Billing & Compliance Reporting

Product Used: Post Trip Route API

Background

An elderly Medicaid patient living in a rural area has a weekly dialysis appointment in a nearby city. The NEMT provider is responsible for picking the patient up from home, transporting them to the dialysis center, and then returning them home after treatment. Medicaid reimburses the provider based on the trip's distance and time, but only if the documentation is accurate and meets strict compliance rules. Any missing or inaccurate trip data can lead to claims rejections, delayed payments, or even penalties for non-compliance.

Problem Statements

The NEMT provider wants to solve for:

1. Accurate trip re-generation: The NEMT provider must document each completed trip's actual route and the total mileage. Any discrepancies in this data could result in claims being rejected or Medicaid payments being delayed.
2. Compliance with Medicaid and Insurance Requirements: Medicaid requires the NEMT provider to submit trip records that match the pre-approved route. Failure to comply with this requirement can result in penalties or lost reimbursements.
3. Billing Accuracy: Inaccurate mileage data can result in underbilling or overbilling. Overbilling can lead to regulatory penalties, while underbilling can cause revenue losses for the provider.

Solution

The Post Trip Route API enables the NEMT provider to capture and store detailed data about the route taken for each completed trip which are helpful in meeting the billing and compliance requirements.

Retrieve actual route taken

Upon providing the GPS tracked location in a chronological order the Post Trip Route API returns the geometry of the actual route taken during the trip along with the total distance traveled during the trip.

Match actual and pre-approved routes

The actual route geometry from the Post Trip Route API’s response can be matched to the pre-approved route geometry to find and flag any deviations for further analysis and corrective actions.

Billing Accuracy

The distance returned in the Post Trip Route API’s response accurately indicates the actual distance traveled during the trip. Providers can use this value as-is for mileage calculations / report

Sample API request and solution

Here is a sample JSON request that we built for regenerating a the actual route taken for a completed trip by specifying the location coordinates tracked by GPS during the trip.

API Request

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curl --location 'https://api.nextbillion.io/postTripRoute?key=<your_api_key>'   
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--header 'Content-Type: application/json'   
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--data '{  
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 "waypoints":"34.04595020,-118.43181417|34.04672575,-118.43049276|34.04754692,-118.42900618|34.04852774,-118.42897865|34.04905237,-118.43018994|34.04975946,-118.43145628|34.05067184,-118.43208946|34.05292603,-118.42941772|34.05688236,-118.42368844",  
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 "mode":"car",  
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 "geometry": "polyline6"  
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}'

API Response

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{  
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    "status": "Ok",  
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    "route": {  
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        "geometry": "s}~|_Azao{`FcBkC{Tod@wV_g@wG_NkMsXwQs]{J_SsS_b@sXnUcLfJgr@vj@nPjRf@~M~WkMnKgm@jf@cQfOkMzJ_IjHsIvGkHbGoKfJgc@{r@cQoZ_IwLcGoKoF_I_IsNgOkgJ{OoF_IcLkRkC{EsSnP_D{E_b@_q@cBsDw`@on@sXce@sIgOsb@ct@kWw`@gJoPoAg@cBg@kC?kCRcBsDoAcBR_Dg@kHcBkH",  
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        "distance": 2014.5  
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    }  
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}

The Post Trip Route API can play a critical role in ensuring accurate billing and compliance reporting for Non-Emergency Medical Transportation (NEMT) providers. Since NEMT services are often funded through Medicaid or insurance providers, maintaining accurate records of trips—both for billing and regulatory compliance is essential.