It happens - sometimes Non-Emergency Medical Transportation (NEMT) trip requests get denied. When this happens, Medicare health plans are required to issue a Notice of Denial of Medical Coverage (or Payment), also known as an Integrated Denial Notice (IDN).
Denials happen for several reasons, all related to eligibility. Some services that are not covered and therefore lead to trip denials, include:
Regardless of the reason, denials must be tracked and communicated, specifically:
Appropriate non-emergency medical transportation software is essential for tracking and reporting denials activity. As soon as a member requests a trip, the first function of the software is to verify that the individual is eligible for transportation. Here's what happens:
Being able to correctly document member denial reasons and refer to those decisions for reporting purposes is important. Additionally, if a member appeals the denial decision, a detailed record of the denial information (and justification) is stored by the NEMT software for easy reference. Finally, reporting of not just the number of denied trips but the reasons for those denials, is important to ensure denials are reasonably and equitably applied among members.