Colorado NEMT Mile Verification Form: Filing, Reimbursement, Denials

To get paid back for driving yourself or being driven to a Health First Colorado appointment, you fill out the Mileage Reimbursement Verification Form and send it to Transdev/IntelliRide, the state’s transportation broker. If the appointment is more than 25 miles from your home, you also need a second document: the 25+ Mile Verification Form, signed by your medical provider. Together these make up the Colorado NEMT mile verification paperwork, and the state currently reimburses personal vehicle travel at $0.46 per mile.¹

Which Form You Need

There are two forms, and they do different jobs.

The Mileage Reimbursement Verification Form is the one you, the member, fill out for every trip. It records who traveled, where, when, and in whose vehicle. You can download it from the Transdev/IntelliRide website under Member Resources, or call 855-489-4999 to request a paper copy by mail.²

The Verification Form for Transportation Services More Than 25 Miles (the 25+ Mile Verification Form) is a separate document signed by your treating or referring provider. It only applies when the one-way distance to the appointment exceeds 25 miles, and it certifies why a closer provider cannot serve you.³ It is available on the Colorado Department of Health Care Policy and Financing’s Provider Forms page.⁴

For a short local trip, you only need the first form. For a longer trip, you need both.

Filling Out the Mileage Reimbursement Verification Form

The form asks for basic identifying information: your first and last name, date of birth, and Health First Colorado ID number. Then, for each trip, you record the date of service and the complete street addresses of both your starting point and the medical facility. Full street numbers and zip codes matter. The broker uses mapping software to calculate reimbursable miles, and an incomplete address will stall the claim.

If someone else drove you, the regulation requires more detail about the vehicle owner and driver: name and address, the insurance company and policy number for the vehicle, and the driver’s license number along with its expiration date.⁵ Collect that information before you leave the car. Tracking it down afterward is where most delays start.

Reimbursement only applies to privately owned, non-commercial vehicles driven by you, a relative, an acquaintance, or a volunteer with no financial interest in your care.⁵

When You Also Need the 25+ Mile Verification Form

If the trip from your home to the medical facility is more than 25 miles one way, your provider must sign the 25+ Mile Verification Form. A few points about this form save a lot of confusion:

Getting the form signed is the NEMT driver’s or provider’s responsibility, not yours. Drivers cannot require members to collect the signatures themselves.³
The signature does not have to happen before the trip. It can be added after the appointment.
For recurring appointments like dialysis or chemotherapy, one signed form covers trips for 90 days from the initial visit date.⁶
Either the treating or the referring provider can sign, and the provider may designate clinical or administrative staff to sign on their behalf.³

If you drive yourself to an appointment that exceeds 25 miles, you still submit your own Mileage Reimbursement Verification Form to the broker. Any NEMT provider claim for a trip over 25 miles that lacks this provider-signed verification will be suspended and likely denied.

How and When to Submit

Once your form is complete, you can send it to Transdev/IntelliRide three ways:²

Email: claims.intelliride@transdev.com
Fax: 402-934-8622
Mail: 2222 Cuming Street, Omaha, NE 68102

Transdev asks members to submit within 10 business days of the appointment.² The underlying state regulation allows longer: 45 calendar days from the final leg of the trip to provide the required information to the state-designated entity.⁵ Submitting soon after each appointment is safer than batching at the end of the month, and keep a copy of every form you send in case anything is lost.

What the State Reimburses

Colorado pays $0.46 per mile for personal vehicle travel to Medicaid-covered appointments.¹ The state only pays for the shortest route between your address and the medical facility, calculated with internet-based mapping or GPS. Exceptions exist for severe weather, road closures, or similar unforeseen circumstances that make the shortest route impassable; if the state-designated entity grants an exception, it must document the reason and pay for the actual route traveled.⁵

Common Reasons Claims Get Denied

The billing manual states that mileage reimbursement can be denied when proper documentation is not submitted within the timely filing window.³ Beyond missed deadlines, the usual culprits are:

Missing or incorrect member information. A blank Health First Colorado ID, missing date of birth, or partial address stops a claim before anyone evaluates the mileage.
Missing driver and vehicle details when someone else drove. Leaving out the driver’s license number, insurance carrier, or policy number is enough to reject the whole form.
Address discrepancies that break the mapping calculation.
Trips to services that are not covered under the state Medicaid plan.
For trips over 25 miles, a missing or insufficient 25+ Mile Verification Form attachment.

One more practical point: the broker verifies distances with mapping tools, so inflated mileage gets flagged quickly. Keep accurate records of each trip, including dates, destinations, and the provider you visited. False mileage claims are Medicaid fraud and carry consequences well beyond losing reimbursement.

If Your Claim Is Denied

Read the denial letter first. Federal Medicaid rules require the notice to state the specific reason for the action, the regulation supporting it, and your right to request a hearing.⁷ A large share of denials come from fixable paperwork errors rather than true ineligibility, so start by calling Transdev/IntelliRide at 855-489-4999 to ask about the reason and whether a corrected resubmission will resolve it. If that does not work, you can request a formal hearing through Health First Colorado’s appeals process.⁸

1
Transdev Health Solutions. Member Resources FAQs – Health First Colorado
2
Transdev Health Solutions. Mileage Reimbursement for Health First Colorado Members
3
Department of Health Care Policy and Financing. Non-Emergent Medical Transportation (NEMT) Billing Manual
4
Department of Health Care Policy and Financing. Provider Forms
5
Legal Information Institute. Colorado Code 10 CCR 2505-10-8.014 – Non-Emergent Medical Transportation
6
Colorado Department of Health Care Policy and Financing. Updated NEMT Mile Verification Form
7
eCFR. Content of Notice
8
Health First Colorado. Get a Ride (Non-Emergent Medical Transportation)