# How to Submit NEMT Claims Electronically in 2027: Portals, Clearinghouses, and 837P Files

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

To submit NEMT claims electronically, enroll with the payer first, then pick a route: type claims into the state Medicaid portal, send 837P files through a clearinghouse or billing service, or send files from your own software under a trading partner agreement. Each route has its own sign-up, such as a submitter ID and test files, and electronic remittances need a separate form.

- Many state Medicaid programs have a web portal for typing in claims, and New York's ePACES and Texas's TexMedConnect are free.
- A clearinghouse or billing service can send 837P files for you, but most payers still want it enrolled with them and linked to you.
- Sending your own files takes a submitter ID, a trading partner agreement, and test files that pass before you go live.
- Broker trips usually go through the broker's own portal, not the state claims system.
- Save every acceptance and rejection report. Texas purges response files after 30 days and charges $541.25 to pull an older one.

An electronic claim is the same claim you would write on paper, sent in a format the payer's computer reads. The hard part is not the claim. It is the sign-up: every payer wants to know who is sending the file, and each one has its own forms, IDs, and tests. This guide covers the three routes, what each state asks for, and what comes back after you send.

## The three ways an electronic claim reaches Medicaid

Every state pays fee-for-service claims through its Medicaid Management Information System, or MMIS. CMS describes it as the group of procedures and computer processing operations a state uses for claims control and for service to providers. A private fiscal agent may run it under contract. The names differ: eMedNY in New York, CoreMMIS in Indiana, and in Texas the Texas Medicaid & Healthcare Partnership (TMHP) processes claims.

Your claim can reach that system three ways.

| Route | How it works | What you sign up for | Best for |
|---|---|---|---|
| The state's web portal | You type each claim into the payer's secure website | A portal account tied to your Medicaid provider ID. New York also wants an ETIN and a Certification Statement. | A few vans and one or two payers |
| A clearinghouse or billing service | Your trip data goes to a company that turns it into 837P files and sends them | The company's own enrollment with each payer, your authorization linking it to your provider ID, and a business associate agreement | Several payers, or no time to bill |
| Your own software, sending files directly | Your billing software builds 837P files and uploads them to the payer | A submitter ID, a trading partner agreement, and test files that pass | Larger companies with an office billing team |

Typing into a portal is called direct data entry. HIPAA lets a portal skip the file format, but the data you enter must still meet the standard's content rules ([45 CFR 162.923](https://www.ecfr.gov/current/title-45/section-162.923)). In practice the portal checks your entries as you go. New York says ePACES, its free portal, runs field checks while you type.

As of September 2026, New York calls ePACES free of charge, and TMHP says all its electronic services, including TexMedConnect, are free. Clearinghouses and billing services charge their own fees. See [NEMT billing services](https://nemtguide.com/guides/nemt-billing-service/) for how those fees work and the Medicaid rule on percentage pricing.

## The federal rules behind every electronic claim

The electronic claim is the 837P, the HIPAA standard for professional claims, version 5010 (ASC X12N 005010X222, [45 CFR 162.1102](https://www.ecfr.gov/current/title-45/section-162.1102)). It carries the same information as the paper [CMS-1500](https://nemtguide.com/guides/cms-1500-for-nemt/). A change already on the books adds a new pharmacy claim standard starting August 14, 2027 and keeps the 837P at version 5010.

Four other rules shape how you send it:

- **Standard when electronic.** If you send a claim electronically to a health plan, it must be a standard transaction ([45 CFR 162.923](https://www.ecfr.gov/current/title-45/section-162.923)). A state Medicaid program is a health plan under HIPAA, and so is an HMO ([45 CFR 160.103](https://www.ecfr.gov/current/title-45/section-160.103)).
- **Plans must take the standard.** A health plan must conduct a standard transaction when you ask, and it may not reject one for carrying data it does not use ([45 CFR 162.925](https://www.ecfr.gov/current/title-45/section-162.925)). A plan that requires you to use a clearinghouse may not charge you more than normal telecommunication costs for it.
- **Agreements cannot rewrite the standard.** A trading partner agreement may not change a data element's meaning, add data elements, or use codes the standard does not allow ([45 CFR 162.915](https://www.ecfr.gov/current/title-45/section-162.915)).
- **The 12-month cap.** States must require claims within 12 months of the date of service, and the date of receipt is the date stamp the agency puts on the claim ([42 CFR 447.45](https://www.ecfr.gov/current/title-42/section-447.45)). Most states set shorter limits.

HIPAA defines a [clearinghouse](https://nemtguide.com/glossary/clearinghouse/) as a company that turns nonstandard data into a standard transaction, or the reverse, and the definition names billing services. One more change is scheduled. A rule published March 24, 2026 adopts standards for electronic claim attachments, and compliance is required by May 26, 2028 ([45 CFR 162.2002](https://www.ecfr.gov/current/title-45/section-162.2002)).

## What each state asks for before your first electronic claim

States set up electronic billing differently. These five show the range, as of September 2026.

| State | State portal | To send files yourself | Where NEMT claims go |
|---|---|---|---|
| New York | ePACES, free, which needs an ETIN and a Certification Statement | An ETIN, a notarized Certification Statement renewed every year, and a trading partner agreement | eMedNY, after the trip is approved and on the transportation roster |
| Texas | TexMedConnect, free | A submitter ID from the TMHP EDI Help Desk, 1-888-863-3638, option 3, and software from a vendor that passed TMHP testing | TMHP for Medical Transportation Program trips. Managed care trips go through the member's plan. |
| Arizona | AHCCCS Online | Become an AHCCCS trading partner and pass testing to be certified | AHCCCS for fee-for-service trips, with the Daily Trip Report attached |
| California | The Medi-Cal Provider Portal, where 837 files are uploaded through EDI Submission | Register in the Provider Portal and pass 837 testing. A billing submitter must also register and be affiliated with you. | Medi-Cal fee-for-service |
| Indiana | IHCP Provider Healthcare Portal | A Trading Partner Profile and a signed IHCP Trading Partner Agreement, using software that passed IHCP testing | IHCP for trips exempt from brokerage, such as hospital-to-hospital. Brokered trips go to Verida. |

Your [state guide](https://nemtguide.com/states/) links to your program's manuals, and the state's companion guide has the details for your own files.

### New York, step by step

New York has the most paperwork, and it applies to paper claims too. You need an ETIN and a Certification Statement before you submit any claim, on paper or electronically.

1. **Finish Medicaid enrollment.** eMedNY will not set up a trading partner until the provider is enrolled. Clearinghouses and billing services must be enrolled too.
2. **Apply for an ETIN.** Use the provider ETIN application, or have your billing service use its own service bureau application.
3. **Sign the Certification Statement.** A notarized statement is needed for each provider ID and ETIN pair, and it must be renewed every year.
4. **Put a trading partner agreement on file.** New York requires one from every trading partner, once the ETIN is issued.
5. **Enroll in ePACES.** Call the eMedNY Call Center at 800-343-9000 for an enrollment token, then name your submitter by its ETIN.
6. **Ask for electronic remittances.** File the Electronic Remittance Request Form, and pick a default ETIN so paper and Medicare crossover claims show up on your electronic remittance.

In ePACES, claims submitted in real time must have 4 lines or fewer. Batches let you send more.

### Texas: portal, vendor, or billing agent

TMHP gives three choices: TexMedConnect, software that sends files to the TMHP EDI Gateway, or a billing agent. TexMedConnect sends individual claims that are processed in seconds. You need a submitter ID if you use vendor software, or if you download the 835 remittance file through TexMedConnect. If a billing agent sends your claims, you do not need one.

Texas also enforces file rules. A 5010 file may hold 5,000 transactions at most. Response files are purged after 30 days, and a submitter folder holds 7,500 files at most. If you lose a transmission report, TMHP resets reports from the last 30 days for free. Older ones cost $500 each, plus $41.25 sales tax unless you hold a tax-exempt certificate.

## Using a clearinghouse or billing service

A clearinghouse or billing service that sends your claims acts as your business associate. You must require it to follow the HIPAA transaction rules ([45 CFR 162.923](https://www.ecfr.gov/current/title-45/section-162.923)), and you need a business associate agreement. See [HIPAA for NEMT providers](https://nemtguide.com/guides/hipaa-for-nemt/).

Each payer also enrolls the company and links it to you:

- **New York.** The service bureau applies for its own ETIN, and a Certification Statement is filed for each provider it bills for.
- **Texas.** Billing agents must finish TMHP testing and appear on its EDI submitter list before they send production files.
- **California.** The submitter registers in the Medi-Cal Provider Portal and asks to be affiliated with you, and you manage that request in your own Provider Portal account.
- **Indiana.** You do not need to become a trading partner if you use an IHCP-approved clearinghouse or billing service, the IHCP portal, or the GABBY phone assistant.
- **Minnesota.** Billing organizations enroll through the state's MPSE provider portal or on form DHS-4049 (February 2024), with the DHS-4087 remittance request. Under the EDI Trading Partner Addendum, a trading partner may submit only for providers who gave written authorization, and must keep a record of every claim for at least 5 years.

Keep your own access. In New York, the submitter you name in ePACES becomes the account's administrator, so you get your login from it. Ask for your own user ID so you can check claims yourself. Error reports can also stop at the company. Indiana sends its daily 277U notice, which lists claims denied for bad billing provider details, to the trading partner. It says the clearinghouse must forward it to you, because those claims never appear on your remittance.

## Sending 837P files from your own software

Each payer publishes a companion guide that says how it wants the standard filled in. New York's Trading Partner Information Companion Guide is version 3.1.2 (July 7, 2026). AHCCCS's 837 companion guide is version 4.0 (November 2022) and puts your five-character AHCCCS sender ID in loop 1000A, NM109.

Plan on testing before your first real file:

- **New York.** The Provider Test Environment runs test files through the same checks as real claims, though New York does not certify files itself. Set ISA15 to "T", and send up to two files a day with up to 50 claims each. A file sent without the "T" is processed as a real claim.
- **Indiana.** Software must pass compliance testing, shown by a 999 acknowledgment with no errors, and then IHCP specification testing. Providers using approved software file the profile and agreement.
- **Arizona.** Providers and clearinghouses must complete testing to be certified to send 837 files.
- **California.** A submitter's 837 test file must hold at least 10 claims for each claim type it will bill. A submitter that has passed does not retest for each new provider if it keeps the same submitter number, format, and claim type (EDI User Guide, June 2026).
- **Texas.** Vendors and billing agents sign a trading partner agreement, complete end-to-end testing, and must be partnered with at least one Texas provider first.
- **Minnesota.** A new trading partner sending batch files must submit test files first, under its EDI Trading Partner Addendum (January 26, 2021).

A few 837P fields matter most on NEMT claims. New York puts the 11-digit prior authorization number from the transportation roster in loop 2300, REF with qualifier G1, and the miles in loop 2400, SV104. Since November 1, 2022, Arizona has required the full pickup and drop-off addresses in the claim's additional information field. See [NEMT billing codes](https://nemtguide.com/guides/nemt-billing-codes/) for the codes and units.

## Broker and health plan claims

A [broker](https://nemtguide.com/glossary/nemt-broker/) takes claims its own way, set by your contract. Brokers such as MTM Health and MediTrans want claims in their own systems, tied to the trip they assigned.

| Broker and program | How claims go in |
|---|---|
| MTM Health, Virginia fee-for-service (trips from October 1, 2026) | An electronic trip log with the trip ID, scheduled and actual pickup times, departure and arrival times, and the member's signature, within 6 months of the ride (handbook approved August 10, 2026) |
| Verida, Indiana fee-for-service | Online, with training from Verida. Clean claims in by Wednesday are paid within 14 days (IHCP module, August 19, 2025). |
| MediTrans, Louisiana | Digital submission, which MediTrans recommends. Paper takes 5 business days to process, and claims are due within 365 days (as of September 2026). |
| Modivcare | Its transportation provider portal, which supports billing and claims |

Medicaid health plans are different. They are HIPAA health plans, so a plan must accept a standard 837P if you ask to send one ([45 CFR 162.925](https://www.ecfr.gov/current/title-45/section-162.925)). Ask each plan for its companion guide and the payer ID your clearinghouse needs. See [how to bill NEMT brokers](https://nemtguide.com/guides/how-to-bill-nemt-brokers/) for deadlines and pay cycles.

## What comes back after you send a file

An electronic claim comes back in stages. Each report answers a different question, and New York's companion guide (July 7, 2026) gives typical timing.

| Report | What it tells you | New York timing |
|---|---|---|
| TA1 or F-file | The file's outer envelope could not be read | Generally within 2 hours, only when there is a problem |
| 999 | The file passed or failed the format check | Generally within 2 hours |
| 277CA | Each claim was accepted into processing or rejected | Generally within 4 hours for batch files |
| 835 remittance | What was paid, denied, or adjusted | After the weekly payment cycle |

A claim rejected at the 277CA stage never enters processing. New York says a claim that fails these edits will not go on to adjudication, so read every response. Texas puts the same results in its Claim Response report (the 27S file) and its accepted and rejected files. Only claims accepted on the 27S file are considered for payment.

Keep every report. Texas requires providers to keep all claim and transmission records and to confirm that every claim was received and accepted. A rejection report can prove you filed on time: Texas accepts an electronic claims report showing the client, date of service, total charges, and batch ID. For what to do with each status, see [how to check Medicaid claim status](https://nemtguide.com/guides/check-medicaid-claim-status/). For the payment side, see [how to read a remittance advice](https://nemtguide.com/guides/read-remittance-advice/) and the 835 ERA.

## How to set up electronic billing, step by step

1. **Finish enrollment and your NPI.** Payers set up electronic billing only for enrolled providers. See [how to get an NPI number for NEMT](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/).
2. **List every payer and how it takes claims.** Your state, each health plan, and each broker may each want something different.
3. **Pick a route for each payer.** If you bill one state and a few trips a day, its portal may be all you need.
4. **Get your IDs.** That means a portal login, and for files an ETIN, submitter ID, or trading partner ID.
5. **Sign the agreements.** A trading partner agreement with each payer you send files to, and a business associate agreement with any company that sends them for you.
6. **Pass testing.** Send test files the payer's way and fix every error the 999 or 277CA shows.
7. **Set up electronic remittances and deposits.** Each payer has its own form, such as New York's Electronic Remittance Request Form or Texas's ER&S Agreement.
8. **Start small.** Send one small batch, and check the acknowledgments the same day.
9. **Make it weekly.** Check rejections and claim status every week, before the [timely filing limit](https://nemtguide.com/glossary/timely-filing-limit/) runs out.

## Mistakes that stop electronic claims

- **Member details that do not match.** Texas rejects claims when the name, date of birth, sex, and 9-digit Medicaid number do not exactly match its eligibility record.
- **No taxonomy code.** Texas says claims from billing providers not in a group may be rejected without one. See [NEMT taxonomy codes](https://nemtguide.com/glossary/taxonomy-code/).
- **Test and production mixed up.** In New York, a file without the test flag is processed as a real claim.
- **An expired certification.** New York needs a Certification Statement renewed every year, and the billing provider must be currently certified with the ETIN on the claim. If ePACES cannot find your submitter's ETIN, the certification may have lapsed.
- **Reports left unread.** Texas purges response files after 30 days.
- **Brokered trips sent to the state.** In Indiana, brokered fee-for-service trips are billed to Verida, not the IHCP.
- **Attachments in the wrong format.** Arizona takes an electronic Daily Trip Report only as a PDF, never as an Excel or HTML file.
- **Fixing a sent claim the wrong way.** In ePACES, a claim in a batch cannot be edited, and only a paid claim can be replaced. A denied claim is edited and resent as a new claim. See [corrected NEMT claims](https://nemtguide.com/guides/corrected-nemt-claims/).

## Frequently asked questions

### Do I have to bill Medicaid electronically?

Federal HIPAA rules do not make you bill electronically. They say that when you do send a claim electronically to a health plan, including a state Medicaid program, it must be a standard transaction (45 CFR 162.923). Many programs still take paper: New York uses its own Form A, and Arizona and Texas take the CMS-1500. Paper is slower and can cost you: since January 29, 2026, Indiana charges $5 for each first-time fee-for-service paper claim. Brokers set their own rules, so check each payer.

### Do I need a clearinghouse to bill Medicaid electronically?

No. Many states offer a portal where you type claims in yourself. New York's ePACES is free of charge, and so is Texas's TexMedConnect, as of September 2026. A clearinghouse helps when you bill several payers from one system. If a health plan requires you to use one, federal rules bar it from charging more than normal telecommunication costs for that (45 CFR 162.925).

### What is a trading partner agreement?

It is the agreement that covers electronic transactions between you, or your billing company, and the payer. Federal rules bar it from changing the standard, adding data elements, or using codes the standard does not allow (45 CFR 162.915). New York requires one on file after you get an ETIN. Indiana requires a signed agreement and a Trading Partner Profile from anyone who sends files directly.

### How long does it take to start billing electronically?

Plan for weeks, not days, if you send files yourself. Indiana says software testing can take several days or weeks, depending on your experience with electronic transactions. A free state portal is faster, because there is no file testing. Start the sign-up as soon as your Medicaid enrollment is approved, since New York sets up electronic billing only for enrolled providers. Keep paper or portal billing going until your first electronic claims are accepted.

### How do I send a trip log with an electronic claim?

It depends on the payer. Arizona requires its Daily Trip Report with every NEMT claim. If the report was filled out electronically, you can upload it as a PDF through the AHCCCS attachment process or mail a printout, and AHCCCS rejects HTML and Excel files (Chapter 14, revised July 31, 2026). A federal standard for electronic claim attachments takes effect for compliance on May 26, 2028.

### Does billing electronically make my company subject to HIPAA?

Yes. Under 45 CFR 160.103, a health care provider that sends health information electronically in connection with a covered transaction, such as a claim, is a covered entity. A clearinghouse or billing service that sends claims for you works as your business associate, and you must require it to follow the transaction rules (45 CFR 162.923). See HIPAA for NEMT providers for the privacy and security rules that follow.

## Official resources

- [eMedNY: Trading Partner Information Companion Guide (ETIN, ePACES, testing)](https://www.emedny.org/HIPAA/5010/transactions/eMedNY_Trading_Partner_Information_CG.pdf)
- [eMedNY: ePACES enrollment steps](https://www.emedny.org/HIPAA/QuickRefDocs/ePACES-Enrollment_Overview.pdf)
- [TMHP: Electronic Data Interchange section of the Texas Medicaid manual](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/1_03_electronic_data_interchange.pdf)
- [AHCCCS: Electronic Data Interchange resources and companion guides](https://www.azahcccs.gov/Resources/EDI/)
- [Indiana Health Coverage Programs: Electronic Data Interchange module](https://www.in.gov/medicaid/providers/files/modules/electronic-data-interchange.pdf)
- [Medi-Cal Provider Manual: Claim Submission and Timeliness Overview](https://mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=claimsub.pdf)
- [eCFR: 45 CFR Part 162, HIPAA transaction standards](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-162)