Business
Letter of Intent to Provide Transportation Services: Fill-In Letters for Plans, Brokers, and Facilities
Overview
A letter of intent to provide transportation services tells a broker, health plan, county, or facility that your company wants to run its rides, and gives the facts it screens on: your legal name, NPI, Medicaid enrollment, vehicles, service area, hours, and insurance. It binds neither side and is not a bid. When the buyer posts its own form, fill in that form instead.
- A letter of intent opens a conversation and commits no one. MTM Health's 2025 form says it is not a contract or an obligation to provide services.
- Use the buyer's own form when there is one. MTM Health wants a separate form for each state, and IEHP returns incomplete forms without considering them.
- Apply for Medicaid enrollment before you write to a Medicaid health plan or its broker. Federal rules require the state to enroll every network provider of a Medicaid plan.
- A notice of intent to bid is a different paper with its own deadline. In some aging agency bids, sending it on time puts you on the list for the answers and addenda.
- Offer rides, hours, and rates, never anything of value for referrals. Paying for referrals of Medicaid or Medicare riders is a federal felony.
Only the title and the template print.
A letter of intent is the first paper most buyers of rides see from you. Brokers and health plans use it to decide whether to move you on to credentialing and a contract. Facilities and county offices use it to decide whether to call you back. Keep it to one page, fill it with numbers the buyer can check, and send the proof with it.
How to use this template
- Look for the buyer’s own form first. MTM Health, IEHP, MediTrans, and Santa Clara Family Health Plan each have one, described below. When a form exists, use Part 1 as your worksheet and copy the answers into the form, field by field.
- Fill in Part 1 from your documents, not from memory. Copy your NPI from the NPPES record, your Medicaid ID from your approval letter, and your insurance limits from the certificate. A number that does not match your paperwork slows credentialing.
- Pick the letter. Use Letter A for a broker or a Medicaid health plan. Use Letter B for a hospital, nursing home, dialysis center, PACE program, county office, or area agency on aging.
- Name the counties and count each vehicle once. MTM Health’s form asks for the exact number of vehicles for each type and warns against counting one vehicle twice. A wheelchair van that also carries ambulatory riders goes under wheelchair.
- Ask what the buyer needs. Ask which counties, hours, and levels of service are short. If its network is full, ask to stay on file, then read when a broker network is full.
- Attach Part 4 as one file and send from a business email address with your company name in the subject line.
- Log it in Part 5 and follow up on the date you wrote down.
Answering a request for proposals takes more than a letter: use the transportation services proposal template. For a one-page company summary that a county or the VA can file, see how to write a NEMT capability statement.
The template
Part 1: Company facts (fill in once)
| Fact | Your answer |
|---|---|
| Legal name, and DBA if any | |
| Business address and mailing address | |
| EIN | |
| NPI (organization) | |
| State Medicaid provider ID, or the date your application was submitted | |
| State and local permits (name, number, expiration date) | |
| Business start date, or years in operation | |
| Levels of service (ambulatory, wheelchair, stretcher, attendant) | |
| Vehicles by type, each counted once | |
| Drivers credentialed and ready | |
| Counties served on a regular basis | |
| Hours on weekdays, weekends, and after hours | |
| Auto liability limit (combined single limit) | |
| General liability limit (aggregate) | |
| Workers’ compensation (policy number, or the waiver that applies) | |
| How you receive and record trips (portal, trip software, paper logs) | |
| Brokers and health plans you already serve | |
| Contact person, title, phone, and email |
Part 2: Letter A, to a broker or health plan
[Your letterhead: legal name, DBA, address, phone, email]
Date: ______________
To: ______________________________ (network or contracting department, broker or plan name, email or mailing address)
Re: Letter of intent to provide ______________ (ambulatory, wheelchair, stretcher) transportation in ______________________________ (counties)
[Legal name], doing business as [DBA], intends to join your transportation provider network and to run non-emergency medical transportation for your members in ______________________________ (counties).
About our company:
- In operation since ______________ in ______________ (state). EIN ______________. NPI ______________.
- [State] Medicaid provider ID ______________. [Or: Our Medicaid application was submitted on ______________, reference number ______________.]
- Permits: ______________________________ (name, number, expiration).
- Vehicles: ______ ambulatory, ______ wheelchair, ______ stretcher, each counted once. Credentialed drivers: ______.
- Hours: ______________ on weekdays, ______________ on weekends, and ______________ after hours.
- Insurance: auto liability $______________ combined single limit, general liability $______________ aggregate, workers’ compensation ______________.
- We receive and record trips by ______________________________.
We would like to know which counties and levels of service you need now, and how to receive your application and credentialing packet. If your network is full in our area, please keep this letter on file.
This letter states our interest and our current capacity. It is not a bid or a contract.
Attached: ______________________________ (see Part 4).
Contact: ______________ (name and title), ______________ (phone), ______________ (email).
Signature: ______________________________ Printed name and title: ______________________________ Date: ______________
Part 3: Letter B, to a facility, county office, or aging agency
[Your letterhead]
Date: ______________
To: ______________________________ (discharge planning, case management, transportation coordinator, or purchasing office)
Re: Rides for your ______________ (patients, residents, or clients) in ______________________________ (area)
[Legal name] would like to provide ______________ (wheelchair, stretcher, ambulatory) rides for ______________________________ (facility or agency), including ______________________________ (discharges, appointments, dialysis, weekend trips).
What we can run:
- Hours: ______________ on weekdays, ______________ on weekends.
- Same-day and discharge rides: a vehicle within ______ of your call, during ______________.
- Area: ______________________________ (counties or cities).
- Vehicles: ______ wheelchair, ______ stretcher, ______ ambulatory. Attendant available: ______________.
How rides are paid: we bill ______________________________ (Medicaid, brokers, health plans) directly for covered rides. For rides no program covers, we invoice ______________________________ at the rates on the attached rate sheet.
Proof we can send now: business license, certificate of insurance, NPI, Medicaid enrollment, driver background and exclusion checks, and HIPAA training records.
We would like to know who books rides for your ______________ (patients, residents, or clients), which rides are hardest to cover, and whether you buy rides through a request for proposals. If you do, please add us to your notice list for the next one.
Contact: ______________ (name and title), ______________ (phone), ______________ (email).
Signature: ______________________________ Printed name and title: ______________________________ Date: ______________
Part 4: Attachments
| Document | What it shows | Attached (yes or no) |
|---|---|---|
| IRS Form W-9, signed this year | Your legal name and taxpayer ID, for payment reporting | |
| Medicaid approval letter, or proof the application was submitted | Your enrollment status | |
| NPI record from NPPES | Your NPI and the name it is under | |
| Certificate of insurance | Auto, general liability, and workers’ compensation limits | |
| Business license and Secretary of State registration | That the company exists and is in good standing | |
| State NEMT permit or certificate, where your state requires one | That you may carry riders for pay in that state | |
| Vehicle list (type, year, last six of the VIN, inspection date) | What you can send | |
| Rate sheet (Letter B only) | What a facility or agency would pay | |
| Capability statement (counties and agencies) | Your company on one page |
For the rate sheet, start from the NEMT rate sheet template.
Part 5: Sending record
| Date sent | Sent to (name, office, email or address) | Letter and attachments | Reply expected by | Follow-up dates | Result |
|---|---|---|---|---|---|
What a letter of intent commits you to
Nothing, in most cases, and the buyer nothing either. MTM Health’s 2025 form calls the letter a show of good faith toward subcontracting, and says it is not a contract, not an obligation to provide services, and no limit on agreements with other brokers. IEHP’s 2026 form says completing it does not guarantee acceptance into its network. MediTrans says not every applicant is accepted, that acceptance depends on how full its network is and which vehicle types an area needs, and that it keeps the information of companies it turns down on file in case its needs change (provider page, October 2026).
The binding paper comes later: the provider agreement you sign after credentialing, or the facility agreement. Read it before you sign. A Medicaid health plan does not have to contract with every company that writes to it, as contracting with Medicaid health plans explains, and a facility deal needs its own written terms, which the facility transportation agreement template covers.
When the buyer has its own form
A buyer’s form shows exactly what it screens on, and a letter that skips those fields comes back. As of October 6, 2026:
- MTM Health takes an online Letter of Intent (2025 form), one for each state you want to serve. Count each vehicle under one type only, as the form asks. For 18 states and the District of Columbia, it asks for a state credential, such as Medi-Cal enrollment in California, an NPI in Texas, or a Public Utility Commission certificate in Pennsylvania, and for most of them it says a form without one will be voided. The full field list is on the MTM Health page.
- IEHP contracts with transportation companies directly and has managed its own NEMT trips since May 12, 2026. Email its 2026 Letter of Interest form, a W-9, and proof of Medi-Cal enrollment or of a submitted application to jointhenetwork@iehp.org. IEHP returns incomplete forms without considering them. What the form’s transportation section asks is on the IEHP page.
- Santa Clara Family Health Plan reviews your letter of interest and then contacts you (provider page last updated April 25, 2025). The form it links now, form 41646, goes to Contracting@scfhp.com by email or fax with documents such as a W-9 and your Medi-Cal approval. It says every contracted provider must bill electronically. It asks for your TIN, NPI, Medi-Cal provider number, and whether you have ever been charged, suspended, or sanctioned by Medicare, Medicaid, or any state or federal program. See Santa Clara Family Health Plan.
- MediTrans in Louisiana sends its letter of intent form on request or posts it in its provider portal. Return it to providers@meditrans.com, and its team contacts you within 3 to 5 business days. See MediTrans.
- Contra Costa Health Plan has taken NEMT companies through a continuous solicitation, CCHP-233, since May 1, 2025. It lists three minimum qualifications: active Medi-Cal enrollment with the state, California Secretary of State registration, and a current certificate of liability insurance. Answer it through the Contact Us form on the county’s contracting page. The plan’s provider page also asked for a letter of interest at CCHPcontracts@cchealth.org (May 2026). See Contra Costa Health Plan.
Medicaid enrollment comes before most plan and broker letters
Federal rules make the state screen and enroll every network provider of a Medicaid health plan, and a plan may sign you while your enrollment is pending for no more than 120 days (42 CFR 438.602(b)). Contracting with Medicaid health plans explains the rule.
Buyers apply it differently at the letter stage. IEHP accepts proof of a submitted Medi-Cal application with your letter, while Contra Costa Health Plan lists active enrollment as a minimum and MTM Health voids a California form without it. If you have not enrolled yet, start with how to become a Medicaid transportation provider, and put the application date in Part 1.
A notice of intent in a request for proposals
Public buyers use the same words for two other papers. Treat each by its own rules.
- A notice of intent to submit a proposal is your short written notice that you plan to bid. The Southern Mississippi Planning and Development District’s area agency on aging required one by April 24, 2026 for its transportation contract running October 1, 2026 to September 30, 2027, with proposals due by 5:00 p.m. on May 11, 2026. Its request said answers that clarify or change it, and any addenda, would go by mail to companies that sent a written notice on time and to others who asked in writing. If you might bid, send the notice by the deadline so those answers reach you. The area agency on aging transportation guide explains how those contracts are scored.
- A notice of intent to award is the buyer’s announcement of the company it plans to choose. It is not yet a contract. On May 21, 2026, Wisconsin’s Department of Health Services announced a notice of intent to select Verida as its NEMT vendor. As of October 6, 2026, its page (last revised August 25, 2026) sets no date for the change and tells transportation providers they do not need to do anything yet. The Wisconsin story tracks what happens next.
Offer service, never something for referrals
A letter to a facility or a caseworker is a request for referrals, so keep it to rides, hours, and rates. Knowingly and willfully offering or paying anything of value, in cash or in kind, to get someone to refer patients for services a federal health care program pays for is a felony, with a fine of up to $100,000, up to 10 years in prison, or both (42 U.S.C. 1320a-7b(b)). Leave out gift cards, free rides for staff, and any payment tied to the number of trips a facility sends. What counts and the safe ways to work with facilities are in anti-kickback rules for NEMT.
Frequently asked questions
Is a letter of intent to provide transportation services binding?
No. It states your interest and your current capacity, and the contract comes later, after credentialing. MTM Health's 2025 form says the letter is not a contract or an obligation to provide services and does not limit agreements with other brokers. IEHP says completing its form does not guarantee acceptance, and MediTrans says not every applicant is accepted.
What should a letter of intent for transportation services include?
Your legal name and any DBA, EIN, NPI, Medicaid provider ID or application date, state permits, vehicles by type with each counted once, the counties you serve, your hours including weekends and after hours, years in operation, insurance limits, and one contact person. Attach a W-9, proof of Medicaid enrollment, and your certificate of insurance.
Where do I send a letter of intent to a NEMT broker or health plan?
Wherever the broker or plan says to. As of October 2026, MediTrans takes its form at providers@meditrans.com, IEHP takes its form with a W-9 and Medi-Cal proof at jointhenetwork@iehp.org, and Santa Clara Family Health Plan takes its form at Contracting@scfhp.com. MTM Health uses an online form, one for each state. Contra Costa Health Plan takes interest through its NEMT solicitation, CCHP-233.
How long does it take to hear back?
It depends on the buyer and on how fast you send documents. MediTrans says its team contacts you within 3 to 5 business days and onboarding usually takes 2 to 4 weeks. MTM Health says its network team contacts companies based on its needs and available contracts. IEHP says a delay in your documents affects the contract's effective date.
Can I send a letter of intent before my Medicaid enrollment is approved?
Sometimes. A Medicaid health plan may sign a network agreement while your state enrollment is pending for up to 120 days. IEHP accepts proof that you submitted your Medi-Cal application. Contra Costa Health Plan lists active Medi-Cal enrollment as a minimum qualification, and MTM Health voids a California form without Medi-Cal enrollment. Check each buyer's rule first.
What is a notice of intent to submit a proposal?
A short written notice, required by some requests for proposals, saying you plan to bid. The Southern Mississippi area agency on aging required one by April 24, 2026 for its transportation contract, and said answers and addenda would be mailed to the companies that sent one on time and to others who asked in writing.