Authorizations 101
Overview of insurance authorizations and how requirements differ by payer type.
What Is an Authorization?
An authorization is insurance's review process to confirm a ride is medically necessary and covered under the rider's plan. It's not a guarantee of payment — just an initial confirmation.
If your organization has authorizations in scope with Roundtrip, we'll attempt to get authorization for eligible rides automatically. Insurance can only be selected as the payer for Medical Sedan, Wheelchair Van, Stretcher Van, and Ambulance rides.
Regardless of authorization, the assigned Transportation Provider is still responsible for following the health plan's billing and documentation rules to get paid.
Which Payers Require Authorization?
Medicare
Medicare covers people 65+, along with some younger people with disabilities or End-Stage Renal Disease. It has several parts:
Part | What It Covers |
Part A | Inpatient hospital stays, skilled nursing, hospice, some home health |
Part B | Outpatient services, preventive care, doctor visits — this is the part that covers medical transportation |
Part C (Medicare Advantage) | A private-insurance alternative to Parts A and B |
Part D | Prescription drug coverage |
A rider's exact coverage depends on which parts they have — some have Part A only, others A and B, and many add a Supplemental ("Medigap") plan to cover what Original Medicare doesn't. Authorization requirements and covered transportation vary across Original Medicare, Medicare Dual plans, and Medicare Advantage plans.
Medicaid
Medicaid covers eligible low-income individuals, jointly funded by federal and state governments and run at the state level — coverage varies by state, and some states use a different name (like Medi-Cal in California).
Medicaid rides must go through a broker — a third party contracted by the state or plan to coordinate transportation. Brokers vary by state and sometimes by plan; some states use a single broker for all Medicaid plans, others use several.
Type of Medicaid Plan | Description | Watch-outs | Vehicle Types Covered | Authorization Required? |
Generic Medicaid | Also called "Straight Medicaid" — the standard Medicaid plan administered by the rider's home state | Transportation must be arranged through a broker | Medical Sedan, Wheelchair Van, Stretcher, Ambulance (BLS, ALS, SCT/CCT) | Yes |
Managed Medicaid | For riders who qualify for Medicaid but whose plan is managed by a private insurance company | Transportation must be arranged through a broker | Medical Sedan, Wheelchair Van, Stretcher, Ambulance (BLS, ALS, SCT/CCT) | Yes |
Dual Medicare | For riders who qualify for both Medicare and Medicaid — their coverage is combined into a "Dual" plan managed by the state's Medicaid program | Transportation must be arranged through a broker | Medical Sedan, Wheelchair Van, Stretcher, Ambulance (BLS, ALS, SCT/CCT) | Yes |
Private Insurance
Any plan not administered under Medicare or Medicaid — usually paid for by the rider or their employer, or purchased on a marketplace. Coverage varies widely even within the same plan name — for example, a single "Gold Plan" from one insurer might have HMO, POS, and PPO versions, each with different coverage rules.