Payer Rules

Configure billing rules once per payer

With Payer Rules, The Fleet Owner can configure billing rules once per payer so they can automate payer-specific compliance — resulting in fewer claim denials.

The Problem

The Core Problem
Payer-specific billing rule violations are the leading cause of claim denials and delayed revenue for NEMT operators.
The Scenario
An operator has 6 active funding sources, each with different billing requirements.
Why It's Urgent
Modivcare requires odometer readings. MTM requires both passenger and driver signatures. A county Medicaid program requires Bing Maps-routed mileage. Private pay requires a flat fee invoice.
Without MediRoutes
Dispatchers must manually remember which rules apply to which trip. When they forget, and they do, the claim is rejected and the operator waits 30 to 60 days for a corrected payment.
With MediRoutes
Each funding source is configured once. The right rules apply automatically to every trip. The Driver App enforces signature requirements without the driver needing to know the rules.

Who This Helps

The Fleet Owner
claim denials pile up at month-end from avoidable billing rule mistakes made during the busy dispatch day. Frustrated by corrections that take days and payments that arrive 60 days late.
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
works at a Medicaid MCO or brokerage. Frustrated by providers submitting incomplete trip data that bottlenecks the entire payment process.
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

No limit. Operators with 20 or more active payers configure a funding source for each one.
Three options. Bing Maps-routed means MediRoutes calculates automatically. Imported means mileage comes from the broker file. Odometer means the driver records start and end readings in the Driver App.
Signature requirements are set independently for passenger and driver, at pickup, dropoff, or both.
Each billing item on a funding source can have a procedure code (for example A0090) and a modifier (for example A0090 U2). These are applied automatically to claims for that payer and level of service.
Billing items support From Time and To Time fields so after-hours charges apply automatically based on pickup time. Overnight windows require two separate billing items to cover the full range.
End-date the old rate, create the new rate with a new effective date, and use the Update Trip Charges function to retroactively apply the new rate to any trips already created in the system.