NEMT Payer Mix Calculator (2027): How Much of Your Revenue Rides on One Payer

What the payer mix calculator does

When you start with one broker, that broker is the business for a while. The calculator puts a number on how much still depends on a single payer. You enter what each payer sends you in a month, and it finds the largest one. Then it shows that payer’s share of your revenue and the money that would stop if it left.

A payer is anyone you bill under an agreement: a broker, a health plan with its own ride network, the state Medicaid agency where it pays ride providers directly, a hospital or dialysis center, a PACE program, or an aging agency. Private pay riders go in their own box. They count toward your total, but they are never the payer at risk, because no single notice ends them all.

Use it when you sign a new contract, before you apply for a loan or line of credit, when a health plan announces a new broker, and once a quarter as your work shifts. The guide to NEMT payer mix covers the risks behind the number and which payers to add.

How to use the calculator

1. Pull a typical month of payments for each payer from your bank deposits or remittance reports.
2. Enter up to five payers, one per box, in any order. Leave a box at zero if you have fewer.
3. Enter what riders and families paid you themselves in the private pay box.
4. Read the revenue at risk a month, your biggest payer’s share, and the revenue left without it.
5. Run it again with each health plan behind your broker as its own payer, as the section below explains.

The results change as you type. Reset to example puts the example numbers back, and Show the formula lists every step of the math.

What each number means

Box	What to enter	Where to find it
Payer 1 revenue a month	What one payer paid you in a month, after denials and deductions	The payer’s remittance advice or payment report, matched to your bank deposits
Payers 2 to 5 revenue a month	The same for each other payer	The same reports. A payer you do not have stays at 0.
Private pay revenue a month	What riders and families paid you themselves	Your card processor and payment records

The results read like this:

Result	What it tells you
Revenue at risk a month if your biggest payer leaves	The monthly revenue that ends with your largest agreement
Share of revenue from your biggest payer	That amount as a percent of everything you took in
Revenue at risk a year	The same loss over 12 months, the number a lender or buyer will look at
Revenue a month from all payers	Your total, private pay included
Revenue left a month without your biggest payer	What would still come in to pay your bills

Enter money received, not money billed. The SBA’s guide to managing your finances explains the difference: the cash method records a sale only when the payment arrives. That view fits this question best, because a denied claim or a penalty offset never pays a bill. If your trips rise and fall with the seasons, use 12 months of payments divided by 12.

A worked example

The calculator opens with example numbers that show the math. They are not a typical company or a market rate, so replace them with your own.

Step	Math	Result
Revenue a month from all payers	$12,000 + $4,000 + $2,500 + $500 + $0 + $1,000 private pay	$20,000
Revenue at risk a month	The largest of payers 1 to 5	$12,000
Share of revenue from your biggest payer	$12,000 ÷ $20,000 × 100	60%
Revenue at risk a year	$12,000 × 12	$144,000
Revenue left a month without your biggest payer	$20,000 minus $12,000	$8,000

If payer 1 ended its agreement, this company would keep $8,000 a month, 40 percent of what it takes in now. The next question is whether $8,000 a month can carry the business while it replaces that work. The section on months your cash covers shows how to answer it.

Run it again with the health plans behind your broker

In states where health plans arrange Medicaid rides, one broker often carries trips for several plans, and each plan picks its own broker. When a plan switches, its riders move to the new broker’s network even while your broker agreement stays in place. Blue Cross and Blue Shield of Texas told providers on June 29, 2026 that its Medicaid rides move from Modivcare to MTM Health on October 1, 2026. Recurring trips and trips already scheduled after that date go to MTM Health. Blue Cross and Blue Shield of New Mexico announced the same move on July 15, 2026, for November 1, 2026.

So run the calculator a second time. Split your broker’s payments by the health plan behind each trip, and enter each plan as its own payer. In the example, say payer 1’s $12,000 comes from two plans: $7,000 from one and $5,000 from the other. Put $7,000 in payer 1 and $5,000 in payer 5. The biggest risk is now $7,000 a month, 35 percent, with $13,000 a month left.

The first run shows what one agreement ending would cost. The second shows what one plan switching brokers would cost. Plan the business around the larger of the two. In Texas, the Health and Human Services Commission lists which ride vendor each Medicaid health plan uses, which helps you see which plans sit behind your trips. Check it against each plan’s provider news too, because the list may not show a switch until the switch date.

A whole state can move too. When a state runs NEMT through a brokerage program, federal rules require it to pick the broker through competitive bidding (42 CFR 440.170(a)(4)). Each new contract period can bring a new broker for the whole program at once.

How fast a payer’s revenue can stop

The share tells you how much is at risk. The agreement tells you how fast it can go. These are published terms:

Agreement or notice	What it says about volume	How much notice
MTM Health standard agreement, in the January 1, 2023 version Pennsylvania posts	No minimum number of trips. MTM may assign or reassign any trip, including recurring trips, at its sole discretion.	30 days’ written notice for convenience from either side. Immediate if MTM’s contract with its client ends, the client loses funding, or the client asks MTM to drop you.
WellTrans Indiana agreement, revised October 16, 2025	No obligation to send a specific number of trip requests. Assigned trips may be withdrawn.	60 days’ written notice without cause. Immediate if WellTrans’s client directs it.
Rhode Island’s broker contract with MTM, effective July 1, 2025	Bars the broker from guaranteeing ridership to transportation providers (section 7.3.3)	Each provider agreement must state when the broker can end it (section 7.2.4.15)
HealthSpring Medicare Advantage, Modivcare to MTM Health on March 1, 2026	The plan’s riders move to the new broker	Notice on the plan’s provider news page, dated February 26, 2026, three days before
Blue Cross and Blue Shield of Texas Medicaid, Modivcare to MTM Health on October 1, 2026	Recurring and already scheduled trips move to the new broker	Notice on the plan’s provider news page, dated June 29, 2026

The money can slow down before the trips stop. Under MTM’s standard agreement, once notice of termination is given, payment for all unpaid claims is withheld until MTM has audited the service records. Liquidated damages can be offset against what it owes you. WellTrans’s agreement lets it delay your payments when its own client is unable or unwilling to pay it. Plan for the last month or more of a payer’s revenue to arrive late.

How many months your cash could cover the gap

The calculator gives you the revenue left. Two more numbers, worked by hand, tell you how long you could last on it:

Monthly shortfall = costs a month after the loss minus revenue left a month

Months your cash covers = cash on hand ÷ monthly shortfall

Costs a month after the loss are your costs today minus the ones that stop with the lost trips, such as fuel and the driver hours you would cut. Insurance, van payments, rent, and the staff you keep go on. Here it is with the example’s $8,000 left, plus three more example numbers:

Step	Math	Result
Costs a month today	Example number	$18,000
Costs that stop with the lost trips	Fuel and driver hours on payer 1’s trips, example number	$6,000
Costs a month after the loss	$18,000 minus $6,000	$12,000
Monthly shortfall	$12,000 minus $8,000 revenue left	$4,000
Cash on hand	Example number	$20,000
Months your cash covers	$20,000 ÷ $4,000	5

If you kept every driver and van running, the shortfall would be $18,000 minus $8,000, or $10,000 a month, and the same cash would last 2 months. If the shortfall is zero or less, the business covers its costs without that payer.

Now compare the months with how long it takes to replace the work: the time to get credentialed with another network, plus the wait for its first payment. Count from the day notice arrives, not the day trips stop, because trips can be reassigned and payments held once notice is given. Ask each broker you would apply to how long its credentialing takes, and read NEMT broker credentialing before you start. The cash reserve calculator sizes the cash you need while you wait to be paid, and the break-even calculator shows how many trips the remaining payers must send to cover your fixed costs.

What moves the answer

Spreading the same revenue across more payers shrinks the risk fast. Here the total stays at $20,000 a month, private pay stays at $1,000, and only the split between payers changes.

Payers 1 to 5	Biggest payer’s share	Revenue at risk a month	Revenue left a month
$19,000, $0, $0, $0, $0	95%	$19,000	$1,000
$12,000, $4,000, $2,500, $500, $0	60%	$12,000	$8,000
$8,000, $6,000, $3,000, $2,000, $0	40%	$8,000	$12,000
$4,000, $4,000, $4,000, $4,000, $3,000	20%	$4,000	$16,000

With the 40 percent split, the months your cash covers change too. If costs that stop still run $0.50 for each dollar of lost revenue, as in the example, losing $8,000 cuts $4,000 of costs. The shortfall is $14,000 minus $12,000, or $2,000 a month, so the same $20,000 lasts 10 months instead of 5.

How to use the answer

• Set your own limit. Pick the largest share you could lose and still cover the shortfall from the day notice arrives until new work is paying you. Treat any payer above that share as the first problem to fix.
• Talk to a lender with the numbers. Under SBA’s SOP 50 10 8.1, effective October 1, 2026, accounts from any one customer that make up more than 20 percent of your total outstanding receivables should not be included in a Working Capital CAPLine’s borrowing base unless an exception applies, such as a customer with a long-standing positive credit history with you. In most cases the lender can advance no more than 80 percent of eligible receivables. The rule looks at what you are owed, not monthly revenue, so a slow payer’s share of your receivables runs higher than its share of revenue. Check it against your accounts receivable report, and see NEMT business loans.
• Plan a sale early. When a new owner, or another operating business, buys a company with an SBA 7(a) loan at a purchase price of $3 million or more, the same SOP requires the lender to get a quality of earnings report. It must assess customer concentration, contract continuity, and whether revenue and margins will hold after the sale. See how to sell a NEMT business.
• Choose the next payer. A second broker network, a facility contract, and private pay riders each lower the share. See working with multiple NEMT brokers, NEMT facility contracts, and private pay NEMT.
• Watch for switches. Check your state Medicaid agency’s notices and each health plan’s provider news every month. When a plan you depend on changes brokers, the broker transition guide covers what to do before the switch date.
• Recheck every quarter. Shares move as contracts start, grow, and end. Run both versions of the calculator again and keep the results with your books.