NEMT Billing for Call the Car (CTC)

Getting credentialed with Call the Car gets you trips. Getting paid for them is a separate job with a separate failure mode. CTC sits between you and a payer you never bill directly, so your claim has to satisfy two audiences at once: the trip record CTC holds in its own dispatch platform, and the medical-necessity rules of whichever plan the member belongs to.

Those plans aren't interchangeable, and you can see it in how CTC answers its phones. There are separate reservation and ride-assist lines for AppleCare Medical Group, Blue Shield of California Promise, Blue Shield of California Medicare, Central California Alliance for Health, Heritage Victor Valley, IEHP, L.A. Care Medi-Cal, L.A. Care Medicare D-SNP, L.A. Care Covered California and San Diego Regional Center. A fleet running three of those books is billing under three sets of documentation rules with, usually, one billing clerk who is also answering the dispatch phone. That's where the leaks start. The sections below follow a CTC claim the whole way: where it begins, what sets its level of service, why it gets denied, how long you actually have to file it, and how to prove you were paid for every trip you ran.

California is stricter about this than most states, and it's the single biggest difference between billing CTC and billing a broker in a state without the requirement. DHCS requires a Physician Certification Statement to establish the level of non-emergency medical transportation a member qualifies for, and the plans behind Call the Car enforce it. The form has to be signed by the clinician responsible for the member's care: a physician, physician assistant, nurse practitioner, certified nurse-midwife, physical, speech or occupational therapist, dentist, podiatrist, or a mental health or substance use disorder provider. It stays valid for twelve months from the transportation start date and covers every NEMT request inside that window.

Now the part that costs fleets money. Once a PCS is on file, neither the plan nor the transportation vendor can change it. If a member's condition has changed and they now need a wheelchair van, a fresh PCS has to come from the prescriber. Bill the wheelchair level against an ambulatory PCS and the claim is wrong no matter how perfect your trip sheet is. We check level of service against the PCS on file before a claim leaves, and when the two disagree we go and get the new form instead of submitting and hoping.

Providers get this backwards constantly, so it's worth being blunt. Medi-Cal fee-for-service runs a six-month billing limit counted from the month of service, with narrow exceptions written into sections 51008 and 51008.5 of title 22 of the California Code of Regulations. That rule governs claims you send the state. It does not govern claims you send Call the Car.

You bill CTC under a subcontractor agreement, and the filing window, the corrected-claim window and the reconsideration path all sit in that contract. They can be shorter than the state's, and they're the deadlines that will actually bite you. Read your agreement, put the numbers somewhere everyone can see them, and count from the date the remittance showed the denial rather than the date somebody noticed it. When we take over a CTC book, pulling those dates out of the agreement is the first thing we do, because a claim that ages past the contractual window isn't arguable on the merits any more. It's just gone.

If you're still working through the CTC subcontractor form and the vehicle inspection, start with credentialing. If you're already carrying CTC trips and the deposits don't track the trip count, the problem is in the claims, and it's usually five repeating things rather than a hundred random ones. We handle both ends, so nothing falls into the gap between approved and paid.

Want us to read your last CTC payment run for leaks? Call +1 (657) 777-0006, 24/7.