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Run: NEMT Trip Mileage Reconciliation Audit

Use this NEMT Trip Mileage Reconciliation Audit template to compare billed loaded miles against GPS shortest-route data, document variances, and catch recurr...

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Audit Scope and Trip Identification

Trip record includes unique trip ID, date of service, member identifier, origin, destination, and vehicle/driver assignment critical (required)

Yes No N/A

Trip is within the audit period and matches the selected claim or encounter record critical (required)

Yes No N/A

Trip type is correctly classified as loaded miles, deadhead miles, or wait time per payer policy critical (required)

Supporting source documents are available for review

Note (optional)

Billed Mileage vs GPS Route Reconciliation

Billed loaded miles match GPS shortest-route miles within payer tolerance critical (required)

Enter the absolute variance in miles between billed loaded miles and GPS shortest-route miles.

Billed loaded miles entered on the claim

Note (optional)

GPS shortest-route miles calculated for the same origin and destination

Note (optional)

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

Yes No N/A

Trip Integrity and GPS Data Quality

GPS breadcrumb or route trace shows continuous trip coverage from pickup to drop-off critical (required)

Yes No N/A

Pickup and drop-off timestamps align with dispatch and trip completion records critical (required)

Yes No N/A

GPS data quality is sufficient to support route validation

Note (optional)

Any GPS gaps, device resets, or signal loss events are documented

Yes No N/A

Exception Review and Pattern Detection

Trip variance exceeds internal exception threshold critical (required)

Yes No N/A

Similar mileage variances are recurring for the same driver, vehicle, route, or facility

Yes No N/A

Exception pattern is categorized for follow-up

Note (optional)

Potential overbilling or underbilling impact is estimated

Note (optional)

Corrective Action, Closeout, and Sign-Off

Corrective action assigned for any mileage discrepancy or documentation deficiency critical (required)

Yes No N/A

Root cause identified and documented

Follow-up owner and due date assigned

Note (optional)

Inspector sign-off completed critical (required)

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