NEMT Trip Mileage Reconciliation Audit

Inspection template for reconciling billed loaded miles on non-emergency medical transportation trips against GPS shortest-route data to identify mileage discrepancies, prevent denials, and flag patterns before broker post-payment audits.

Audit Scope and Trip Identification

• Trip record includes unique trip ID, date of service, member identifier, origin, destination, and vehicle/driver assignment
• Trip is within the audit period and matches the selected claim or encounter record
• Trip type is correctly classified as loaded miles, deadhead miles, or wait time per payer policy
• Supporting source documents are available for review

Billed Mileage vs GPS Route Reconciliation

• Billed loaded miles match GPS shortest-route miles within payer tolerance
  Enter the absolute variance in miles between billed loaded miles and GPS shortest-route miles.
• Billed loaded miles entered on the claim
• GPS shortest-route miles calculated for the same origin and destination
• Variance reason is documented and supported by the trip record
• Mileage rounding, minimum-mile rules, or base-mile rules were applied consistently with payer policy

Trip Integrity and GPS Data Quality

• GPS breadcrumb or route trace shows continuous trip coverage from pickup to drop-off
• Pickup and drop-off timestamps align with dispatch and trip completion records
• GPS data quality is sufficient to support route validation
• Any GPS gaps, device resets, or signal loss events are documented

Exception Review and Pattern Detection

• Trip variance exceeds internal exception threshold
• Similar mileage variances are recurring for the same driver, vehicle, route, or facility
• Exception pattern is categorized for follow-up
• Potential overbilling or underbilling impact is estimated

Corrective Action, Closeout, and Sign-Off

• Corrective action assigned for any mileage discrepancy or documentation deficiency
• Root cause identified and documented
• Follow-up owner and due date assigned
• Inspector sign-off completed