NEMT Medicaid Billing in California

California runs a hybrid model, and that is what makes the billing work. Medi-Cal covers roughly 14.9 million enrollees (per KFF Medicaid state fact sheets, 2025), split between fee-for-service and managed care. On the FFS side, DHCS-enrolled providers bill Medi-Cal directly. On the managed-care side, each health plan contracts its own transportation broker — commonly Modivcare or MTM, American Logistics (ALC) on Molina, or Call the Car — and the claim goes to that broker's portal, not to the state. On top of that, Medi-Cal splits transport into NEMT (medically necessary ambulance, gurney, or wheelchair-van trips that need a physician certification of medical necessity) and NMT (non-medical car, taxi, transit, or mileage), each with its own authorization and codes. So a single California fleet is billing across two payer types and two trip categories at once. This page walks the full cycle — routing each trip to the right payer, documenting the claim so it is clean, working denials, and reconciling the money across every portal.

A clean Medi-Cal claim is one that cannot be bounced, and for NEMT the center of it is the physician certification of medical necessity. The certification has to be on file, current, and consistent with the level of service billed — a wheelchair-van trip billed without the certification that supports it is a predictable denial. NMT trips carry their own authorization instead, so the two categories cannot share a template. On the managed-care side, the broker adds its own trip authorization and its own field requirements on top of the Medi-Cal rules. We build the match into each claim before it goes: the right certification or authorization, the correct NEMT or NMT codes, the level of service and mileage reconciled to the trip. The first submission becomes the one that pays instead of the one that gets kicked back.

The last mile is proving you were paid for every trip you ran — and in California that means reconciling across more than one payer. FFS trips reconcile against the Medi-Cal remittance; managed-care trips reconcile against each broker's remittance. Every payment has to be matched to its trip, and the trips that were run but not paid — short-pays, missing claims, silent denials — have to surface instead of disappearing into the gap between FFS and the portals. This is the step fleets skip when they are busy, and it is exactly where the money leaks when you are billing four different payers. We reconcile every remittance against your trip records, post payments, and chase the gaps, so your revenue matches your operation instead of trailing it.