Contract Rules

Block out-of-contract trips at dispatch

With Contract Rules, The Fleet Owner can enforce contract terms at dispatch so they can block out-of-scope trips — resulting in zero violation-based denials.

The Problem

The Core Problem
Out-of-contract trips performed without detection waste driver time, create denial risk, and damage broker relationships.
The Scenario
A provider has a Medicaid contract that only covers trips within a specific county. A dispatcher books a trip 15 miles outside the covered area.
Why It's Urgent
The trip is performed, billed, and denied 45 days later because the dropoff address is outside the contracted service area.
Without MediRoutes
There is no automatic check. The dispatcher has to remember the contract terms for each payer. Violations are discovered at billing, not at dispatch.
With MediRoutes
A Contract Rule attached to the funding source flags the out-of-area trip at the moment of scheduling. The dispatcher sees the warning before the trip is confirmed, not after it is performed.

Who This Helps

The Fleet Owner
has different contract terms with each broker including geographic limits, service type restrictions, and hours of operation. Frustrated by accidentally dispatching trips that violate contract terms and discovering it at billing time.
Frustrations
  • Cannot tell which runs are profitable until month-end
  • Losing money on certain broker contracts unknowingly
  • Audit exposure from incomplete documentation
Pain Points
  • Razor-thin margins with no per-trip visibility
  • Scaling requires proportionally more staff
Ideal Workflow
See real-time margin per trip, auto-enforce contract rules, pass audits with GPS-verified records
The Broker Compliance Officer
providers who repeatedly perform out-of-contract trips create audit risk for the broker and the MCO. Contract Rules enforce terms at the source before a trip is ever performed.
Frustrations
  • Providers submit incomplete trip data
  • Missing GPS, signatures, and wrong timestamps
  • Manual review bottlenecks payment for everyone
Pain Points
  • Cannot verify service was actually delivered
  • Compliance review is entirely manual
Ideal Workflow
Receive clean claims with GPS proof, auto-validate before payment, resolve disputes in minutes

How It Works

Each step shows what happens when things go right — and what MediRoutes does when they don't.

Start / End
Process Step
Decision Point

Common Questions

Service area (geographic limits), eligible space types or levels of service, time windows (hours of operation), mileage caps per trip, maximum companion counts, and whether no-shows are billable under that contract.
Each funding source has its own Violation Set. Rules for Modivcare do not affect MTM trips and vice versa.
Configurable per rule. Options include a warning the dispatcher must acknowledge, a soft block requiring supervisor override, or a hard block that prevents the trip from being assigned until corrected.
Users with Admin access. Dispatchers can see violation warnings but cannot modify the rules.
The dispatcher can override the violation flag with a documented reason. The exception is logged in the trip record with the approver's user ID and timestamp.
Contract document upload is planned. Confirm current availability with product. In the current system, contract terms are captured as rules rather than as an attached document.