NEMT Billing for Alivi Health Providers

Most NEMT brokers are transportation companies at heart. Alivi is not. It describes itself as a licensed third-party administrator running fully delegated provider networks, and transportation is one of several benefits it manages on a health plan's behalf; the same platform also handles specialty networks such as physical, occupational and speech therapy, ABA and vision. Alivi has been doing this in NEMT since 2016 out of Miami.

That structure has a practical consequence for your money. Because Alivi administers a benefit that belongs to the plan, the terms that govern your claim are the plan's terms. The filing deadline, the dispute deadline, the mileage threshold that triggers prior authorization, whether out-of-state trips are covered at all: those are set contract by contract. A Florida Medicaid line and a long-term-care line can both come to you through Alivi and disagree on all four.

Take the Sunshine Health book as a worked example, since it is public. Sunshine Health moved its entire non-emergency transportation benefit to Alivi on 1 January 2025, covering its Medicaid plan plus its child-welfare, serious-mental-illness, HIV and long-term-care specialty plans. Sunshine publishes 180 days from date of service to file as a participating provider and 365 days as a non-participating one, with reconsiderations due within 90 days of the explanation of payment, and it requires prior authorization on trips over 100 miles. None of those numbers are Alivi's. They are Sunshine's, and the plan next door will have its own. The rest of this page is about billing inside whatever numbers your agreement actually sets.

Alivi advertises a weekly claim payout and puts its own clean-claim rate above 98 percent. Read that from your side of the table. The upside is real cash-flow speed, faster than most of the broker market. The cost of a bad claim changes too: it is no longer "we get paid a bit late", it is a missed cycle, then a correction, then another cycle. Two avoidable errors a month on a fleet running four hundred trips can push a meaningful slice of a month's revenue into the following month, every month, forever.

So the checks happen before submission, not after the denial. Each claim has to agree with the authorization Alivi holds on level of service, mileage, the pickup and drop-off, and the date and time window. Each leg is its own claim, and the return leg on a will-call is the one that most often goes missing when a driver waits three hours and nobody closes the trip out. A trip that ran past the plan's mileage threshold, or crossed a state line, needed prior authorization before the wheels turned; no amount of documentation afterwards fixes that, so it belongs in dispatch's checklist rather than billing's.

Standing orders deserve their own look. When Sunshine Health switched from its previous vendor, existing standing orders transferred to Alivi automatically, so a fleet's recurring dialysis and behavioral-health series carried across without anyone re-entering them. Recurring series are exactly where a stale authorization silently repeats itself into thirty denied claims, so we verify a series against the portal before billing a month of it.

Reconcile on the payer's clock, not on yours. Fleets in the habit of closing books monthly will reconcile an Alivi remittance monthly too, which means carrying four unexamined cycles at all times and finding a systematic short-pay in week five instead of week one. Weekly in, weekly out.

Match on the trip identifier out of the portal rather than on member name plus date. Members with two appointments in a day, a swapped A-leg and B-leg, or a rescheduled ride that kept its original date will all reconcile wrongly on name-and-date and look fine doing it.

The split that fleets miss most often comes from how Alivi credentials. Because one credentialing file covers participation across Alivi's plans, a single provider can be running Medicaid trips, a long-term-care line and a Medicare Advantage line under one Alivi relationship, with different rates and different rules, and see them arrive in one payment. Reconcile the total and it looks right. Reconcile by plan and you find out which line is quietly paying you less than the contract says. We post payments, split by plan, and chase the gap.