MedicaidDocumentationMedium impact
Addendum to Notice of Adverse Benefit Determination (NOABD) for Non-Emergent Medical Transportation (NEMT) Services Requirement Update (sent October 21, 2024).
Oregon Health Plan·OR·Plan contract
Effective date
Sep 18, 2025
We identified it
Aug 19, 2026
Summary
Oregon Health Authority is waiving the requirement to include the member's primary care provider (PCP), primary care dentist (PCD), or behavioral health professional (BH) name in Grievance and Appeals notices that pertain ONLY to Non-Emergent Medical Transportation (NEMT) Services. This simplifies notice documentation for NEMT-specific denials and appeals effective immediately. Updated model templates will be posted by October 1, 2025.
Action Required
By October 1, 2025: Billing and appeals team must update all Grievance and Appeals notice templates for NEMT Services to remove the requirement to include PCP, PCD, or BH professional names. Remove these name fields from NOABD (Notice of Adverse Benefit Determination) and NOAR (Notice of Appeal Resolution) notices that are NEMT-specific only. Download and implement the 2026 OHA Model NOABD and NOAR templates from the CCO Contract Forms website when posted. Do not include provider names on NEMT-only grievance/appeals notices created on or after September 18, 2025, to avoid audit findings from OHA. Mixed notices (NEMT + other services) should continue to include provider names for non-NEMT components.