NEMT Resources for Case Managers and Social Workers in NJ

A Professional Resource for Healthcare Coordinators

Case managers, social workers, discharge planners, and care coordinators working in New Jersey hospitals, clinics, nursing facilities, and community health organizations play a critical role in ensuring patients can actually get to the appointments their care plans prescribe. NEMT coordination is a core competency in these roles — and one that can be complicated to navigate across different insurance types, managed care organizations, and transportation providers.

This guide is written specifically for healthcare professionals who regularly need to arrange transportation for patients in New Jersey. It covers the authorization process from the professional perspective, how to set up efficient recurring arrangements, how to establish accounts with NEMT providers like Delta, and what to do when things go wrong.

What Information to Gather Before Requesting NEMT Authorization

Efficiency in NEMT coordination starts with gathering the right information upfront. Before contacting an MCO or NEMT provider, have the following ready for each patient:

• Patient's full name, date of birth, and Medicaid/insurance ID number
• Managed care plan name (Amerigroup, Horizon NJ Health, UnitedHealthcare Community Plan, Aetna Better Health, WellCare) — the transportation contact number differs by plan
• Appointment details — provider name, facility address, date and time
• Transport level required — ambulatory, wheelchair, stretcher (this must be clinically appropriate and defensible if questioned)
• Medical basis for transport level — for wheelchair or stretcher transport, have physician documentation ready (mobility assessment, diagnosis, physician order)
• Special requirements — oxygen, bariatric equipment, stairs at pickup, cognitive limitations requiring escort, companion
• Whether this is a one-time or recurring trip — for recurring, have the full schedule ready to set up a standing order

The Medicaid NEMT Authorization Process from a Professional Perspective

Each NJ FamilyCare MCO routes transportation differently, but the general structure is consistent:

1. Identify the patient's MCO — confirm active enrollment by calling the MCO or checking the NJ Medicaid web portal if your organization has access
2. Call the transportation line — not the general member services line; there is usually a dedicated transportation number. Request this number from each MCO's provider relations team and maintain a reference list.
3. Request authorization — provide patient information, appointment details, and transport level. For stretcher or wheelchair transport, expect to provide clinical justification. For ambulatory, authorization is typically more straightforward.
4. Record the authorization number — essential for billing and dispute resolution
5. Communicate to the patient — inform the patient (or their family/caregiver) of the scheduled transport time, driver name if available, and what to expect

Setting Up Standing Orders for Recurring Patients

For patients with recurring appointment schedules — dialysis, chemotherapy, ongoing rehabilitation — a standing order is far more efficient than trip-by-trip authorization. To establish a standing order:

• Obtain a physician order specifying the appointment schedule, frequency, destination, and transport level
• Submit the standing order request to the MCO's transportation line with all relevant patient and appointment information
• Confirm the duration of the standing order (typically 60-90 days) and set a reminder to renew before it expires
• Notify the transportation provider (or broker) of the established standing order so they can pre-schedule accordingly

Standing orders should be reviewed and renewed regularly — changes in patient condition, transport level, or appointment schedule require updates to the standing order.

Handling NEMT Authorization Denials

Denials happen, and knowing how to respond effectively protects your patients' access to care:

Common Denial Reasons

• Trip not submitted with sufficient advance notice
• Destination provider not in the MCO's Medicaid network
• Transport level (e.g., stretcher) not supported by submitted clinical documentation
• Duplicate request (a ride was already authorized for the same trip)

Denial Response Protocol

1. Request the denial in writing with the specific denial code and reason
2. Assess whether the denial is correctible — often it is (insufficient notice, missing documentation)
3. For clinical denials (transport level not justified): obtain a letter of medical necessity from the attending physician and resubmit
4. For procedural denials: correct the issue and resubmit, escalating to the MCO's supervisor level if necessary
5. For systemic issues: contact your organization's Medicaid managed care liaison if you have one, or file a formal MCO grievance
6. Document all denial and appeal activity in the patient's care management record

Urgent Same-Day Transport Requests

The standard NEMT system is not designed for same-day requests — most MCOs require 48-72 hours notice. However, urgent situations arise: a patient who needs to be seen today, an appointment that moved up, a post-hospitalization discharge with an urgent follow-up. Options for urgent transport include:

• MCO urgent transport request line — most plans have an expedited process for medically urgent situations; ask for the supervisor level if the standard line can't help
• Private pay NEMT — Delta Medical Transportation can frequently accommodate same-day private-pay requests. The cost can sometimes be reimbursed retroactively from the MCO with proper documentation of the urgency.
• Patient assistance programs — nonprofit and community organizations may be able to assist in true hardship situations

Establishing a Facility Account With Delta

Healthcare facilities, clinics, and social service organizations that regularly coordinate NEMT for patients benefit from establishing a direct account relationship with Delta Medical Transportation. Benefits of a facility account include:

• A dedicated contact at Delta for your coordination team — no call center, direct access
• Consolidated monthly invoicing for private-pay patient transports
• Priority scheduling for established account patients
• Consistent, vetted drivers familiar with your patients and facility
• Transport reports documenting pickup times, arrival times, and any incidents
• Ability to set up recurring standing orders for your highest-volume patients

To discuss a facility account, contact Delta Medical Transportation and ask to speak with our client relations team.

What to Tell Patients About NEMT Eligibility

Part of your role is educating patients and families about their transportation benefits. Key messages to communicate:

• NJ FamilyCare members are entitled to NEMT — it's a covered benefit, not a favor
• Transport must be booked in advance — 48-72 hours for Medicaid; same-day is not reliably available
• For recurring appointments, a standing order simplifies everything — encourage patients to ask for one
• If transport doesn't show, call the MCO immediately and document it — repeated no-shows can be escalated
• Private pay is available from providers like Delta when Medicaid transport isn't covering the need

Delta Medical Transportation is a trusted NEMT partner for healthcare organizations throughout New Jersey. Contact us to establish a facility account, discuss high-volume patient transport arrangements, or get answers to your NEMT coordination questions. Visit our insurance coverage page for a full overview of covered transport types.