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NEMT Claims Prep & Eligibility Check · Healthcare & NEMT

Catch NEMT billing errors before the broker denies the claim

Checks each completed trip against your broker and state billing rules, posts the exact fix for errors, and queues clean claim lines for your biller.

Available now $179 one-time · never renewsIncluded in Enterprise
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Free account to start. Buying and running live need a paid plan.

  • Starts when your form or app sends it something
  • 1 AI step
  • A person approves before it acts
  • About 25 min to set up

Sound familiar?

The job, before and after this agent.

What it feels like today

  • “Claims come back denied for a missing modifier or an expired eligibility check.”
  • “We only find out a trip was never verified after we've billed it.”
  • “Checking every trip by hand before billing is slow and easy to get wrong.”

What you get with the agent

  • Each completed trip checked against the broker and state rules you paste in: required fields, eligibility check date, prior authorization, codes, modifiers, mileage, times, signatures and filing window
  • Errors posted to your billing channel in Slack with the exact fix, using trip ids only and no member details
  • Clean trips prepared as claim lines and added to your ready-to-bill sheet after a biller approves
  • Every check kept in the run history and Agent analytics

Before

Your biller submits a batch, waits, and works through denials for missing prior authorizations and stale eligibility weeks later.

After

Errors surface in Slack the day the trip is completed, with exactly what to fix. The biller submits from a checked ready-to-bill sheet.

How it works

The whole workflow, step by step.

Each completed trip your trip system sends in is checked by AI against the broker and state billing rules you paste in: required fields, the eligibility check your team recorded (date and reference), prior authorization, procedure codes and modifiers, mileage, times, signatures and the timely-filing window. Trips with errors are posted to your billing channel in Slack with the exact fix, using trip ids only (no member details). Clean trips are prepared as a claim line and, once a biller approves, added to your ready-to-bill Google Sheet for submission in the broker or state portal. It doesn't query eligibility systems or submit claims.

  1. TriggerCompleted trip
  2. LogicCheck the trip dates
  3. AI stepCheck the claim against your billing rules
  4. LogicReady or needs a fix?
    • Needs a fix:Ask billing to fix the trip in Slack
    • Ready:Biller approves the claim line
  5. App callAsk billing to fix the trip in Slack
  6. Human approvalBiller approves the claim line
    • Approved:Add the claim to your ready-to-bill sheet
    • Rejected:Held by the biller
  7. App callAdd the claim to your ready-to-bill sheet
  8. OutputHeld by the biller

This is the workflow that opens in your workspace when you set the agent up. Every step can be edited.

  1. Step 1Completed tripYour trip or dispatch system (or a Google Sheets / form automation) posts each completed trip with its billing details to the workflow's webhook URL.
  2. Step 2Check the trip datesIn code, not AI: works out the days since the date of service (filing window: 90 days by default, with a warning in the last 14), and reads the eligibility-check date as an exact date. Nothing is filtered out. Change the filing window here (the buckets' days).
  3. Step 3Check the claim against your billing rulesAI checks the trip's billing details against your broker and state rules: required fields, eligibility check date, prior authorization, codes and modifiers, mileage, times, signature and filing window.
  4. Step 4Ready or needs a fix?Claims with errors go to your billing channel to be fixed; clean claims go to a biller for approval.
  5. Step 5Ask billing to fix the trip in SlackPosts the trip id and the list of errors (no member details) to your billing channel.
  6. Step 6Biller approves the claim lineA biller checks the prepared claim line and warnings in Reviews, edits anything needed and approves it to add it to your ready-to-bill sheet.
  7. Step 7Add the claim to your ready-to-bill sheetAdds the approved claim line as a row in your Google Sheet, ready for your biller to upload or key into the broker portal.
  8. Step 8Held by the billerRejected claims stay in the run history only.

Example run

What goes in, and what comes out.

Example with fictional data

Comes in

A fictional completed wheelchair trip, 7.4 loaded miles, codes A0130 and S0209 with an RH modifier, eligibility checked 7 days earlier, prior authorization blank.

The agent produces

Posted to #billing for trip T-48213: prior authorization missing (your rules require one for this broker); add it before billing. The trip doesn't go to the ready-to-bill sheet until fixed and approved.

What you need

Everything it takes to run it.

About 25 minutes from purchase to live. A checklist above the canvas takes you through each step.

Plan

Included in Enterprise; on other paid plans it's $179 once. Agents run live on paid plans, from Basic ($39/mo).

Your AI key

Connect any of 14 AI providers on your own key. Your provider bills usage directly, at cost; we add no markup.

Apps

Checklist

  • A paid plan (agents run live on paid plans).
  • An AI provider key (Settings → AI Providers). Check that your AI provider agreement covers health data (many offer a BAA).
  • Slack and Google Sheets, connected in Settings → Integrations.
  • A trip system, form or sheet automation that can send completed trips to a webhook URL.

Setup, about 25 minutes

  1. Connect your AI provider. The AI steps run on your own key (OpenAI, Anthropic, Google and more). Add one in Settings → AI Providers.
  2. Connect Slack. Connect the Slack workspace your billing team uses (Settings → Integrations → Slack).
  3. Connect Google Sheets. Connect the Google account that owns your ready-to-bill sheet (Settings → Integrations → Google Sheets).
  4. Paste your billing rules. Open “Check the claim against your billing rules” and replace the placeholder with each broker's rules. The agent checks only what's written there. Set your filing limit on “Check the trip dates” (90 days by default).
  5. Pick the billing channel. Open “Ask billing to fix the trip in Slack” and pick your account and channel. Invite the app to private channels first (/invite @Fluxo Flow).
  6. Pick the ready-to-bill sheet. Open “Add the claim to your ready-to-bill sheet”, pick your Google account, paste the spreadsheet link and pick the tab.
  7. Test it with Dry Run. Press Dry Run: the agent runs on sample data with no messages sent and nothing written to your apps.
  8. Switch the trigger on. Open the trigger, switch the webhook on and have your trip system send each completed trip to its URL. Assign the review step to your biller.

Is it a fit?

Who it's for, and what it won't do.

Built for

  • NEMT providers billing brokers and state Medicaid programs
  • NEMT billing staff and office managers
  • Medical transportation companies with a trip system that can send webhooks

What it doesn't do

  • It doesn't query Medicaid or broker eligibility systems (no 270/271 or clearinghouse connection); it checks the eligibility record your team saved on the trip.
  • It doesn't submit claims, upload to broker portals or track claim status and payments; your biller submits from the ready-to-bill sheet.
  • It never makes up codes, mileage or authorization numbers; missing data is flagged for a person to fix.
  • It's a pre-billing check, not billing or compliance advice.

We list the limits up front so you can decide before you buy.

Price

$179 one-time

Per workspace. It never renews.

Available now
  • Included at no extra cost on Enterprise.
  • Buying and running it live need a paid plan, from Basic ($39/mo).
  • Dry Run costs nothing: simulated AI and app calls, nothing sent.
  • AI usage is billed by your own provider, at cost. No AI credits to buy from us.
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One-time agent purchases aren't covered by the 30-day money-back guarantee. Refund policy

FAQ

Questions about NEMT Claims Prep & Eligibility Check.

Does it check Medicaid eligibility or submit claims?

No. It can't query eligibility systems; it checks the eligibility date and reference your team recorded on the trip. It doesn't submit claims or track payments; your biller submits from the ready-to-bill sheet.

What about health data?

Slack alerts use trip ids only, with no member details. The trip data passes through your own AI provider key, so check that your provider agreement covers health data (many offer a BAA).

Could it get a code wrong?

It never makes up codes, mileage or authorization numbers; missing data is flagged for a person. It's a pre-billing check against your rules, not billing or compliance advice, and a biller approves every claim line.

What's involved and is it worth it?

About 25 minutes with Slack, Google Sheets and a webhook from your trip system. It's a one-time purchase that never renews, catching errors before they turn into denials and rework. Live runs need a paid plan.

Does it check Medicaid eligibility?

It can't query the state system. It checks the eligibility date and reference your team recorded on the trip and flags trips that were never verified or were verified too long ago.

Does it submit claims?

No. It prepares a checked claim line in your Google Sheet; your biller submits it in the broker or state portal.

How is the filing window checked?

In code, not by the AI: “Check the trip dates” counts the days since the date of service — over 90 days is an error, the last 14 days a warning. Change the days on that step's buckets to match your broker's limit.

Is this a subscription?

No. NEMT Claims Prep & Eligibility Check is a one-time purchase of $179 per workspace and never renews. The Enterprise plan includes it at no extra cost. Running it live needs a paid plan (from Basic ($39/mo)), and your AI provider bills you directly for usage.

Can I test it before it touches real data?

Yes. Once it's set up in your workspace, Dry Run plays every step on sample data with simulated AI and app calls: nothing is sent and nothing in your apps changes. Switch the trigger on only when you're happy.

Put NEMT Claims Prep & Eligibility Check to work.

Free account, no credit card. Your Agents page opens with NEMT Claims Prep & Eligibility Check ready to buy and set up, then Dry Run it before it goes live.

Get this agent See how it works