NEMT Medicaid Billing in Pennsylvania

Here is the part that trips up Pennsylvania fleets: NEMT is carved out of the HealthChoices managed-care plans and run as the Medical Assistance Transportation Program (MATP) by DHS/OMAP at the county level, across all 67 counties - and both fee-for-service and managed-care members use the same MATP. Pennsylvania covers roughly 3.0 million Medicaid enrollees per KFF Medicaid state fact sheets (2025), and there is no single statewide broker. Your county MATP program authorizes and coordinates the trip, but the claim goes to Pennsylvania Medical Assistance through PROMISe, the state MMIS. Philadelphia County is the one exception - it has been coordinated through Modivcare since 2005. So billing a MATP trip is a two-source job: the authorization comes from the county MATP (or Modivcare in Philadelphia), and the claim is built and submitted to PROMISe. Getting assigned the trips is one job; getting paid for them is another. This page walks the full cycle, and points to our Modivcare billing page for the Philadelphia portal mechanics.

Pennsylvania has two billing routes and you have to run whichever ones your counties fall into. In 66 counties, the broker is the county's own MATP program - there is no statewide contract, so authorizations, documentation habits, and contacts vary county by county. In Philadelphia, trips are coordinated through Modivcare, and the portal mechanics there work like any other Modivcare market - for that step-by-step we point you to our Modivcare billing page. What both routes share is the destination: the claim lands in PROMISe. We keep each county's route straight, match every claim to its authorization, and make sure a Philadelphia trip and a rural-county trip both end up as clean PROMISe claims instead of a pile of mismatched paperwork.

The last mile is proving you were paid for every MATP trip you ran. Because PROMISe pays these claims, reconciliation runs against the PROMISe remittance: each 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. Pennsylvania adds one more line to watch: own-vehicle mileage reimbursement, where a member or approved driver uses a personal vehicle to reach a covered service and distance limits may apply. That money is easy to leave uncollected. We reconcile every PROMISe remittance against your trip records and authorizations, capture mileage reimbursement, post payments, and chase the gaps, so your revenue matches your operation instead of trailing it.