# NEMT Claim Denial Log: Track Every Denied Trip From Code to Payment

Canonical URL: https://nemtguide.com/templates/claim-denial-log/ · Updated 2026-09-30

A claim denial log is your running list of every denied or cut claim line, one row per trip, with the reason and remark codes, the fix, the date you resent or appealed it, and the last day the payer will still act. Log each denial the day the remittance arrives, work the rows in deadline order, and keep the payer's own papers as proof.

- Log every denied or cut line the day the remittance arrives, and add claims the payer rejected before processing.
- The last day to act is the earliest clock that still applies: the filing limit from the date of service, or the fix or appeal window from the remittance date.
- Work the rows in deadline order, not dollar order, and never resend a denied claim unchanged.
- The log is your work list, not your proof. Keep the remittance, the claim status screen, and the appeal receipt for each row.
- Count denials by cause every month, and fix the setup that keeps producing them.

A denied claim is a ride you already gave and have not been paid for. It turns into money only if someone finds the cause, sends the fix, and does it before the payer's window closes. This log keeps every denied trip in one place: the code the payer used, what you did about it, and the last day the payer will still listen.

## How to use this template

1. **Fill in Part 1 once for each payer.** Write its filing limit and its window to fix or appeal a denial, taken from your provider manual or broker agreement. The table after the template lists several real ones.
2. **Log each denial the day it arrives.** Give every denied or reduced line its own row in Part 2. Most come from the remittance, and your [NEMT payment log](https://nemtguide.com/templates/nemt-payment-log/) is where short pays first show up. Add claims the payer rejected before processing too, because they may never reach a remittance.
3. **Copy the codes exactly.** Write the group code, the reason code, and every remark code. X12 requires at least one remark code with reason codes 16, 96, 252, and A1, and that remark code usually names what failed. If a broker portal shows its own denial reason instead of a code, copy its words exactly.
4. **Leave contractual write-offs out.** Reason code 45 with group code CO is the normal gap between your charge and the payer's rate. It is not a denial, so it does not belong here.
5. **Find the cause, then pick a route in Part 3.** Open the trip record, the authorization, and the eligibility check for the date of service before you decide anything.
6. **Work the rows by the last day to act, not by size.** A $30 trip that expires Friday comes before a $300 claim with months left.
7. **Track each appeal in Part 4** until the payer decides it, and write down the next deadline if you lose.
8. **Close a row only when the money arrives or a write-off is signed in Part 6.** Record the result and the amount recovered in Part 3.
9. **Count the month in Part 5.** A cause that repeats is a setup problem, such as a wrong modifier on a standing order, not a one-time slip.
10. **File the payer's papers with each row.** The section on proof below says which ones count.

For what each code means and how to fix the common ones, see [NEMT claim denials](https://nemtguide.com/guides/nemt-claim-denials/).

## The template

### Part 1: Payer deadlines

| Payer | First claim due within | Fix a denied claim within | Appeal or review within | Clock starts on | Where to send a fix or appeal |
|---|---|---|---|---|---|
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |

### Part 2: Denials received

| No. | Date logged | Trip no. and date of service | Payer and payer claim no. | Amount denied or cut | Codes (group, reason, remark) | Last day to act |
|---|---|---|---|---|---|---|
| 1 | | | | | | |
| 2 | | | | | | |
| 3 | | | | | | |
| 4 | | | | | | |
| 5 | | | | | | |
| 6 | | | | | | |
| 7 | | | | | | |
| 8 | | | | | | |
| 9 | | | | | | |
| 10 | | | | | | |
| 11 | | | | | | |
| 12 | | | | | | |

### Part 3: Fix and follow-up

| No. | Cause (key) | Route (key) | Date sent, and new claim or appeal no. | Result and date | Amount recovered | Closed (date, initials) |
|---|---|---|---|---|---|---|
| 1 | | | | | | |
| 2 | | | | | | |
| 3 | | | | | | |
| 4 | | | | | | |
| 5 | | | | | | |
| 6 | | | | | | |
| 7 | | | | | | |
| 8 | | | | | | |
| 9 | | | | | | |
| 10 | | | | | | |
| 11 | | | | | | |
| 12 | | | | | | |

Cause key: E, rider not eligible or ID wrong. P, wrong payer. A, authorization or trip number. C, code, modifier, or level of service. M, miles or units. D, duplicate or split claim. R, trip record, signature, or attachment missing. N, provider, driver, or vehicle enrollment, or an NPI. T, filed late. O, other (write it in).

Route key: N, new claim (the first one was rejected or unprocessable). F, corrected or replacement claim. V, void. B, bill the right payer. A, appeal or review request (fill in Part 4). W, write off (fill in Part 6).

### Part 4: Appeals and review requests

| No. | Filed with (payer and office) | Date filed and how sent | Proof of delivery kept | Documents attached | Decision due by | Decision, date, and next deadline |
|---|---|---|---|---|---|---|
| | | | | | | |
| | | | | | | |
| | | | | | | |
| | | | | | | |

### Part 5: Monthly count by cause

Month and year: ______________ Claims billed this month: ________ Denial rate (denials logged ÷ claims billed): ________

| Cause | Denials logged | Dollars | Dollars recovered | Most common reason code | What changed to stop it |
|---|---|---|---|---|---|
| E, eligibility or ID | | | | | |
| P, wrong payer | | | | | |
| A, authorization | | | | | |
| C, code or modifier | | | | | |
| M, miles or units | | | | | |
| D, duplicate | | | | | |
| R, record or attachment | | | | | |
| N, enrollment or NPI | | | | | |
| T, filed late | | | | | |
| O, other | | | | | |
| Total | | | | | |

### Part 6: Write-offs

| No. | Trip no. | Amount | Why it cannot be recovered | Approved by (signature and date) |
|---|---|---|---|---|
| | | | | |
| | | | | |
| | | | | |
| | | | | |

Reviewed by the owner (signature and date): ______________________________

## What to write in "last day to act"

Every row runs on at least two clocks. The filing limit counts from the date of service and decides whether any claim for the trip can still be paid. The window to fix or contest a denial often counts from the remittance or notice date instead. Write the earliest date that still applies, and note which clock it is.

Federal rule [42 CFR 447.45(d)](https://www.ecfr.gov/current/title-42/section-447.45) makes every state Medicaid agency require claims within 12 months of the date of service. States and brokers set shorter windows of their own:

| Payer | Filing limit for the first claim | Window to fix or contest a denial |
|---|---|---|
| New York Medicaid (18 NYCRR 540.6) | 90 days from the date of service | Correct and resubmit within 60 days of the notice. Every claim must be finally submitted within 2 years. |
| Texas Medicaid, claims to TMHP (provider manual, September 2026) | 95 days from the date of service | Appeals and adjustment requests within 120 days of the date on the R&S Report that shows the claim. A deadline on a weekend or listed holiday moves to the next business day. No payment more than 24 months after the date of service. |
| Indiana Medicaid, for trips billed to the state itself, such as those exempt from brokering (claim module version 8.5, February 24, 2026) | 180 days from the date of service | A corrected claim counts as a new first claim, still due within 180 days of the date of service. A written administrative review is due within 60 days of the remittance date. |
| Arizona AHCCCS fee-for-service (Chapters 4 and 28, revised November 2025) | 6 months from the date of service | Reach clean claim status, or correctly adjust a processed claim, within 12 months of the date of service. A claim dispute is due within 12 months of the date of service or eligibility posting, or 60 days after the denial of a timely claim, whichever is later. |
| Medi-Cal fee-for-service (manual pages updated through May 2025) | Six months following the month of service. Without an allowed delay reason, claims received in months 7 to 9 pay 75 percent, months 10 to 12 pay 50 percent, and later claims deny. | A Claims Inquiry Form within six months of the remittance date, or an appeal within 90 days of the remittance or claims inquiry letter |
| MTM Health, Virginia Medicaid fee-for-service trips from October 1, 2026 (handbook approved August 10, 2026) | A clean claim within 6 months of the date of service | Appeal within 365 calendar days in MTM's online claims portal |
| MTM Health standard agreement (January 1, 2023 version Pennsylvania posts) | 90 days, or the limit MTM's client sets | Through MTM's appeals process |
| WellTrans, Indiana (agreement revised October 16, 2025) | 60 days. Invoices more than 90 days after the ride are disallowed in full. | A claim returned for missing information may be resubmitted with it |

A few events move the clock, and each one needs proof attached to the claim:

- **Medicare was billed first.** The federal rule lets a state pay within 6 months after notice of Medicare's decision, if the Medicare claim was filed on time. MTM Health in Virginia and WellTrans start their own clocks on the Medicare denial date.
- **Coverage was approved after the ride.** Texas allows 95 days from the date eligibility is added to its file, within 365 days of the ride. Indiana allows one year from the date eligibility was entered, and Arizona 6 months from the date it was posted.
- **The delay was outside your control.** New York gives 30 days from the time the claim comes back within your control, with a delay reason code on the claim.

The [timely filing limit](https://nemtguide.com/glossary/timely-filing-limit/) page covers more payers, and the [timely filing calculator](https://nemtguide.com/tools/nemt-timely-filing-calculator/) counts the days for you.

### One row, filled in

A Texas Medicaid ride on Monday, September 14, 2026 comes back with $0 allowed and $0 paid on the R&S Report dated October 5, 2026. Texas says a zero-paid claim still inside its 95-day limit should go back as a new claim, which it processes faster than an appeal. That makes the last day for a new claim December 18, 2026, the 95th day after the ride. An electronic appeal has until February 2, 2027, the 120th day after the R&S date. Write December 18 in "last day to act" and the appeal date beside it.

## Reading the codes you copy in

Each denied line carries a group code (the kind of adjustment, such as CO for contractual obligation or PR for patient responsibility), a reason code (why), and often a remark code (the detail). The codes come from national lists kept by X12, so a code means the same thing from any payer. These are the ones behind most NEMT rows, with the cause and route to write in Part 3.

| Codes on the remittance | What the X12 list says | Cause | Usual route |
|---|---|---|---|
| Reason 27 | Expenses incurred after coverage terminated | E | Recheck eligibility for the date of service. Bill again only if coverage is restored for that date. |
| Reason 31 or 140 | Patient cannot be identified as our insured, or the ID and name do not match | E | Copy the ID exactly from the eligibility response and send a corrected claim |
| Reason 109, or remark N904 | Not covered by this payer, send it to the correct one; the transportation vendor is responsible | P | Bill the broker or health plan that covers the trip |
| Reason 197, 198, or 284 | Authorization absent, exceeded, or valid but not for the service billed | A | Correct the number or units if you hold a matching authorization. Appeal with a copy if the payer lost it. |
| Reason 16 with remark M22 or M53 | Missing information: miles traveled, or days or units of service | M | Fix the miles or units from the trip record and send a corrected claim |
| Reason 16 with remark N822 or N823 | A procedure modifier is missing or invalid | C | Send a corrected claim with the modifier in force on the date of service |
| Reason 18, used only with group OA | Exact duplicate claim or service | D | Check the first claim's status before doing anything else |
| Reason 252 with remark N706 | An attachment is required; documentation is missing | R | Send the trip record or document the payer names |
| Reason 29 | The time limit for filing has expired | T | Contest it only with the payer's own proof that you filed on time. Otherwise write it off. |
| Remark MA130 | Incomplete or invalid information, unprocessable, no appeal rights | Any | Send a new claim with complete, correct information |

Payers pick their own codes for the same problem, so read the remark code before you decide. The [claim adjustment reason codes](https://nemtguide.com/glossary/claim-adjustment-reason-codes/) page covers more of them.

Broker denials often start with the trip record rather than the claim form, so they belong under cause R:

- **MTM Health in Virginia** denies a claim when the electronic trip log is missing the trip ID, the scheduled pickup, the actual pickup, departure, or arrival time, or the member's signature, or when the trip is no longer in completed status (handbook approved August 10, 2026).
- **WellTrans in Indiana** does not pay unsigned trips, trips with the rider's initials instead of a signature, or trips marked "unable to sign." When a rider cannot sign, a household member, caretaker, or facility representative signs their own name and relationship. A driver or attendant never signs for the rider (agreement revised October 16, 2025).

The fix for these is the missing piece from your own trip record, sent the way the broker asks. If the record never had it, the row usually ends in Part 6, and the cause goes on next month's list in Part 5.

## Correct, resend, or appeal: the rules behind the route column

**New claim (N).** A claim rejected or returned as unprocessable was never really received. Remark MA130 says to submit a new claim with complete, correct information. Log it anyway, since its filing clock never stopped.

**Corrected or replacement claim (F).** On the CMS-1500, item 22 takes frequency code 7 to replace a prior claim or 8 to void one, with the payer's original reference number. The national instructions (NUCC version 13, July 2025) say the field is not for original claims. Payers differ on the details:

- **Arizona** wants every line of the original claim again, with the original claim reference number in item 22. Without that number the claim counts as new, and it can deny as late or reject as a duplicate. Any paid line you leave off is recouped. A replacement cannot change the service provider ID, the billing provider ID, or the tax ID. For those, void the claim and file a new one inside the 6-month limit.
- **Indiana** does not allow adjustments or void and replacement on denied claims. You resubmit the denied claim with corrections, and it counts as a new first claim inside the 180-day limit. When only one line was denied, resubmit that line on its own, unless the lines depend on each other for payment. A denied claim resent with nothing corrected is a duplicate: it keeps denying, and it does not count as an attempt to resolve the problem.
- **New York** says to fix a paid claim with an adjustment, called a replacement in its portal, rather than a void. A claim sent after a void is treated as brand new, and every timeliness edit applies again.

See [corrected NEMT claims](https://nemtguide.com/guides/corrected-nemt-claims/) for where the payer's claim number sits on each remittance.

**Appeal or review (A).** Use it when your claim was right and the payer's decision was wrong, such as a denial for a missing authorization you actually hold. Attach the trip record, the authorization, and the remittance page. Write the office and address in Part 1, because each payer has its own:

- **Indiana Medicaid** takes a written administrative review that says why you disagree, within 60 days of the remittance date.
- **Verida**, which brokers most of Indiana's fee-for-service trips and pays them itself, starts with an administrative review requested through ZenDesk in the Verida Provider Portal. That review also covers underpayments. If it does not settle the problem, a formal appeal goes in writing to Claim Appeals, Verida Claims, 843 Dallas Highway, Villa Rica, GA 30180 (Indiana transportation module, August 19, 2025). As of September 2026, Verida's Indiana claims line is 678-510-4600, option 2.
- **Arizona AHCCCS** takes claim disputes at its Office of the General Counsel, and the date the office receives yours is the filing date.
- **MTM Health in Virginia** takes appeals in its online claims portal, where you present the correct information.

[How to appeal a denied Medicaid claim](https://nemtguide.com/guides/appeal-denied-nemt-claim/) walks through each step.

**Void (V).** For a claim billed in error, such as a ride that was canceled. MTM Health's Virginia handbook says to contact your Field Monitor right away so MTM can void it.

**Write off (W).** Only when no route is left or the last day has passed. Sign it in Part 6 so every lost trip has a name and a reason on record.

## Proof that keeps a late claim payable

Your log shows the work, but a payer decides a late claim on its own records. Indiana's list of what it accepts for a claim past its 180-day limit includes remittance advice statements, 277 responses to claim status inquiries, screen prints from its provider portal, answered inquiries, dated explanations of benefits from other payers, and its own records of an earlier submission. It says provider-generated notes and claim filing timelines are not acceptable. Each claim needs its own set of papers, and a late claim without them denies automatically.

Keep these with each row:

- The remittance page or broker notice that shows the denial
- The claim status response or portal screen print for each resend
- Each appeal letter, with proof of when it was sent and received
- The trip record, authorization, and eligibility check you used to fix it

Keep the log and its papers as long as your longest record rule. New York requires Medicaid providers to keep all information about claims for six years from the date of service (18 NYCRR 504.3), and its transportation manual requires the records for each trip leg to be kept for six years after the date of payment. MTM Health's standard agreement requires 10 years, and WellTrans's Indiana agreement requires the contract term plus 10 years.

## What the fix column should never say

- **"Bill the rider."** Federal rule [42 CFR 447.15](https://www.ecfr.gov/current/title-42/section-447.15) limits Medicaid to providers who accept the state's payment as payment in full, apart from allowed cost sharing. MTM Health's standard agreement bars billing a member even when MTM or its client does not pay, apart from a copay MTM or its client authorizes. AHCCCS's billing manual cites A.R.S. 36-2903.01(K) as barring providers from billing AHCCCS members for covered services. WellTrans's Indiana agreement leaves one narrow opening: a trip denied because the rider never went to a covered medical visit may be billed to the rider, but only as far as the law allows.
- **"Resend as is."** A claim sent again with nothing changed is a duplicate. It denies again, and in Indiana it does not even count as an attempt to fix the problem.
- **"Keep the extra."** If working a denial shows you were paid for more than you gave, federal law requires you to report and return the overpayment, with a written reason, within 60 days after you identify it (42 U.S.C. 1320a-7k(d)). Money kept past that date becomes an obligation under the False Claims Act. See [the 60-day overpayment rule](https://nemtguide.com/guides/medicaid-overpayment-60-day-rule/).

Brokers watch the same numbers you count in Part 5. MTM Health's Virginia handbook scores providers on claims denied, with a standard of under 0.29 percent, and on claims sent with missing or incorrect information, under 0.99 percent of claims paid. A short Part 5 each month is the easiest way to stay under both.

## Frequently asked questions

### What should a claim denial log include?

For each denied or cut line: your trip number, the date of service, the payer and its claim number, the amount, the group, reason, and remark codes, the cause you found, what you did about it and when, and the last day the payer will accept a fix or appeal. Add the result, the amount recovered, the date the row closed, and who approved any write-off.

### How long do I have to fix a denied NEMT claim?

It depends on the payer, and the clock may start on the date of service or on the remittance date. New York wants a corrected claim within 60 days of the notice. Texas Medicaid takes appeals within 120 days of the R&S Report date. Indiana allows 60 days from the remittance date for an administrative review, and MTM Health in Virginia allows 365 days to appeal. Write the earliest date that applies.

### Should rejected claims go on the denial log?

Yes. A rejected claim never entered processing, so it may never appear on a remittance, and its filing clock keeps running. Remark code MA130 means the claim was unprocessable, has no appeal rights, and needs a new claim with complete, correct information. Log it with the route for a new claim and send it again the same week.

### Is my denial log proof that I filed on time?

Usually not. Indiana says provider-generated notes and claim filing timelines are not acceptable documentation for a late claim. It accepts payer records such as remittance advice statements, 277 claim status responses, and screen prints from its provider portal, with a separate set for each claim. File those papers with the log row they belong to.

### Can I bill the rider when a claim stays denied?

Not for a covered ride. Federal rule 42 CFR 447.15 limits Medicaid to providers who accept the state's payment as payment in full, apart from allowed cost sharing. MTM Health's standard provider agreement bars billing a member even when MTM or its client does not pay, and Arizona bars billing AHCCCS members for covered services. Write the trip off in Part 6 instead, and fix the cause.

### What denial rate should a NEMT company aim for?

Below your broker's standard. MTM Health's Virginia handbook, approved August 10, 2026, sets a provider standard of under 0.29 percent of claims denied. Claims sent with missing or incorrect information must stay under 0.99 percent of claims paid. Part 5 of this log gives your own rate each month: denials logged divided by claims billed.

## Official resources

- [X12: Claim Adjustment Reason Codes (the full list)](https://x12.org/codes/claim-adjustment-reason-codes)
- [X12: Remittance Advice Remark Codes (the full list)](https://x12.org/codes/remittance-advice-remark-codes)
- [NUCC: 1500 claim form instruction manual (resubmission codes in item 22)](https://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2025_07-v13.pdf)
- [eCFR: 42 CFR 447.45, Timely claims payment](https://www.ecfr.gov/current/title-42/section-447.45)
- [New York: Guide to Timely Billing and delay reason codes](https://www.emedny.org/ProviderManuals/AllProviders/Guide_to_Timely_Billing.pdf)
- [TMHP: Claims filing deadlines and appeal time limits (Section 6)](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/1_06_claims_filing.pdf)
- [Indiana Medicaid: Claim Submission and Processing module (filing limits, Section 11)](https://www.in.gov/medicaid/providers/files/modules/claim-submission-and-processing.pdf)
- [AHCCCS: Chapter 4, General Billing Rules (replacement and void claims)](https://www.azahcccs.gov/PlansProviders/Downloads/FFSProviderManual/FFS_Chap04GeneralBillingRules.pdf)
- [Medi-Cal: Claim Submission and Timeliness Overview](https://mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=claimsub.pdf)