{"product_id":"nemt-facility-service-contract-template-41594","title":"NEMT Facility Service Contract Template | Medical Transportation Agreement | Nursing Home, Hospital \u0026 Rehab Transport Contract | PDF \u0026 Word","description":"\u003cp class=\"PDq2pG_selectionAnchorContainer\"\u003eProfessionalize your healthcare transportation partnerships and clearly document service expectations with this comprehensive \u003cstrong\u003eNEMT Facility Transportation Service Contract Template\u003c\/strong\u003e.\u003cspan class=\"PDq2pG_selectionAnchor\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eDesigned specifically for \u003cstrong\u003eNon-Emergency Medical Transportation (NEMT) providers entering service arrangements with nursing homes, rehabilitation centers, hospitals, long-term care facilities, therapy centers, and other healthcare organizations\u003c\/strong\u003e, this customizable agreement provides a structured framework for establishing transportation services between an NEMT \u003cstrong\u003eProvider\u003c\/strong\u003e and a healthcare \u003cstrong\u003eFacility\u003c\/strong\u003e. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eFrom \u003cstrong\u003etransportation services and facility billing to scheduling, health and safety requirements, cleaning fees, confidentiality, termination, and indemnification\u003c\/strong\u003e, this template helps both parties put important business expectations in writing.\u003c\/p\u003e\n\u003ch3\u003eWHAT’S INCLUDED\u003c\/h3\u003e\n\u003cp\u003eThis NEMT Facility Transportation Service Contract includes:\u003c\/p\u003e\n\u003cp\u003e• NEMT Provider Information\u003cbr\u003e• Healthcare Facility Information\u003cbr\u003e• Scope of Transportation Services\u003cbr\u003e• Ambulatory Transportation\u003cbr\u003e• Wheelchair Transportation\u003cbr\u003e• Stretcher Transportation\u003cbr\u003e• Medical Appointment Transportation\u003cbr\u003e• Therapy Appointment Transportation\u003cbr\u003e• Hospital Discharge Transportation\u003cbr\u003e• Service Fees \u0026amp; Rate Sheet Terms\u003cbr\u003e• Weekly \/ Biweekly \/ Monthly Billing Options\u003cbr\u003e• Invoice Payment Deadline\u003cbr\u003e• Late Payment Terms\u003cbr\u003e• Approved Payment Methods\u003cbr\u003e• Invoice Dispute Procedures\u003cbr\u003e• Scheduling \u0026amp; Dispatch Requirements\u003cbr\u003e• Last-Minute Transportation Requests\u003cbr\u003e• Health \u0026amp; Safety Requirements\u003cbr\u003e• Driver Certification Requirements\u003cbr\u003e• Background Check Requirements\u003cbr\u003e• Vehicle Inspection Requirements\u003cbr\u003e• Sanitation Requirements\u003cbr\u003e• Cleaning Fee Policy\u003cbr\u003e• Vehicle Damage Responsibility\u003cbr\u003e• Contract Term \u0026amp; Renewal\u003cbr\u003e• Termination Procedures\u003cbr\u003e• Confidentiality \u0026amp; Privacy Provisions\u003cbr\u003e• Indemnification\u003cbr\u003e• Governing Law\u003cbr\u003e• Provider \u0026amp; Facility Signatures\u003c\/p\u003e\n\u003ch3\u003eSCOPE OF NEMT SERVICES\u003c\/h3\u003e\n\u003cp\u003eClearly establish the transportation services your company will provide to the healthcare facility.\u003c\/p\u003e\n\u003cp\u003eThe agreement covers transportation for facility patients or residents traveling to:\u003c\/p\u003e\n\u003cp\u003e✓ Medical Appointments\u003cbr\u003e✓ Therapy Sessions\u003cbr\u003e✓ Hospital Discharges\u003cbr\u003e✓ Other Approved Destinations\u003c\/p\u003e\n\u003cp\u003eTransportation options specifically include:\u003c\/p\u003e\n\u003cp\u003e• Ambulatory Transportation\u003cbr\u003e• Wheelchair Transportation\u003cbr\u003e• Stretcher Transportation \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eSERVICE FEES \u0026amp; BILLING\u003c\/h3\u003e\n\u003cp\u003eEstablish clear financial expectations before transportation services begin.\u003c\/p\u003e\n\u003cp\u003eThe agreement provides for compensation according to an agreed-upon \u003cstrong\u003eRate Sheet attached as Exhibit A\u003c\/strong\u003e and allows invoices to be submitted:\u003c\/p\u003e\n\u003cp\u003e• Weekly\u003cbr\u003e• Biweekly\u003cbr\u003e• Monthly\u003c\/p\u003e\n\u003cp\u003eCustomize:\u003c\/p\u003e\n\u003cp\u003e✓ Invoice Frequency\u003cbr\u003e✓ Payment Due Date\u003cbr\u003e✓ Late Payment Percentage\u003cbr\u003e✓ Facility Rate Sheet \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003ePAYMENT METHODS \u0026amp; INVOICE DISPUTES\u003c\/h3\u003e\n\u003cp\u003eCreate a structured payment process for facility transportation accounts.\u003c\/p\u003e\n\u003cp\u003eThe agreement allows payment by:\u003c\/p\u003e\n\u003cp\u003e✓ Check\u003cbr\u003e✓ ACH Transfer\u003cbr\u003e✓ Other Approved Payment Method\u003c\/p\u003e\n\u003cp\u003eIf the facility disputes an invoice, the contract requires the dispute to be submitted in writing within \u003cstrong\u003efive business days of receipt\u003c\/strong\u003e, while undisputed amounts remain due on time. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eSCHEDULING \u0026amp; DISPATCH\u003c\/h3\u003e\n\u003cp\u003eEstablish a professional process for requesting transportation.\u003c\/p\u003e\n\u003cp\u003eThe facility agrees to provide accurate and timely ride requests through:\u003c\/p\u003e\n\u003cp\u003e• Phone\u003cbr\u003e• Portal\u003cbr\u003e• Email\u003c\/p\u003e\n\u003cp\u003eThe provider agrees to make reasonable efforts to fulfill scheduled transportation requests, while emergency or last-minute trips may be accommodated depending on available capacity. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eHEALTH \u0026amp; SAFETY REQUIREMENTS\u003c\/h3\u003e\n\u003cp\u003eDocument important operational expectations for your NEMT business.\u003c\/p\u003e\n\u003cp\u003eThe agreement states that the provider will maintain compliance with applicable health and safety regulations involving:\u003c\/p\u003e\n\u003cp\u003e✓ Vehicle Sanitation\u003cbr\u003e✓ Driver Certifications\u003cbr\u003e✓ Driver Background Checks\u003cbr\u003e✓ Vehicle Inspections \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eCLEANING \u0026amp; VEHICLE DAMAGE FEES\u003c\/h3\u003e\n\u003cp\u003eProtect your transportation vehicles from unexpected cleaning and damage expenses.\u003c\/p\u003e\n\u003cp\u003eThe agreement provides a customizable cleaning fee when a patient causes:\u003c\/p\u003e\n\u003cp\u003e• Bodily Fluid Spills\u003cbr\u003e• Other Unsanitary Vehicle Conditions\u003c\/p\u003e\n\u003cp\u003eIt also addresses responsibility for patient-caused vehicle damage when the loss is not covered by insurance. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eCONTRACT TERM \u0026amp; AUTOMATIC RENEWAL\u003c\/h3\u003e\n\u003cp\u003eEstablish how long the facility relationship will remain in effect.\u003c\/p\u003e\n\u003cp\u003eThe template provides for an initial \u003cstrong\u003eone-year contract term\u003c\/strong\u003e with automatic renewal unless either party provides \u003cstrong\u003e30 days' written notice of termination\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eIt also allows immediate termination in the event of a material breach. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eCONFIDENTIALITY \u0026amp; PATIENT INFORMATION\u003c\/h3\u003e\n\u003cp\u003eAddress the handling of confidential patient information within the transportation relationship.\u003c\/p\u003e\n\u003cp\u003eThe agreement requires both parties to maintain the confidentiality of patient information and states that the parties will comply with HIPAA and other privacy laws. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eOrganizations should determine whether their particular relationship also requires a separate Business Associate Agreement or other privacy documentation.\u003c\/p\u003e\n\u003ch3\u003eINDEMNIFICATION\u003c\/h3\u003e\n\u003cp\u003eThe agreement includes a mutual indemnification provision.\u003c\/p\u003e\n\u003cp\u003eEach party agrees to indemnify, defend, and hold the other harmless against claims or liabilities resulting from that party's own negligence or misconduct. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003cp\u003eBecause indemnification provisions can have significant legal and insurance consequences, this section should be reviewed for your particular business relationship and jurisdiction.\u003c\/p\u003e\n\u003ch3\u003eGOVERNING LAW\u003c\/h3\u003e\n\u003cp\u003eCustomize the contract with the state whose laws will govern and interpret the agreement. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003eSIGNATURES\u003c\/h3\u003e\n\u003cp\u003eComplete the agreement with dedicated signature sections for:\u003c\/p\u003e\n\u003cp\u003e• NEMT Provider Representative\u003cbr\u003e• Provider Representative Name \u0026amp; Title\u003cbr\u003e• Healthcare Facility Representative\u003cbr\u003e• Facility Representative Name \u0026amp; Title\u003cbr\u003e• Signature Dates \u003cspan class=\"contents\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3\u003ePERFECT FOR\u003c\/h3\u003e\n\u003cp\u003e• NEMT Providers\u003cbr\u003e• Medical Transportation Companies\u003cbr\u003e• Wheelchair Transportation Companies\u003cbr\u003e• Ambulatory Transportation Providers\u003cbr\u003e• Stretcher Transportation Providers\u003cbr\u003e• Nursing Home Transportation Providers\u003cbr\u003e• Rehabilitation Center Transportation\u003cbr\u003e• Long-Term Care Transportation\u003cbr\u003e• Hospital Transportation Contractors\u003cbr\u003e• Healthcare Facility Administrators\u003cbr\u003e• Assisted Living Transportation Providers\u003cbr\u003e• Therapy Center Transportation Providers\u003cbr\u003e• NEMT Business Owners\u003cbr\u003e• Transportation Contract Managers\u003cbr\u003e• Healthcare Transportation Partnerships\u003c\/p\u003e\n\u003ch3\u003eUSE THIS TEMPLATE FOR\u003c\/h3\u003e\n\u003cp\u003e• NEMT Facility Contracts\u003cbr\u003e• Nursing Home Transportation Agreements\u003cbr\u003e• Rehabilitation Center Transportation Contracts\u003cbr\u003e• Hospital Transportation Agreements\u003cbr\u003e• Long-Term Care Facility Contracts\u003cbr\u003e• Medical Appointment Transportation\u003cbr\u003e• Therapy Transportation\u003cbr\u003e• Hospital Discharge Transportation\u003cbr\u003e• Wheelchair Transportation Agreements\u003cbr\u003e• Ambulatory Transportation Agreements\u003cbr\u003e• Stretcher Transportation Agreements\u003cbr\u003e• Facility Billing Arrangements\u003cbr\u003e• Recurring Medical Transportation Services\u003cbr\u003e• Healthcare Transportation Partnerships\u003cbr\u003e• NEMT Client Onboarding\u003c\/p\u003e\n\u003ch3\u003eEASY TO CUSTOMIZE\u003c\/h3\u003e\n\u003cp\u003ePersonalize the agreement with your:\u003c\/p\u003e\n\u003cp\u003e• NEMT Company Name\u003cbr\u003e• Provider Address\u003cbr\u003e• Healthcare Facility Name\u003cbr\u003e• Facility Address\u003cbr\u003e• Transportation Services\u003cbr\u003e• Rate Sheet\u003cbr\u003e• Billing Frequency\u003cbr\u003e• Payment Deadline\u003cbr\u003e• Late Payment Fee\u003cbr\u003e• Cleaning Fee\u003cbr\u003e• Scheduling Procedures\u003cbr\u003e• Governing State\u003cbr\u003e• Provider Representative Information\u003cbr\u003e• Facility Representative Information\u003c\/p\u003e\n\u003ch3\u003eWHY USE AN NEMT FACILITY SERVICE CONTRACT?\u003c\/h3\u003e\n\u003cp\u003eA written facility transportation agreement can help establish a consistent business relationship between an NEMT provider and the healthcare organizations it serves.\u003c\/p\u003e\n\u003cp\u003eIt provides one organized document for establishing \u003cstrong\u003etransportation services, pricing, billing, scheduling procedures, operational responsibilities, cleaning fees, privacy expectations, contract duration, and termination procedures\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eFor NEMT companies pursuing recurring facility accounts, a professional service contract can also help present a more organized process when approaching nursing homes, rehabilitation facilities, hospitals, and other healthcare organizations.\u003c\/p\u003e\n\u003ch3\u003eDIGITAL DOWNLOAD\u003c\/h3\u003e\n\u003cp\u003e\u003cstrong\u003eTHIS IS A DIGITAL PRODUCT. NO PHYSICAL ITEM WILL BE SHIPPED.\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp\u003eYour purchase includes a customizable \u003cstrong\u003e2-page NEMT Facility Transportation Service Contract in PDF and Word formats\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eSimply download the files, customize the agreement with your NEMT company's information, facility information, rates, billing terms, and service procedures, and have both parties carefully review the completed agreement before signing.\u003c\/p\u003e\n\u003ch3\u003eIMPORTANT — PLEASE READ BEFORE PURCHASING\u003c\/h3\u003e\n\u003cp\u003eThis template is provided for general informational, administrative, and document-preparation purposes only. It does not constitute legal, HIPAA, healthcare, transportation, insurance, regulatory, tax, or compliance advice.\u003c\/p\u003e\n\u003cp\u003eUse of this template does \u003cstrong\u003enot guarantee compliance with federal, state, local, Medicaid, Medicare, NEMT, transportation, healthcare, privacy, licensing, credentialing, or insurance requirements\u003c\/strong\u003e.\u003c\/p\u003e\n\u003cp\u003eThe template states that the provider will comply with applicable health and safety requirements, including sanitation, driver certifications, background checks, and vehicle inspections. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e Actual requirements can vary based on the provider's location, vehicle type, payer contracts, transportation services, and facility relationship.\u003c\/p\u003e\n\u003cp\u003eThe confidentiality provision references HIPAA. \u003cspan class=\"contents\"\u003e\u003c\/span\u003e Whether HIPAA applies to a particular NEMT provider or arrangement—and whether a separate Business Associate Agreement is required—depends on the specific relationship and handling of protected health information.\u003c\/p\u003e\n\u003cp\u003eThe contract also includes provisions involving \u003cstrong\u003ecleaning and damage fees, automatic renewal, termination, and mutual indemnification\u003c\/strong\u003e that should be reviewed and customized for the specific business arrangement.\u003c\/p\u003e\n\u003cp\u003eNEMT providers and healthcare facilities should consider having a qualified attorney, insurance professional, and appropriate compliance professional review the completed agreement before implementation.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDue to the nature of digital products, all sales are final.\u003c\/strong\u003e\u003c\/p\u003e","brand":"DocuBridge","offers":[{"title":"Default Title","offer_id":46989955399782,"sku":null,"price":6.99,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0736\/2586\/2246\/files\/il_fullxfull.8516135217_27bo_a73ae16c-229f-4e87-a33f-180292336f5d.jpg?v=1788484838","url":"https:\/\/docubridgeadmin.com\/fr\/products\/nemt-facility-service-contract-template-41594","provider":"DocuBridge","version":"1.0","type":"link"}