M
Definition
A status assigned when the driver arrives at the correct pickup location within the scheduled window, waits the required time (usually 10-15 minutes), but the member is not there or refuses the trip.
Overview
Why it Matters
This is a major cost sink. You paid the driver and gas to get there, but (usually) you cannot bill the state for the trip because the passenger was not transported.
How it Works
Driver arrives -> Starts timer -> Waits 15 mins -> Calls Dispatch -> Dispatch attempts to call Member -> No answer -> Driver marks "No Show."
Code Comparison
Comparison: Member No-Show vs. Provider No-Show
Member No-Show: The Member failed (Driver arrived, Member missing).
Provider No-Show: The Driver failed (Driver never showed up).
Common Questions
- Billing for it: It is generally illegal to bill a claim line for a Member No-Show (since no service was rendered), though some managed care contracts allow a small "administrative fee."
- Insufficient Proof: Marking "No Show" without GPS data proving the driver was actually at the address.
- Take a photo of the house/door (if allowed by privacy policy) to prove the driver was there.
- Leave a "Door Hanger" or "Sorry we missed you" card to reduce disputes.
Sources
CMS Medicaid Integrity - Billing for Services Not Rendered