MedicaidAdministrativeHigh impact
Billing and process changes to support assessment of Oregon’s NEMT Transportation Network Companies (TNC) Pilot Program
Oregon Health Plan·OR·Plan contract
Effective date
Apr 1, 2025
We identified it
Aug 19, 2026
Summary
Oregon Health Authority (OHA) requires billing teams to append modifier Q2 to all non-emergent medical transportation (NEMT) claims for services provided by transportation network companies (TNCs) such as Uber or Lyft, effective April 1, 2025. This change distinguishes TNC-provided NEMT services from traditional NEMT network services for pilot program assessment purposes. Billing teams must also maintain records for 11 specific pilot program metrics and establish check-in meetings with OHA by April 11, 2025.
Action Required
By April 1, 2025: Billing team must update billing system configuration to automatically append modifier Q2 to all NEMT claims for Uber and Lyft services. Create or update claim submission rules in the billing software to identify TNC-provided transportation and apply the Q2 modifier. By April 11, 2025: Designated staff member must contact David Simnitt (503-451-0008) to establish regular check-in meetings with OHA. Immediately and ongoing: Billing and operations teams must establish processes to capture and maintain records for all 11 TNC pilot measures (total NEMT rides, total TNC rides, OHP members served, utilization rates, ride destinations, same-day scheduling rates, member dissatisfaction rates, TNC-specific dissatisfaction rates, resolution documentation, member age ranges, pickup-to-destination distances, and language access support provision). Ensure these metrics can be reported quarterly (for CCOs) or monthly (for FFS) upon OHA request. Failure to append Q2 modifier will result in inability to distinguish TNC claims from traditional NEMT claims and compromise OHA's pilot program assessment.