B
Definition
A third-party organization contracted by a State Medicaid Agency or Managed Care Organization (MCO) to administer the NEMT benefit. They handle call intake, eligibility verification, and dispatching trips to a network of independent transportation providers.
Overview
Why it Matters
The majority of NEMT in the US is managed by brokers (e.g., Modivcare, Veyo, MTM). Providers usually do not bill the state directly; they bill the Broker.
How it Works
The Broker operates a "capitated" or "risk-based" model where they are paid a flat fee per member by the state, and they try to manage transportation costs efficiently.
Code Comparison
Comparison: Broker vs. Provider
The Broker is the administrative middleman (logistics & call center). The Provider owns the vehicles and drives the patients.
Common Questions
- Information Silos: Critical patient needs (e.g., "patient is on oxygen") getting lost in translation between the Member -> Broker -> Provider.
- Low Rates: Brokers often negotiate volume discounts that drive down per-mile rates for providers.
- Diversify your business; do not rely 100% on a single Broker for all your revenue.
- Integrate your software directly with the Brokeru2019s API to avoid manual data entry errors.
Sources
Medicaid.gov - NEMT Brokerage Model