Run NEMT Broker Trip Authorization Verification — Free

Inspection Setup and Trip Identification

Trip record identified on the current dispatch manifest critical (required)

Confirm the trip is present on the active manifest for the correct service date and dispatch run.

Yes No N/A

Broker name and trip authorization number recorded critical (required)

Capture the broker identifier and authorization number exactly as shown on the trip record.

Service date and scheduled pickup time match the manifest critical (required)

Verify the scheduled date/time on the manifest matches the trip assignment.

Trip origin and destination verified critical (required)

Confirm pickup and drop-off locations match the broker authorization and manifest.

Yes No N/A

Authorization and Eligibility Verification

Trip authorization is active and valid for the service date critical (required)

Confirm the authorization is not expired, suspended, or otherwise invalid for the scheduled trip date.

Yes No N/A

Member eligibility verified for the trip date critical (required)

Verify the rider is eligible for the transportation benefit on the date of service.

Yes No N/A

Authorization covers the requested trip type and appointment purpose critical (required)

Confirm the authorization supports the trip purpose, appointment type, and any round-trip or one-way designation.

Yes No N/A

Any broker restrictions or trip notes reviewed before dispatch

Check for special instructions, time windows, escort requirements, or limitations attached to the authorization.

Yes No N/A

Level of Service and Mobility Coding

Assigned level of service matches broker authorization critical (required)

Verify the service level on the manifest matches the authorized transport mode.

Wheelchair-versus-ambulatory coding verified critical (required)

Confirm the mobility code is consistent with the rider's authorized service level and trip notes.

Yes No N/A

Required attendant, escort, or lift assistance noted

Verify whether the trip requires an attendant, escort, or special boarding assistance.

Yes No N/A

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

Confirm the dispatched vehicle can safely and legally provide the authorized transport mode.

Yes No N/A

Manifest Detail Reconciliation

Passenger name matches authorization and manifest critical (required)

Confirm the rider name on the trip record matches the authorized member.

Yes No N/A

Pickup address, destination address, and facility name match exactly critical (required)

Verify all location details reconcile across the trip documents.

Yes No N/A

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.

Yes No N/A

Exceptions, Deficiencies, and Corrective Action

Any discrepancy identified and documented critical (required)

Record whether any eligibility, authorization, or manifest discrepancy was found.

Yes No N/A

Corrective action taken before dispatch

Describe the action taken to resolve the discrepancy, if any.

Dispatch hold applied when required critical (required)

Confirm the trip was held from dispatch if a critical deficiency existed.

Yes No N/A

Closeout and Sign-Off

Inspection completed by authorized dispatcher or reviewer critical (required)

Signature of the person completing the verification.

Verification timestamp recorded critical (required)

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.

Yes No N/A

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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