State Medicaid transportation integrity: own the trip record for every ride
A state pays for each Medicaid ride. It should also hold the record that shows the ride happened. VectorCare gives the state its own trip infrastructure. Every order, assignment and completion sits on a record the state controls. The state can keep its broker or not. Either way, it gets an independent check on what it pays for.
Infrastructure the state owns
In many programs, the broker holds the trip data. The broker takes the call, assigns the provider, collects the trip sheet and sends the claim. The state sees the result. It does not see each step.
VectorCare moves that record to the state. The state gets its own VectorCare account, with the tools to manage program integrity. The program runs its orders, providers and trip status in that account. The state sets the rules and controls how the data flows. VectorCare is software. It is not a broker, and it is not a transport company. It does not take the contract or the trip.
Keep your broker or not
Some states keep a broker. Others contract providers directly, or mix the two by region. VectorCare works either way.
- With a broker: the broker keeps its role. The state holds its own record of what was ordered and what was done, so it can check the broker's reports against it. How broker systems connect is set up per program.
- Without a broker: the state or its plans send trips to contracted providers on VectorCare and see status until each trip is done.
What happens to the record when the state changes brokers
Broker contracts end, get rebid, or change by region. When the trip history lives in a broker's system, getting it out can be slow and hard. That can make a change of broker harder than it should be.
On VectorCare, the record is in the state's account. A broker can join the program, leave it, or be replaced, and the state keeps every order and trip record. The state does not have to extract its data from a departing system. A new broker starts on the same record. How each broker connects is set up per program.
Checks and balances
When one party takes the order, runs the trip and reports on it, nobody checks that party with independent data. A state record gives the program a second source of data. The broker or provider still runs the trip, and the state can check the trip on its own record.
The state pays on data it does not hold
Medicaid NEMT is high volume. It runs on many local providers. Audits usually look at a sample of claims, long after payment. When the trip record lives with the party that is paid for the trip, the state has to ask that party for proof. Sometimes the proof is not there.
For the public audit findings behind this, see NEMT fraud, waste and abuse prevention.
1. Order from any channel
Staff order in the VectorCare web app or mobile app. Where the EHR supports SMART on FHIR, they can start the order from the chart through SoFaaS. Each order goes on the state's record when it is placed.
Program rules at the point of order
The state's program integrity rules run when the order is placed. That holds in the web app, the mobile app, and inside the EHR with SMART on FHIR, through SoFaaS.
- Eligibility is checked for the date of service.
- The level of service is recommended from the record, and overrides are logged.
- Where the program requires prior authorization, the order follows that rule.
- Where the program requires a PCS form, the order is not complete until a valid signer e-signs it.
- Standing orders for repeat treatment, such as dialysis, carry the same rules on every trip.
- Recurring authorizations cover repeat treatment, so staff do not request a new one for each ride.
These checks make the right trip easy to order. They do not add a step for members who qualify.
2. Send only to credentialed providers
Providers join the network through VectorCare Trust. Trust holds onboarding, credentialing and compliance records, and it enforces service zones. A.D.I. (Automated Dispatching Intelligence) sends each trip only to providers that meet the program's rules.
Credentials and exclusion lists are checked when the trip is assigned.
3. Record the trip as it happens
The provider accepts the trip and updates its status. Pickup and dropoff are GPS-timestamped and tied to the assigned driver and vehicle. Where the program requires a PCS form, staff complete it with an electronic signature on the order.
4. Check claims before payment
Each completed trip has one record: the order, the eligibility check, the provider and its credentials, the GPS pickup and dropoff, and the signed forms. The state's claims team checks claims against that record before payment. Trips with no completion record, mileage gaps, or duplicate claims are flagged. Trips with no qualifying appointment that day are flagged too.
Trip charges are checked against the contract rates the program sets. For rideshare trips, the fare is checked against the trip that was ordered.
Staff get an alert when an appointment or a route looks wrong, so they can check it before the trip is paid.
An intelligence layer across the program
Some problems show only across many trips. VectorCare looks at patterns over the whole program, such as the same driver and member on repeat trips, trips to distant clinics, or a sudden rise in trip frequency. Flags come with the trip records attached, so the program integrity unit starts from evidence. See how VectorCare handles NEMT fraud, waste and abuse.
Program staff also get standing reports on documentation rates and GPS coverage, and provider scorecards built from verified trips.
What the state gets
- One trip record across brokers, plans, providers and facilities.
- Rules the state sets: who can take which trips, in which zones.
- Dashboards and reports on trips and providers, from VectorCare Insights.
- A per-trip evidence packet for program integrity units and auditors, from the order to completion.
- Full data export on request.
- The power to remove a provider from dispatch after a finding, through VectorCare Trust.
Where it fits
Rural Health Transformation
States that fund rural access through the Rural Health Transformation Program need to show what happened to each ride and each referral. The same rails let rural hospitals order rides and home health visits from contracted local vendors. See the rural transport and home health network.
Recurring rides
Dialysis rides repeat several times a week. Each trip in a standing order needs the same proof as the first. See dialysis ride coordination.
What VectorCare does not do
- It does not run vehicles or employ drivers.
- It does not take the broker contract or subcontract trips.
- It does not pay claims or decide eligibility policy. The state and its plans do.
- It does not replace the state's claims system or its program integrity unit. It gives them a trip record to check claims against.
- It does not administer Rural Health Transformation funds.
- It does not run a special investigations unit or decide cases. The state's program integrity unit does. VectorCare gives it the records.
- It does not cover personal care visit verification.
Compared with the current way
| Topic | Broker holds the record | State owns the record on VectorCare |
|---|---|---|
| Who keeps the trip data | The broker | The state |
| How the state checks a trip | Asks the broker for the trip sheet | Opens the trip record |
| Audit scope | A sample, after payment | Any trip on the record |
| Broker role | Required | The state's choice |
| Change of broker | Trip history stays with the old system | Trip history stays in the state's account |
Members who call a broker call center can still call. The state just has its own copy of what happened next.
At one VectorCare client, the average time to schedule a ride went from 31 minutes to 3 minutes.
VectorCare has completed a SOC 2 Type II audit, is HIPAA compliant, and signs BAAs with covered entities.
Frequently asked questions
- It is how a state makes sure each Medicaid ride it pays for was ordered, delivered and billed correctly. A state that holds its own trip record can check claims against that record instead of relying only on the party that was paid.
- No. The state can keep its broker or not. Either way, the state holds its own record of each order and trip, so it has an independent check on broker reports.
- No. VectorCare is software. It does not take the broker contract, subcontract trips, run vehicles or employ drivers. The state and its plans keep their contracts with brokers and providers.
- Providers join through VectorCare Trust, which holds onboarding, credentialing and compliance records and enforces service zones. Trips go only to providers that meet the program's rules.
- Staff order in the VectorCare web app or mobile app. Where the EHR supports SMART on FHIR, they can start the order from the chart. Each order goes on the state's record when it is placed.
- Yes, where the state plan allows it. Rural hospitals can order rides and home health visits from contracted local vendors on the same rails. VectorCare does not administer Rural Health Transformation funds.
- The data stays in the state's VectorCare account. A broker can join, leave or be replaced, and the state keeps every order and trip record without a hard data extraction. How each broker connects is set up per program.
- Credentials and exclusion lists are checked when the trip is assigned. Eligibility, level of service and required forms are checked at the order, in the EHR with SMART on FHIR, or in the VectorCare apps.
Hold the record for every ride you pay for
See a trip go from the order to a completion record the state controls.