NEMT Medicaid Billing in Florida

Here is the part that trips up Florida fleets: there is no single payer. Since Statewide Medicaid Managed Care 3.0 launched February 1, 2025, NEMT is carved into managed care, roughly eight plans operate across nine regions, and each plan selects its own transportation broker. So the broker that pays your trip depends on which plan the member belongs to and which region they are in - Modivcare for plans like Humana, Simply, Aetna and Community Care Plan, MTM for UnitedHealthcare, Alivi for Sunshine Health, or Ride2MD for Florida Community Care. Trips that fall to residual fee-for-service run through the state AHCA broker and adjudicate in FMMIS. Getting the trip is one job; billing it to the payer that will actually pay is another. This page walks the full cycle: how each trip gets routed to the right broker, what makes a clean claim, why claims deny, and how the money gets reconciled across four payers so nothing quietly goes unpaid. For portal mechanics on a specific broker, we link down to the broker pages below.

A clean claim is one the payer cannot bounce, and in Florida the challenge is that "clean" is defined slightly differently by each broker plus FMMIS for fee-for-service. The trip authorization number, level of service, pickup and drop-off, mileage, and dates and times all have to match what that broker authorized - and the format that satisfies Modivcare will not be identical to MTM, Alivi or Ride2MD. Most denials trace back to a claim drifting from its authorization, or to being sent to the wrong payer entirely. We build the right match for each payer into the claim before it goes, so the first submission is the one that pays instead of the one that gets kicked back to the wrong portal.

The last mile is proving you were paid for every trip you ran, across every payer. With Modivcare, MTM, Alivi, Ride2MD and FMMIS all paying different slices of your volume, reconciliation means matching each remittance to its trip and surfacing the trips that were run but not paid - short-pays, missing claims, silent denials - before they disappear. This is the step fleets skip when they are busy, and it is where the money leaks. Separately, AHCA publishes an SMMC Non-Emergency Transportation Timeliness Report on on-time performance and complaints; the same tight trip records that protect your standing there are what make a clean claim. We reconcile every broker and FMMIS remittance against your trip records, post payments, and chase the gaps, so your revenue matches your operation instead of trailing it.