# NEMT Credentialing Checklist: Every Document Brokers and Health Plans Ask For

Canonical URL: https://nemtguide.com/templates/nemt-credentialing-checklist/ · Updated 2026-09-28

NEMT credentialing is the document check a broker or health plan runs before it sends you trips. Have your formation papers, IRS EIN letter, W-9, NPI, state Medicaid ID, owner details, insurance certificates naming the broker, vehicle registrations and inspections, driver files, and signed policies ready. Brokers such as MTM Health pay nothing for trips run by uncredentialed drivers or vehicles.

- Get your IRS EIN letter, NPI, and state Medicaid ID first, since applications such as MTM Health's ask for all three.
- Every owner of 5 percent or more and every managing employee is disclosed and checked against federal exclusion lists.
- Insurance certificates must name the broker as certificate holder, and often as additional insured, before the first trip.
- Nothing runs until it is approved: MTM Health pays nothing for trips by uncredentialed drivers or vehicles.
- Track every expiration date and upload renewals early. MTM Health in Rhode Island wants them 10 business days ahead.

Every broker and health plan checks your company, your owners, your insurance, your vans, and your drivers before it sends a single trip. This checklist puts every document in one place, with where to get it and when it expires. Work through it before you apply, and keep it current after you are approved.

## How to use this template

1. **Start with Part 1.** The company items take the longest: the EIN letter, the NPI, and state Medicaid enrollment. Broker applications ask for all three.
2. **Print one copy for each broker or plan.** Their lists overlap, but each has its own limits and forms. Write the payer's name at the top of Part 1.
3. **Use one legal name and address everywhere.** Match the IRS letter exactly on the NPI record, insurance, state filings, and bank account.
4. **Scan every document into one folder.** Name each file with the item and its expiration date.
5. **Fill in every date column.** Put renewals in Part 8, with a reminder 30 days before each one.
6. **Send the file only when it is complete.** Check each item against the broker's own list first.

Your driver and vehicle files have their own checklists: the [driver qualification file checklist](https://nemtguide.com/templates/nemt-driver-file-checklist/) and the [vehicle inspection checklist](https://nemtguide.com/templates/nemt-vehicle-inspection-checklist/). For the steps around the paperwork, see [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/).

## The template

### Part 1: Company identity

| Field | Entry |
|---|---|
| Broker or health plan this copy is for | |
| Date started | |
| Broker contact, name and phone | |

| Item | Where to get it | Have it (yes or no) | Number or expiration |
|---|---|---|---|
| Legal name and any DBA, exactly as on IRS records | Formation papers and the IRS EIN letter | | |
| Articles of organization or incorporation | Your state's Secretary of State | | |
| Certificate of good standing | Your state's Secretary of State | | |
| IRS EIN letter (CP575 or Letter 147C) | IRS Business Tax Account, or call 800-829-4933 | | |
| Signed Form W-9, March 2024 revision | irs.gov | | |
| Type 2 (organization) NPI and taxonomy code | NPPES, at nppes.cms.hhs.gov | | |
| State Medicaid provider ID | Your state Medicaid enrollment portal | | |
| State transportation permit or operating authority | Your state DOT, DMV, or utility commission | | |
| City or county business license and local permits | Your city or county | | |
| USDOT number and FMCSA operating authority, if FMCSA requires them for your trips across state lines | FMCSA | | |
| Counties served, days and hours, and vehicle count by type | You | | |
| Business start date and owner or manager contact | You | | |
| Small or minority business certification (optional) | Your state's program | | |

### Part 2: Owners and managers

One row for each person with an ownership or control interest of 5 percent or more, each officer, director, or partner, and each managing employee.

| Name | Role and ownership percent | Home address on file | Date of birth and SSN on file | OIG list search date | SAM.gov search date | State list search date | Criminal convictions to disclose |
|---|---|---|---|---|---|---|---|
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |

### Part 3: Insurance

| Coverage or form | Limit the contract requires | Your limit | Carrier and rating | Policy number | Expires | Broker named on it (yes or no) |
|---|---|---|---|---|---|---|
| Commercial general liability, per occurrence and aggregate | | | | | | |
| Commercial auto liability, combined single limit | | | | | | |
| Hired and non-owned auto | | | | | | |
| Workers' compensation, or the state's exemption letter | | | | | | |
| Umbrella or excess | | | | | | |
| Certificate of insurance with the broker as certificate holder | | | | | | |
| Additional insured endorsement | | | | | | |
| Notice of cancellation endorsement | | | | | | |
| Waiver of subrogation | | | | | | |
| Schedule listing every vehicle on the auto policy | | | | | | |

### Part 4: Vehicles

| Unit | Year, make, model | VIN | Plate | Type and seats | Registration expires | Last inspection | Lift or ramp certified | Insurance card | Photos taken |
|---|---|---|---|---|---|---|---|---|---|
| | | | | | | | | | |
| | | | | | | | | | |
| | | | | | | | | | |
| | | | | | | | | | |

### Part 5: Drivers and attendants

| Name | License number and expiration | Driving record date | Background check date | Drug test date | Exclusion search date | Training complete | Broker approval date |
|---|---|---|---|---|---|---|---|
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |
| | | | | | | | |

### Part 6: Policies, training, and agreements

| Item | Done (yes or no) | Date |
|---|---|---|
| Drug and alcohol policy (substance-free workplace) | | |
| HIPAA privacy policy and staff training | | |
| Fraud, waste, and abuse training for every employee, yearly | | |
| Business associate agreement with the broker | | |
| Complaint and incident reporting procedure | | |
| Emergency and bad weather plan | | |
| Driver orientation and training program | | |
| Compliance program certification, where the state requires one | | |
| Broker orientation or portal training | | |

### Part 7: Payment and trip setup

| Item | Done (yes or no) | Notes |
|---|---|---|
| Direct deposit form and voided check | | |
| Signed provider agreement | | |
| Rate sheet signed with the agreement | | |
| Portal logins for the owner, dispatch, and billing | | |
| Driver app or vehicle tracking set up | | |
| Trip software connected to the broker, if you use one | | |
| Broker provider ID received | | |

### Part 8: Renewal tracker

| Item | Expires | Reminder date | Uploaded to broker | Approved |
|---|---|---|---|---|
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |

## What brokers and health plans ask for

Each broker keeps its own list. MTM Health's is Appendix B of its provider agreement. These are the written lists from several brokers and one health plan, with their dates.

| Broker or plan | Company and insurance | Vehicles | Drivers | Rule and date |
|---|---|---|---|---|
| MTM Health | Certificate of good standing on request. Liability of at least $500,000 general and $500,000 auto, with MTM as additional insured, notice of cancellation, and waiver of subrogation. Workers' compensation or proof of exemption. Some states require more: Wisconsin asks for a $1 million combined single limit for general and auto liability, with MTM as certificate holder and additional insured. | State registration or inspection sticker, ADA compliance for wheelchair vehicles, and vehicle tracking | License, background check at hire and yearly, 3-year driving record yearly, drug tests, and training certificates | Standard agreement, January 1, 2023 version Pennsylvania posts; Wisconsin page, September 2026 |
| MTM Health, Virginia | Business license, DMV intrastate authority, and FMCSA authority, each with its expiration date, plus any EMS permit and your NPI | Inspection and license dates, insurance expiration, plate and registration copies, and seats | Date of birth, SSN, training dates, license expiration, last background check, drug test, and record review | Provider handbook, approved August 10, 2026 |
| Verida, Georgia | Business license and proof of liability insurance: an insurer rated A- or better, a general liability policy with what Verida lists as "$1 M SAM coverage with $2M aggregate", and auto coverage for all owned, hired, and non-owned vehicles. Verida asks you to confirm the limits with its provider relations manager. | The vehicles on the auto policy, and a safety inspection by Verida | Driver credentials, background checks, and driving records, plus drug screens for all owners and drivers | Georgia provider page, September 2026 |
| SafeRide Health | SafeRide as additional insured on the certificate, general liability of at least $1 million per occurrence and $2 million aggregate, and auto liability of at least $500,000 | Registration and insurance | License, Social Security card, national background check, national sex offender registry check, driving record, pre-hire drug screen, and first aid, defensive driving, and securement training | Provider page, September 2026 |
| MediTrans, Louisiana | Auto liability of at least $1 million per occurrence, general liability, and workers' compensation or an approved waiver, with MediTrans as certificate holder | Registration, inspection report, insurance declaration page, inside and outside photos, and ADA papers if any | License, background check clearance, defensive driving and CPR or first aid certificates, and drug test results | Provider page, September 2026 |
| CareOregon | Proof of insurance before the first ride, at each renewal, and at any change. Copies of all licenses and certifications. | Registration, a safety inspection by an ASE-certified mechanic within the last year, a yearly ADA check for wheelchair vans, and an insurance card or ACORD certificate | License of the right class, OIG exclusion check, criminal background check, and first aid and CPR before driving. Defensive driving and passenger safety courses within three months of hire, then every three years. | Transportation Provider Manual, version 1.3, February 2024 |

A few more rules shape the file. Verida has you submit its Request for Qualifications with driver and vehicle lists first, and asks for documents only if it needs providers in your area. MTM Health says its system will not assign trips to a provider whose credentials are not current. Modivcare says it visits providers in the field to confirm that vehicles meet contract standards (provider page, September 2026). For each broker's full steps, see [MTM Health](https://nemtguide.com/brokers/mtm-health/), [Verida](https://nemtguide.com/brokers/verida/), [SafeRide Health](https://nemtguide.com/brokers/saferide-health/), and [Modivcare](https://nemtguide.com/brokers/modivcare/).

## The federal screening behind every checklist

Every state Medicaid program has to check the same basics, and brokers pass those checks down to you.

- **Driver minimum.** Since section 209 of the Consolidated Appropriations Act, 2021, each state must make sure every NEMT provider and driver is not excluded from federal health programs and every driver has a valid license. Each provider must also have a process for state drug law violations and for reporting each driver's driving history to the state (SMD 23-006, September 28, 2023).
- **Broker oversight.** A state broker program must make sure transport staff are "licensed, qualified, competent, and courteous" ([42 CFR 440.170](https://www.ecfr.gov/current/title-42/section-440.170)).
- **Ownership disclosure.** You disclose the name, address, date of birth, and SSN of each person with an ownership or control interest and each managing employee. It is due when you apply, when you sign the provider agreement, at revalidation, and within 35 days after an ownership change ([42 CFR 455.104](https://www.ecfr.gov/current/title-42/section-455.104)). An ownership or control interest means 5 percent or more, or being an officer, director, or partner.
- **Criminal history.** You disclose any owner, agent, or managing employee convicted of a Medicare or Medicaid crime ([42 CFR 455.106](https://www.ecfr.gov/current/title-42/section-455.106)). A 5 percent owner with such a conviction in the last 10 years generally means denial ([42 CFR 455.416](https://www.ecfr.gov/current/title-42/section-455.416)).
- **Database checks.** The state checks the Social Security Death Master File, NPPES, the OIG exclusion list, and the federal excluded parties list, now part of SAM.gov. It checks the exclusion lists at least monthly ([42 CFR 455.436](https://www.ecfr.gov/current/title-42/section-455.436)).
- **Risk level.** Moderate and high risk providers get site visits before and after enrollment. High risk adds a criminal background check and fingerprints from each 5 percent owner, due within 30 days of a request ([42 CFR 455.450](https://www.ecfr.gov/current/title-42/section-455.450) and [455.434](https://www.ecfr.gov/current/title-42/section-455.434)). CMS says states may raise transportation from limited to moderate or high risk.
- **Application fee.** CMS set the fee at $750 for applications filed in 2026. States collect it before signing a provider agreement, unless you are enrolled in, or already paid the fee to, Medicare or another state ([42 CFR 455.460](https://www.ecfr.gov/current/title-42/section-455.460)).
- **Revalidation.** The state revalidates every provider at least every 5 years ([42 CFR 455.414](https://www.ecfr.gov/current/title-42/section-455.414)).

Health plans add their own layer. Each Medicaid plan must follow a documented process for credentialing and recredentialing, and it may not contract with excluded providers ([42 CFR 438.214](https://www.ecfr.gov/current/title-42/section-438.214)). The state must screen and enroll every network provider of those plans. A plan may sign you while your enrollment is pending, but for no more than 120 days ([42 CFR 438.602](https://www.ecfr.gov/current/title-42/section-438.602)). See contracting with Medicaid health plans and [how to become a Medicaid transportation provider](https://nemtguide.com/guides/how-to-become-a-medicaid-transportation-provider/).

## State credentials brokers ask about

MTM Health's 2025 letter of intent form, in use as of September 2026, asks for a state credential in many states. Have yours before you apply.

| State | What MTM Health's form asks for |
|---|---|
| Arizona | AHCCCS ID |
| California | Medi-Cal enrollment |
| Connecticut | DOT permit |
| Illinois | IMPACT ID |
| Kansas | KMAP ID |
| Maryland | Public Service Commission certificate |
| Michigan | CHAMPS ID |
| Minnesota | STS certification through MnDOT, the MnDOT number, and UMPI numbers for drivers |
| Nebraska | Public Service Commission certificate |
| North Carolina | NCTracks registration |
| Ohio | EMS license and ODM ID |
| Pennsylvania | Public Utility Commission certificate |
| Rhode Island | NEMT certificate |
| Virginia | State operating authority certificate |
| Washington, DC | WMATC certificate |

The same form asks for your EIN, NPI, Medicaid ID, counties served, vehicle counts, and insurance limits. For what each state requires, see [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/) and our [state guides](https://nemtguide.com/states/).

## Getting the company items

**EIN letter.** The IRS gives three ways to confirm an EIN: a business entity transcript, a digital CP575 notice in your Business Tax Account, or Letter 147C, which you request from its business and specialty tax line at 800-829-4933 (IRS page, updated July 17, 2026). New York Medicaid wants this letter with your FEIN and applicant name, and says a W-9 is not acceptable.

**W-9.** Brokers use it to report what they pay you. The current revision is dated March 2024. Sign it with the same name and EIN as the IRS letter.

**NPI.** Apply for a Type 2 NPI for the company in NPPES. The taxonomy codes for NEMT include 343900000X for non-emergency medical transport (van), 344600000X for taxi, and 347C00000X for private vehicle, in NUCC code set version 26.1. Update your NPPES record within 30 days of any change ([45 CFR 162.410](https://www.ecfr.gov/current/title-45/section-162.410)). See [how to get an NPI number for NEMT](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/).

**Exclusion searches.** Search every owner, manager, and driver on the OIG list and SAM.gov, and keep a saved copy of each result. The OIG online search takes up to five names at a time and can confirm a match with an SSN or EIN. OIG generally updates the list by the middle of each month. See the [OIG exclusion list](https://nemtguide.com/glossary/oig-exclusion-list/) and keep an exclusion screening log.

**State Medicaid enrollment.** Apply in your state's portal and expect the fee, the disclosures, and possibly a site visit. New York's transportation enrollment (page updated May 2026) asks for the $750 fee, an EFT authorization, an ETIN certification, a prior conduct questionnaire if you answer yes to its questions, copies of your permits and licenses, the IRS letter, a signed attestation, and a letter of support from [Medical Answering Services](https://nemtguide.com/brokers/medical-answering-services/), which assigns New York Medicaid trips. That letter has been required for new applications submitted after April 15, 2024.

## Keeping credentials current

Approval is not the end. Every credential has a date, and brokers act on it.

| Rule | What happens | Rule and date |
|---|---|---|
| MTM Health, Rhode Island | Upload renewals at least 10 business days before expiration. Under 5 days, trips can come off the manifest on the expiration date. | Provider handbook, updated July 1, 2026 |
| MTM Health, Virginia | Using a driver or vehicle with an expired credential costs 2 points for each expired credential, and trips by drivers with expired documents can go unpaid | Provider handbook, approved August 10, 2026 |
| CareOregon | Missing papers or a lapse in insurance can stop new trips, and trips assigned for the uncovered time are removed | Transportation Provider Manual, February 2024 |
| MediTrans, Louisiana | A provider out of compliance loses its standing orders, and trips resume only after a corrective action plan | Provider page, September 2026 |
| Louisiana Medicaid | Send the broker the registration and certificate of insurance for each new vehicle before it is used | Manual chapter 10, issued July 14, 2025 |
| Federal rule | Report ownership changes within 35 days and NPI changes within 30 days | 42 CFR 455.104 and 45 CFR 162.410 |

Put every date from Parts 3 to 5 in Part 8, and review it each month. For the full recheck cycle, see NEMT recredentialing and reporting changes to Medicaid.

## Why credentialing gets stuck

- **Names that do not match.** The IRS letter, NPI record, insurance, state filings, and bank account all need the same legal name.
- **Certificates missing the broker.** MTM Health and MediTrans want to be the certificate holder, and MTM Health and SafeRide Health want additional insured status too. Ask your agent for the broker's exact wording. See certificate of insurance.
- **Vehicles missing from the auto policy.** MTM Health's standard agreement says a scheduled auto policy must list every vehicle, and you must tell MTM right away about additions and removals.
- **Unfinished applications.** SafeRide Health restarts an application not completed within 30 days. New York deletes an enrollment application not submitted within 45 days of starting it.
- **Owners left out.** Every 5 percent owner must be disclosed and screened. A missing or false disclosure can end the enrollment.
- **Applying where no one is needed.** Verida and MediTrans first check whether your area needs providers. See [how to get NEMT broker contracts](https://nemtguide.com/guides/how-to-get-nemt-broker-contracts/) for how to find the openings.

## Frequently asked questions

### What documents do I need for NEMT broker credentialing?

Company papers (formation documents, IRS EIN letter, W-9, NPI, state Medicaid ID, business license, and any state transportation permit), owner details for exclusion checks, insurance certificates naming the broker, and a file for every vehicle and driver. Vehicles need registration, inspection, and insurance proof. Drivers need a license, driving record, background check, drug test, and training certificates. Add signed policies and a direct deposit form.

### How long does NEMT credentialing take?

Plan on weeks, not days. MediTrans in Louisiana says onboarding typically takes 2 to 4 weeks from its letter of intent to activation, and its background checks take 5 to 7 business days, as of September 2026. The clock often starts only after the broker confirms it needs providers in your area. State Medicaid enrollment, which many brokers want first, is a separate step on its own timeline.

### Do I need Medicaid enrollment before a broker or health plan will credential me?

Often, yes. Federal rules require the state to screen and enroll every network provider of a Medicaid health plan, and a plan may contract with you for up to 120 days while that enrollment is pending (42 CFR 438.602). MTM Health's application asks for your Medicaid ID. In New York, a new transportation enrollment needs a letter of support from Medical Answering Services.

### Is there a fee for NEMT credentialing?

The state enrollment step can carry one. CMS set the 2026 provider enrollment application fee at $750, and states collect it before signing a provider agreement unless you are enrolled in, or already paid it to, Medicare or another state. New York charges it to transportation providers. Also budget for insurance, background checks, drug tests, and inspections.

### Can I send a W-9 instead of my IRS EIN letter?

Not everywhere. New York Medicaid asks for the IRS letter showing your FEIN and applicant name and says a W-9 is not acceptable. The IRS offers three ways to confirm an EIN: a business entity transcript, a digital CP575 notice in your Business Tax Account, or Letter 147C by phone at 800-829-4933. Send the W-9 as well, since brokers use it for tax reporting.

### What is recredentialing?

The regular recheck after you are approved. Medicaid health plans must follow a documented process for credentialing and recredentialing their network providers (42 CFR 438.214), and states revalidate every provider at least every 5 years (42 CFR 455.414). Brokers also recheck each expiring item. MTM Health in Rhode Island wants renewals uploaded 10 business days before expiration.

## Official resources

- [CMS: NPPES, apply for or update an NPI](https://nppes.cms.hhs.gov/)
- [HHS OIG: Search the exclusion list (LEIE)](https://exclusions.oig.hhs.gov/)
- [SAM.gov: Search federal exclusions](https://sam.gov/search/?index=ex)
- [IRS: Confirm your EIN (CP575 or Letter 147C)](https://www.irs.gov/businesses/small-businesses-self-employed/employer-identification-number)
- [IRS: Form W-9 and instructions](https://www.irs.gov/forms-pubs/about-form-w-9)
- [eCFR: 42 CFR 455 subpart E, provider screening and enrollment](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-455/subpart-E)
- [MTM Health: Join the transportation provider network](https://www.mtm-inc.net/driverswanted/)
- [Verida: Credentialing process for transportation providers](https://verida.com/provider-driver-training/)
- [SafeRide Health: Credentialing requirements for NEMT providers](https://www.saferidehealth.com/what-to-expect-nemt-provider)