# NEMT Payment Log: Match Every Deposit and Remittance to a Trip

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

A NEMT payment log ties every payment you receive to the trips it pays for. Record each deposit with its remittance, give each remittance line its own row by trip number, and compare what was paid with what your rate sheet says the trip should pay. Send every short pay, denial, and takeback to follow-up the same week.

- Put your own trip number on every claim, so each remittance line points back to one trip.
- A deposit is net of takebacks: the remittance lines, plus or minus its adjustments, must equal the money that landed.
- Write the expected amount from the rate sheet or rate agreement in force on the date of service, so a short pay stands out.
- Reason code 45 is the normal gap between your charge and the rate. Short pays, denials, and takebacks are the lines to work.
- Log every takeback against the trip it came from, and return any overpayment within 60 days of finding it.

A deposit tells you how much money arrived. It does not tell you which rides it paid, which it paid short, or what it took back. Payers pay in batches, net of takebacks, and sometimes weeks after the remittance that explains them. This log turns each payment back into trips, so every ride you gave ends up marked paid, paid short, denied, or still waiting.

## How to use this template

1. **Fill in Part 1 once for each payer.** Write how it pays, when it pays, how its remittance arrives, and the date of the rate sheet or rate agreement you are paid under. List every payer: the state, each broker and health plan, facilities, and private pay riders.
2. **Put your trip number on every claim.** On the CMS-1500 it goes in item 26, the patient account number, which holds 14 characters, and the national instructions say payers report it back on the 835 remittance. New York's transportation claim returns up to 20 characters from field 10. A broker's trip ID does the same job on broker trips.
3. **Log remittances and deposits in Part 2 as each one arrives.** They do not always come together. New York posts its PDF remittance before the check date and starts the electronic deposit more than two weeks after it.
4. **Tie the two together.** Match the deposit's check or trace number to its remittance, then check that the amounts agree. Write any difference in the last column and find it before you move on.
5. **Give every remittance line a row in Part 3.** Copy the trip number, the payer's claim number, what you expected, what was paid, and the codes, then mark the status from the key. For a facility or private pay rider, your invoice number takes the place of the remittance number, and each ride on the invoice gets its own row.
6. **Put amounts not tied to one line in Part 4.** Recoupments, broker offsets, liquidated damages, and interest all go there, each matched to the trip or claim it came from.
7. **Send short pays and denials to the [claim denial log](https://nemtguide.com/templates/claim-denial-log/) the same day,** with their codes and the last day to act.
8. **Once a week, fill in Part 5** for every claim past its expected pay date. Check its status before you resend anything, so you never create a duplicate.
9. **Once a month, close Part 6.** Match the month's deposits to your bank statement and sign it.

For what each part of a remittance means, see [how to read a remittance advice](https://nemtguide.com/guides/read-remittance-advice/).

## The template

### Part 1: Payers and how they pay

| Payer | Pays by (EFT, check, or card) | Pay cycle and usual pay day | Remittance comes as (835, PDF, portal, or paper) | Rate sheet or agreement in force (date) | Who to call about a payment |
|---|---|---|---|---|---|
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### Part 2: Deposits and remittances

| Date received | Payer | Check no. or EFT trace no. | Amount received | Remittance no. and date | Remittance net total | Matches (yes, or the difference) |
|---|---|---|---|---|---|---|
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### Part 3: Remittance lines by trip

| Trip no. | Date of service | Payer claim no. | Expected | Paid | Codes (group, reason, remark) | Status (key) |
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Status key: P, paid as expected. S, short pay (write the difference, then log it on the claim denial log). D, denied (log it on the claim denial log). H, held or pended (carry it to Part 5). R, reversed or replaced (write the original claim number). X, paid more than you are owed (list it in Part 6).

### Part 4: Takebacks and other amounts not tied to one line

| Date | Payer | Payer's reference (notice, control number, or code) | Reason | Amount (minus for a takeback) | Trip or claim it relates to | Balance still owed |
|---|---|---|---|---|---|---|
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### Part 5: Claims past their expected pay date

| Trip no. | Payer | Date sent | Expected pay date | Status checked (date and how) | What the payer said | Next step and date |
|---|---|---|---|---|---|---|
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### Part 6: Monthly close

Month and year: ______________

| Line | Amount or count |
|---|---|
| Deposits logged in Part 2 this month | |
| Payer deposits on the bank statement this month | |
| Difference, and why | |
| Short pays sent to the claim denial log (count and dollars) | |
| Denials sent to the claim denial log (count and dollars) | |
| Takebacks logged in Part 4 (dollars) | |
| Takeback balances still owed at month end | |
| Overpayments found (trip numbers and dollars) | |
| Overpayments returned (date and how) | |

Closed by (signature and date): ______________________ Reviewed by the owner (signature and date): ______________________

## How to fill in the expected amount

The expected amount is what the payer owes for that code and those units on the date of service, under the fee schedule, rate sheet, or rate agreement in force that day. It is not your billed charge. Writing it down before you look at the paid column is what makes a short pay stand out.

Here is how it works with Arizona's fee-for-service rates effective October 1, 2026, for a one-way wheelchair van trip with 12 loaded miles:

| Trip | Base rate, [A0130](https://nemtguide.com/glossary/a0130/) | Mileage, [S0209](https://nemtguide.com/glossary/s0209/) | Expected |
|---|---|---|---|
| Starts in the Phoenix or Tucson metro area | $11.15 | 12 × $1.54 = $18.48 | $29.63 |
| Starts anywhere else in Arizona (rural, TN modifier) | $12.21 | 12 × $1.66 = $19.92 | $32.13 |

AHCCCS counts every trip that starts outside the Phoenix and Tucson metro areas as rural, billed with the TN modifier. If a rural trip comes back at $29.63, check whether the TN modifier made it onto the claim. Units matter as much as rates: reason code 151 means the payer decided the information did not support that many services, which on a mileage line usually means fewer miles allowed. [NEMT mileage billing](https://nemtguide.com/guides/nemt-mileage-billing/) covers how payers measure them.

Brokers pay from their own agreements, and some set the units as well:

- **Verida in Indiana** bases its NEMT rates on the Indiana Medicaid professional fee schedule, has each provider sign a rate agreement, and may negotiate higher or special rates with individual providers (transportation module, August 19, 2025). Use your signed agreement, not the state schedule.
- **WellTrans in Indiana** pays the lesser of your billed charge or its rate schedule. It measures miles with mapping software as the shortest distance from pickup to drop-off, rounded to the nearest whole mile, and decides which trips count as shared rides. Running the trip accepts its mileage (agreement revised October 16, 2025). Write its miles in the expected column, not your odometer's.
- **MTM Health in Virginia**, which takes over fee-for-service trips scheduled on or after October 1, 2026, figures each trip's pay from its Schedule A rate sheet for Virginia, based on mileage driven, the mode of transportation, and multiloading (handbook approved August 10, 2026). Keep your signed Schedule A beside the log, and figure a shared trip from its multiloading terms, not the single-rider rate.

Reason code 45, "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement," is the gap between your charge and the rate. X12 does not allow a reason 45 amount to equal the whole charge, so reason 45 alone never explains a line paid at zero. When the expected column holds the rate, a line with only CO 45 reads as paid as expected, and the rows left to work are the real problems.

## Matching a deposit to its remittance

**Electronic deposits.** HIPAA's standard for a health care payment sent through the ACH network is the NACHA CCD+ entry. Its addenda record carries the reassociation trace number from the TRN segment of the 835 ([45 CFR 162.1602](https://www.ecfr.gov/current/title-45/section-162.1602)). In the 835 itself, TRN02 holds the check number or the EFT reference number, and CLP01 holds your patient account number for each claim (South Dakota Medicaid's 835 addendum). State Medicaid programs count as HIPAA health plans (45 CFR 160.103). Brokers set their own payment formats, so ask each one what its deposit shows.

The federal operating rules, published August 10, 2012 and in force since January 1, 2014, require providers to contact their own bank to receive each deposit's effective date, amount, trace type, trace number, and payer ID. They also require a health plan to send the EFT within three days of the remittance. A remittance with no deposit, or a deposit with no remittance, is worth a call once that window passes. See [835 ERA](https://nemtguide.com/glossary/835-era/) and [EFT enrollment](https://nemtguide.com/glossary/eft-enrollment/) for how to sign up with each payer.

**Paper and PDF remittances.** New York's guideline (version 2013-01) gives the rule to copy: the net financial transaction amount, added to the claim detail grand total, must equal the Medicaid check or EFT amount. Each takeback in its financial transactions section carries a financial control number (FCN). Write that number in Part 4.

**Card payments.** Some plans pay with a virtual credit card. CMS says the HIPAA standards allow it, that card networks typically charge providers a percentage of each payment, and that a health plan must pay with the standard EFT and 835 if you ask it to (guidance letter GL-2022-04, March 22, 2022). If you accept a card payment, log the fee as its own line so the deposit still ties to the remittance.

## What each status means and where the row goes next

| What the remittance shows | How to spot it | Status | Next step |
|---|---|---|---|
| Paid as expected | Paid equals expected, and any CO 45 is only the gap from your charge | P | None |
| Paid short | Fewer units allowed (reason 151), an old rate, or a missing modifier | S | Claim denial log, for a corrected claim or an appeal. Indiana Medicaid wants a paid claim with your own billing error fixed by adjustment or void and replacement within 60 days of the remittance date. |
| Denied | $0 paid. In an 835, claim status code 4. | D | Claim denial log |
| Pended | Reason 133 with group OA: the line is pending further review | H | Part 5. X12 requires the payer to reverse and correct the line once it is finalized. |
| Reversed | Negative amounts, and in an 835, claim status code 22 (reversal of previous payment) | R | Match the payer's claim number to the original trip, then look for the corrected line on the same or a later remittance. |
| Takeback not tied to a claim line | A line in the financial or provider adjustment section | Part 4 | Match it to the original trip and track the balance |
| Interest | Under Indiana law, clean paper claims not decided within 30 days and clean electronic claims not decided within 21 days are subject to interest, with a few exceptions | Part 4 | Record it as money in |

Takebacks often come out before the deposit is figured. Indiana calculates each weekly payment from paid claims, less outstanding receivables and liens. A remittance can even arrive with no money at all: New York issues a summout when a cycle's approved claims are less than or equal to the recoupments scheduled for it, and Illinois's 835 companion guide (December 2011) says the state does not pay vouchers under one dollar. Log those remittances like any other, because every trip on them still changes status.

## When each payer usually pays

Set each claim's expected pay date in Part 5 from the date you sent it plus the payer's cycle.

| Payer | When the money comes | What to watch |
|---|---|---|
| Texas Medicaid through TMHP (provider manual, September 2026) | Weekly cycle. The R&S Report posts as a PDF each Monday after the cycle, and payments are released the next Friday. The 835 file is ready by the Thursday of payment week. | If a claim is not in Claims In Process, or listed as paid, denied, or incomplete, within 30 days, resubmit it inside 95 days of the ride. Electronic billers tell TMHP when an accepted claim is missing from the R&S within ten workdays. |
| Indiana Medicaid (financial module, March 13, 2025) | The financial cycle runs every Friday. Checks are dated, and EFT deposits land, the Wednesday after. | Payments come net of outstanding receivables and liens. The weekly remittance posts in the IHCP Provider Healthcare Portal. |
| New York Medicaid (eMedNY cycle calendar, April 2025) | Cycles run Thursday to Wednesday, with the check date on the next Monday. PDF remittances post the Thursday before the check date. The EFT starts on the Wednesday two weeks and two days after the check date. | Log the remittance when it posts. The deposit comes close to three weeks later. |
| Verida, Indiana fee-for-service (state module, August 19, 2025) | Clean claims submitted by Wednesday of each week are paid within 14 days, by check or EFT | A remittance comes with each payment cycle |
| MTM Health standard agreement (January 1, 2023 version Pennsylvania posts) | Properly submitted, uncontested invoices within 30 days after online submission | Overpayment recoveries and liquidated damages come out of later payments |
| WellTrans, Indiana (agreement revised October 16, 2025) | Twice a month, within 30 days after submission, by check or electronic transfer. A payment date on a holiday moves to the next working weekday. | WellTrans may delay payments while its own client has not paid it |
| Arizona AHCCCS fee-for-service (Chapter 28, revised November 19, 2025) | Check the claim's status in AHCCCS Online, which shows whether it was received and processed | Allow 14 days after you send a claim before asking about it, and ask well before 6 months from the date of service, the limit for a first claim |
| State Medicaid agencies, federal standard ([42 CFR 447.45](https://www.ecfr.gov/current/title-42/section-447.45)) | 90 percent of clean claims from practitioners in individual or group practice within 30 days of receipt, and 99 percent within 90 days. All other claims within 12 months of receipt. | Medicaid health plan contracts must meet the practitioner standard unless the plan and its providers agree to a different schedule in the contract (42 CFR 447.46) |

A claim past its expected date is not always late in the contract's terms. [NEMT broker late payment](https://nemtguide.com/guides/nemt-broker-late-payment/) explains when it is and what to send, and [NEMT accounts receivable](https://nemtguide.com/guides/nemt-accounts-receivable/) shows how to age what is still open.

## When a payer pays too much or takes money back

**Paid too much.** A trip paid twice, a canceled ride that was paid, or a line paid above your rate is an overpayment. Federal law requires you to report and return it, with a written reason, within 60 days after you identify it. Money kept past that date becomes an obligation under the False Claims Act (42 U.S.C. 1320a-7k(d)). Indiana does not apply its 180-day filing limit to overpayment adjustments, but it wants an explanation attached for a partial recoupment, or it recoups the whole claim. List each one in Part 6 with the date you returned it. See [the 60-day overpayment rule](https://nemtguide.com/guides/medicaid-overpayment-60-day-rule/).

**Money taken back.** Brokers usually recover money from later payments rather than asking for a check:

- **MTM Health's standard agreement** lets it recover overpayments by offsetting future payments, and lets it withhold, offset, recoup, and deduct liquidated damages from any amount it owes you.
- **WellTrans's Indiana agreement** lets it offset duplicate payments and overpayments. When a medical office reports that a rider missed the appointment on a paid trip, a provider that does not answer WellTrans in writing within 30 days is treated as confirming the trip did not happen, and the trip comes out of the next payment. If no payment is due, the money is owed within 30 days of written demand.

Write each takeback in Part 4 with the trip it came from, and change that trip's status in Part 3. A takeback you cannot match to a trip is the first thing to ask the payer about. [Medicaid recoupment](https://nemtguide.com/guides/medicaid-recoupment/) covers how to dispute one.

A takeback can also reopen a trip. When AHCCCS recoups a payment for a reason other than third-party recovery, such as missing documentation, you may resubmit a clean claim within the latest of 12 months from the date of service, 12 months from a retroactive eligibility posting, or 60 days from the adverse action, the status date printed on the remittance. That extra time does not apply when the AHCCCS Office of Inspector General recoups for misrepresentation (Chapter 4, revised November 3, 2025). Write the new last day in Part 4 and send the row to the [claim denial log](https://nemtguide.com/templates/claim-denial-log/).

## How long to keep the log

Keep each month's log with its remittances and bank statements for as long as your longest record rule. New York requires Medicaid providers to keep all information about their 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 records for 10 years, and WellTrans's Indiana agreement for the contract term plus 10 years. The log is often the fastest answer to an auditor's question about a single trip: the claim, the remittance line, and the deposit, all on one row.

## Frequently asked questions

### What is the difference between a payment log and accounts receivable?

Accounts receivable is what you are still owed. A payment log is what arrived and which trips it paid. Kept side by side, they answer the same question from both ends: every completed trip is either on the payment log as paid, or still open on your receivables list with a status and a next step.

### How do I match an electronic deposit to its remittance?

Use the trace number. Under HIPAA, a health plan paying through the ACH network puts a reassociation trace number in the deposit record, and the same number appears in the TRN segment of the 835 remittance. Ask your bank to show each deposit's date, amount, trace number, and payer ID. The federal operating rules expect providers to arrange that with their bank.

### What counts as a short pay on a NEMT claim?

A line paid less than the rate you are owed for that code and those units on the date of service. Reason code 45 on its own is not a short pay: it is the gap between your billed charge and the payer's rate. Short pays include fewer miles allowed, an old rate, a rural modifier left off the claim, or a shared-ride rate you did not expect.

### Why did I get a remittance but no money?

Takebacks can use up the whole payment. New York sends a summout instead of a check when the approved claims are less than or equal to the recoupments scheduled for that cycle. Illinois does not pay vouchers under one dollar. Log the remittance anyway, mark each trip, and track the balance still owed in Part 4.

### Can a broker take money back from later payments?

Yes, when your agreement allows it, and most do. MTM Health's standard agreement lets it recover overpayments by offsetting future payments and lets it deduct liquidated damages. WellTrans's Indiana agreement lets it offset duplicate payments and overpayments, and deduct trips it finds a rider did not attend. Log each deduction in Part 4 against the trip it came from.

### How long should I keep payment records?

At least as long as your longest rule. New York requires Medicaid providers to keep all claim information for six years from the date of service, and trip records for six years after payment. MTM Health's standard agreement requires 10 years, and WellTrans's Indiana agreement requires the contract term plus 10 years. Keep each remittance with its page of the log.

## Official resources

- [X12: Claim Adjustment Reason Codes (the full list)](https://x12.org/codes/claim-adjustment-reason-codes)
- [X12: Claim Adjustment Group Codes](https://x12.org/codes/claim-adjustment-group-codes)
- [eCFR: 45 CFR 162.1603, EFT and remittance advice operating rules](https://www.ecfr.gov/current/title-45/section-162.1603)
- [CMS: Virtual credit cards and your right to standard EFT and ERA (GL-2022-04)](https://www.cms.gov/files/document/guidance-letter-vcc-eft-era.pdf)
- [eMedNY: Remittance Advice Guideline (paper and PDF layout)](https://www.emedny.org/ProviderManuals/AllProviders/General_Remittance_Guidelines.pdf)
- [eMedNY: Cycle Processing Calendar](https://www.emedny.org/hipaa/news/PDFS/CYCLE_CALENDAR.pdf)
- [TMHP: Claims filing and R&S Report schedule (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: Financial Transactions and Remittance Advice module](https://www.in.gov/medicaid/providers/files/modules/financial-transactions-and-remittance-advice.pdf)
- [AHCCCS: Ground transportation fee schedules by year](https://www.azahcccs.gov/PlansProviders/RatesAndBilling/FFS/transportationground.html)