Cabinet Secretary
Matt Althoff
Non-Emergency Medical Travel Frequently Asked Questions
How do I know if I qualify for NEMT reimbursement?
For you to be reimbursed for your medical travel you must be on a medical assistance program that provides Medicaid travel coverage at the time of service.
Travel must be from an eligible recipient’s city of residence to a medical facility located in another city. Travel must be to the closest medical facility capable of providing the necessary services, unless the recipient has a written referral or a written authorization from the recipient’s medical provider.
What can I be reimbursed for?
The NEMT program may reimburse you for mileage, lodging and meals at the current rate of payment. Reimbursement rates are located at https://dss.sd.gov/medicaid/recipients/title19transportation.aspx#rates
A recipient may not receive reimbursement for lodging and meals for days the recipient is an inpatient in a hospital or medical facility.What do I need to do to get travel reimbursement to and from my medical appointment?
You must submit a claim to NEMT. You can enroll and submit claims online using the NEMT Portal or you can submit a paper claim to NEMT.
- NEMT Portal
NOTE: Before you begin, review the appropriate instruction video on the NEMT website.
- Before your appointment, print an NEMT Appointment Verification Form. You should take this form with you to your medical appointment. The medical facility must FULLY complete and sign the form.
- After your trip is complete, log onto the NEMT Portal, enter and submit your claim. Make sure to attach the NEMT Appointment Verification form and any other required documentation to your online claim before submitting to NEMT.
Using the NEMT Portal will allow you to:
- Update and maintain your personal and banking information.
- Submit claims online.
- Track the status of your claim.
- Receive and review correspondence and Paid Claims Statements.
- Submit a Paper claim to NEMT
- Before your appointment, print a NEMT Requirement Form (day trip or overnight). You should take this form with you to your medical appointment. The medical facility must FULLY complete and sign Medical Section of the form.
- This form, along with any necessary documentation, may be turned in at your local DSS office or you may fax, email or mail your form directly to the address listed on the NEMT form.
The NEMT program must receive a completed claim form within six months following the month the service was provided.
Can I get reimbursed to travel to my Primary Care Provider (PCP) or health Home Provider (HHP)?
Travel to the closest PCP or HHP is reimbursable. If travel is not to the closest PCP or HHP, travel will only be reimbursed if a "good cause" exception has been approved by Medical Services. Lodging and meals are not reimbursable when travel is to a PCP or HHP.
If my PCP or HHP refers me to a medical specialty provider, do I need a copy of my referral card?
Yes. Trips to medical specialty providers other than your PCP or HHP require a referral.
How or where can I get the Medicaid Non-Emergency Medical Travel Form?
NEMT Forms can be found on the NEMT website or on the DSS online Forms and Publications page under Medical Services. You may also obtain the Medicaid Non-Emergency Medical Travel Forms at your local Department of Social Services Office.
After my appointment I realized that I forgot to have the medical provider sign the reimbursement form verifying my appointment, what can I do?
Before you submit your claim to NEMT, you should mail or fax the NEMT Reimbursement form or an NEMT Appointment Verification Form to the medical facility. After you receive the completed form back from the medical facility, you can submit your claim to NEMT. Any claims that are submitted to NEMT that do not have the Medical Provider section of the NEMT Reimbursement form or the NEMT Appointment Verification Form fully completed and signed by the medical provider will be returned and may delay the processing of your claim.
Can I get reimbursed to travel to medical appointments out-of-state?
Medicaid covered services received more than 50 miles outside of the State of South Dakota, except Bismarck, ND, will require prior authorization. This applies to all Medicaid recipients, including those not in the PCP or HHP program.
If your doctor recommends you see a doctor out-of-state, please ask your doctor if prior authorization is needed before you make the appointment. If approval is not given, you will be responsible for the medical bill and travel costs.
Prior authorization must be approved before travel expenses can be approved or paid.
NOTE: If you are in the PCP or HHP program and traveling to Bismarck, ND, a referral from your PCP or HHP is still required. If you are not in the PCP or HHP program, travel will only be reimbursed if Bismarck, ND, is the closest provider capable of providing the services.
If I had to stay overnight due to my medical appointment, do you need a copy of my motel receipt?
Yes. A motel receipt is required for lodging reimbursement. Lodging is reimbursable when the provider is at least 150 miles from the recipient's city of residence and travel is to obtain specialty care or treatment that result in an overnight stay.
If I have already completed the NEMT Payment Authorization form, do I need to complete the form again?
NEMT payment providers should enroll using the NEMT Portal. The NEMT Portal allows providers to update and maintain their personal and banking information.
If you choose to enroll using paper, you will need to complete an NEMT Payment Authorization form and submit it to NEMT. A new form only needs to be submitted if you want to change your personal or banking information.
Will I be reimbursed for meals for a same day medical trip?
No. Meals will be reimbursed only if an overnight stay is medically necessary, and the overnight meets the lodging requirement criteria.
I have a hotel room booked, and I do not want to lose my room but must return home over the weekend. Can I keep my belongings in the room and still be reimbursed by NEMT?
No. NEMT can only reimburse for nights the recipient and/or escort are present in the lodging establishment.
Can lodging be paid by NEMT if one parent/guardian/escort stays in the hospital and the other parent/guardian/escort stays in a hotel room?
No. NEMT will only reimburse for one parent/guardian/escort at the least costly method to the State.
Which forms are required when submitting NEMT claims?
Claims Submitted Online using the NEMT Portal:
- NEMT Appointment Verification Form
Paper Claims Submitted to NEMT via email, fax or mail:
- NEMT Reimbursement Form (Day Trip or Overnight)
- Additional Lodging Form (if overnight is more than 3 nights)
- Appointment Verification Form (if multiple appointments during the same trip)
When will I receive my reimbursement?
You will receive your reimbursement when all required forms and verifications have been received in our office and processed. Claims are processed in the order they are received in our office. You will receive a Paid Claims Statement showing specific travel dates and amounts in the mail once your claim has been paid.
Does NEMT reimburse to pick-up prescription drugs, durable medical equipment, and optical supplies?
The Non-Emergency Medical Travel (NEMT) Program may cover medically necessary transportation services to pick-up prescription drugs, durable medical equipment, and optical supplies when delivery or mailing is not an option for obtaining the supply. Travel must be to the closest medical provider capable of providing the services. Trips for the first fill of a new prescription or a medical equipment fitting, or adjustment are allowable even if a delivery program is available. If a recipient has multiple prescriptions or DME items, orders must be coordinated for pick-up on the same date from the same provider/location whenever feasible.