Run NEMT Broker Trip Authorization Verification — Free

Inspection Setup and Trip Identification

Trip identifier, date, and scheduled pickup time match the manifest record critical (required)

Yes No N/A

Member name or unique member identifier matches the broker authorization record critical (required)

Yes No N/A

Origin and destination addresses match the authorized trip details critical (required)

Yes No N/A

Broker name and authorization reference number are present and legible

Yes No N/A

Verification completed before vehicle dispatch critical (required)

Yes No N/A

Authorization and Eligibility Verification

Authorization is active for the scheduled date and time window critical (required)

Yes No N/A

Member eligibility was verified against the applicable broker or payer source critical (required)

Yes No N/A

Trip authorization covers the requested one-way or round-trip service critical (required)

Yes No N/A

Any trip limits, mileage limits, or time restrictions are within authorized parameters critical (required)

Yes No N/A

Any broker notes, special instructions, or prior approval requirements were reviewed

Yes No N/A

Level of Service and Mobility Coding

Authorized level of service matches the manifest coding critical (required)

Wheelchair-versus-ambulatory coding matches the broker authorization critical (required)

Yes No N/A

Any attendant, escort, or additional rider authorization is documented

Yes No N/A

Vehicle type assigned is appropriate for the authorized level of service critical (required)

Yes No N/A

Any special equipment requirement is reflected in the manifest

Yes No N/A

Manifest Detail Reconciliation

Pickup location, destination, and appointment time are consistent across documents critical (required)

Yes No N/A

Trip status, trip count, and leg sequence match the authorized service

Yes No N/A

Any same-day changes, reroutes, or updated instructions are documented and approved critical (required)

Yes No N/A

No duplicate, overlapping, or conflicting trip assignment is present critical (required)

Yes No N/A

Manifest notes clearly identify any exception or hold status

Yes No N/A

Exceptions, Deficiencies, and Corrective Action

Any deficiency identified during verification was documented critical (required)

Yes No N/A

Dispatch was held or escalated when authorization could not be confirmed critical (required)

Yes No N/A

Corrective action or broker follow-up was recorded for the exception

Yes No N/A

Inspector comment summarizes the discrepancy and resolution

Closeout and Sign-Off

Verification completed with no unresolved non-conformance critical (required)

Yes No N/A

Inspector name and signature critical (required)

Verification timestamp critical (required)

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Run: NEMT Broker Trip Authorization Verification

Inspection Setup and Trip Identification

Authorization and Eligibility Verification

Level of Service and Mobility Coding

Manifest Detail Reconciliation

Exceptions, Deficiencies, and Corrective Action

Closeout and Sign-Off

Get your results