3 by checking the exception requested, giving the duration of need, and explaining why. The form asks for the referral provider and the reason a local provider cannot serve the rider, or for the special mode (attendant, service animal, vehicle type) and why it is needed, or for the nights of lodging and why.
4. The provider signs Section 4, an attestation, with printed name, phone, signature, and date, and faxes the form back to the county.

MA-2910 adds the rules about who may sign. For a specialist, the referring physician signs. For a primary care provider, that provider signs. A specialist referred by another specialist can have the referring specialist complete it, and a nurse practitioner, physician assistant, or other qualified medical staff in the office may complete it. The county sets a time frame for return and files the finished form. The form warns that incomplete or inaccurate forms will not be approved and could delay the ride.

The medical reasons MA-2910 gives for a distant provider are an established course of treatment that must be completed, such as chemotherapy or surgical follow-up visits, and harm to the rider from disrupting an established provider relationship.

Where you come in:

• You do not sign it or carry it. The form has no line for a transportation company. MA-2910 tells the county to mail or fax it to the clinic rather than let the rider carry it, although the form’s own note still tells the rider to bring it to the provider. Either way, only a form the provider faxes to the county counts.
• Ask the coordinator when a trip looks like an exception. A request for a trip over 30 miles one way needs prior approval, and the DHB-5048 is how the county gets the medical reason. A rider with an attendant, a service animal, or a mobility device that is not obvious may need one in the file too.
• Do not fill in the clinic’s part. If a rider hands you the form, send them back to the county coordinator.

DHB-5118: proof the rider got a covered service

A county can only pay for a ride to a Medicaid covered service. MA-2910 requires each county to verify at least 10% of its trips before they happen and at least 10% after. The county works out the 10% from its average monthly trips in the July through September quarter of the year before, and the sample should mix trip types, such as vans, gas vouchers, and public transit.

A county can verify three ways: a phone call to the provider, a signed DHB-5118A, or another method that works, with the date, the person spoken to, and the result noted in the file. A DHB-5118 is not required when a phone call or other documentation does the job.

The two versions differ in one block:

• DHB-5118A has the provider’s office certify that the rider visited on a given date and received a Medicaid covered service. It lists the provider or facility name, the person completing the form, a phone number, and a signature.
• DHB-5118B is the same form plus a consent for the provider to release the information to the county, valid up to one year. MA-2910 says to use it only if the provider requires a signed release.

MA-2910 says the job of getting the DHB-5118 signed and returned can be placed on the beneficiary or the transportation vendor, and counties split it differently. Gaston County’s 2023 bid (RFP 2023-TRANS001) required the DHB-5118A for every client and every trip, attached to the invoice, and said missing forms meant no payment for the trip. The Buncombe County guidelines from 2025 make the rider responsible for getting the form completed and signed by the provider and returned to the vendor. Other counties set their own terms, so read your county’s page, such as Wake County or New Hanover County, and its contract.

If your county puts the form on you:

• Keep blank DHB-5118A forms where dispatch and drivers can reach them, or ask whether the county would rather verify by phone.
• Have the clinic staff complete and sign it. The form asks for the name of the person completing it and their signature.
• Match each form to its trip on your invoice.

No-show notices and the trip log

The county, not you, sends the no-show notices, and your no-show reports are how it learns of them. MA-2910 sets this ladder: the first missed trip without good cause gets counseling by phone, or a letter on the DHB-5125 if the rider cannot be reached. The second within three months gets a warning call, or a letter on the DHB-5125A. The third within three months of the first gets a 30-day suspension notice, the DHB-5125B. A rider who cancels less than 24 hours ahead may be counted as a no-show unless there was good cause. Good cause is illness of the rider, or illness or death of the rider’s spouse, child, or parent.

Dialysis and chemotherapy riders are the exception. MA-2910 says a rider who needs critical care such as dialysis or chemotherapy cannot be denied rides to those services, however many trips are missed. The county can still suspend that rider’s rides to other appointments.

The county contract spells out your side. MA-2910 requires a written contract that obligates the vendor to report all no-shows daily and cancellations monthly, and to record each complaint about matters in its control with the date, the nature of the complaint, and what was done. If the county agrees to pay for no-shows or driver wait time, those charges are invoiced separately.

The DHB-2056 is the county’s trip log. The county logs every request from intake through disposition, and it may not use your invoice as the log or to complete the log after the fact, except to record trip costs. When a county contracts out its whole NEMT administration, the vendor takes on that duty: log every trip on the DHB-2056 or an equivalent form that captures all its fields, and send the county a detailed invoice it can compare to each trip. See NEMT trip documentation for what each trip record needs and the free trip log template.

Health plan rides use plan and broker forms

Members of a health plan book through the plan, not the county. NC Medicaid’s NEMT page lists each plan’s ride line. AmeriHealth Caritas and Healthy Blue use Modivcare. UnitedHealthcare Community Plan moved to MTM Health on January 1, 2026, and Carolina Complete Health moved to MTM on April 1, 2026. The state guide has the full broker list, including the Tailored Plans.

The plan, not DSS, runs the assessment and documents a rider’s level of need. Two examples:

• MTM uses a Level of Need form for Carolina Complete Health members. A medical professional describes the rider’s devices and limits, and the clinic faxes the form to MTM. The MTM Level of Need form guide covers each question.
• AmeriHealth Caritas says in its July 2026 member handbook that it reviews a trip before Modivcare schedules it when the level of need on the member’s assessment does not match the ride requested, such as a stretcher request with a bus or car assessment. See the Modivcare medical necessity form guide for how that broker’s forms work.

For plan riders, follow the broker’s manual for trip records and forms rather than the DHB forms. See the medical necessity form entry for what these forms do in general.

How to keep your North Carolina paperwork straight, step by step

1. Ask each county how it verifies trips. Does it use phone calls, the DHB-5118A, or both, and who gets the form signed.
2. Read the contract for the forms it names, and for the invoice terms, no-show reporting, and complaint log.
3. Get the current MA-2910 from the state policies site, and confirm the revision date.
4. Keep blank DHB-5118A forms in each van or in your dispatch system, if the county wants them.
5. Report no-shows to the coordinator the same day, with the date, time, and address.
6. Send exception questions to the coordinator, not to the clinic or the rider.
7. Keep copies of each signed form with the trip record, and file them where an audit can find them. See how long to keep trip records.