NEMT Broker Trip Authorization Verification

Inspection template for verifying broker-assigned non-emergency medical transportation trip details, level of service, and authorization against the manifest before dispatch. Designed to catch eligibility, service-level, and wheelchair-versus-ambulatory coding errors before the vehicle departs.

Inspection Setup and Trip Identification

• Trip record identified on the current dispatch manifest
  Confirm the trip is present on the active manifest for the correct service date and dispatch run.
• Broker name and trip authorization number recorded
  Capture the broker identifier and authorization number exactly as shown on the trip record.
• Service date and scheduled pickup time match the manifest
  Verify the scheduled date/time on the manifest matches the trip assignment.
• Trip origin and destination verified
  Confirm pickup and drop-off locations match the broker authorization and manifest.

Authorization and Eligibility Verification

• Trip authorization is active and valid for the service date
  Confirm the authorization is not expired, suspended, or otherwise invalid for the scheduled trip date.
• Member eligibility verified for the trip date
  Verify the rider is eligible for the transportation benefit on the date of service.
• Authorization covers the requested trip type and appointment purpose
  Confirm the authorization supports the trip purpose, appointment type, and any round-trip or one-way designation.
• Any broker restrictions or trip notes reviewed before dispatch
  Check for special instructions, time windows, escort requirements, or limitations attached to the authorization.

Level of Service and Mobility Coding

• Assigned level of service matches broker authorization
  Verify the service level on the manifest matches the authorized transport mode.
• Wheelchair-versus-ambulatory coding verified
  Confirm the mobility code is consistent with the rider's authorized service level and trip notes.
• Required attendant, escort, or lift assistance noted
  Verify whether the trip requires an attendant, escort, or special boarding assistance.
• Vehicle type assigned is appropriate for the authorized service level
  Confirm the dispatched vehicle can safely and legally provide the authorized transport mode.

Manifest Detail Reconciliation

• Passenger name matches authorization and manifest
  Confirm the rider name on the trip record matches the authorized member.
• Pickup address, destination address, and facility name match exactly
  Verify all location details reconcile across the trip documents.
• Trip direction and load status are correct
  Confirm whether the trip is one-way, round-trip, will-call, or return-only as authorized.
• Special instructions and contact notes reviewed
  Verify dispatch reviewed any broker or facility instructions that affect pickup or drop-off.

Exceptions, Deficiencies, and Corrective Action

• Any discrepancy identified and documented
  Record whether any eligibility, authorization, or manifest discrepancy was found.
• Corrective action taken before dispatch
  Describe the action taken to resolve the discrepancy, if any.
• Dispatch hold applied when required
  Confirm the trip was held from dispatch if a critical deficiency existed.

Closeout and Sign-Off

• Inspection completed by authorized dispatcher or reviewer
  Signature of the person completing the verification.
• Verification timestamp recorded
  Record the date and time the verification was completed.
• Supervisor or broker escalation completed when needed
  Confirm escalation occurred for unresolved discrepancies or critical failures.