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Provider Notices

Non-Emergent Ambulance Transportation Process Update

5/18/2020 6:23:46 PM

Non-Emergent Ambulance Transportation Process Update

PacificSource Community Solutions is implementing process changes for non-emergent ambulance transportation rides and how they should be requested and provided to our members, in each of our CCO regions. Effective immediately, the process to arrange and provide these rides is as follows:


Step 1:  Clinical/Facility provider should contact the local non-emergent ambulance providers or Emergency Medical Services (EMS) providers (as needed) to set up the ride for eligible members. This is applicable to transports for non-emergent ambulance and transports for COVID-19 potentially infectious or confirmed cases. A prior authorization or notification to the NEMT Brokerage is not required for non-emergent ambulance transports.


All other types of NEMT transports should be arranged by contacting the NEMT Brokerage using the General Contact Information below.


Step 2:  Member eligibility, on a PacificSource Community Solutions plan, should be verified prior to transportation being provided. A member’s eligibility can be verified using PacificSource’s InTouch system or the OHA’s MMIS system. If you need access to InTouch, please contact one of our Provider Representatives for more information.


Contact Provider Network if you have questions about InTouch.
Toll-free: (800) 624-6052 ext. 2580



Once eligibility has been verified, the non-emergent ambulance provider should then obtain necessary documentation to confirm medical necessity, for record keeping purposes. In addition, PacificSource requires that the Oregon Health Authority’s (OHA) 405T form is on file with the NEMT Brokerage. The form is located here under the “Forms” section on the OHA’s website:


Step 3:  The non-emergent ambulance provider will send the completed 405T form to the NEMT Brokerage after services have been provided. See below for the submission methods. The NEMT Brokerage will contact the ambulance provider if there are any questions or additional information is needed.


Step 4:  The non-emergent ambulance provider providing the ride will submit a claim for reimbursement to PacificSource Community Solutions. Please visit our website for claims billing details:


Note:    Please continue to review the guidance from the Oregon Health Authority in the “Medical Transportation Announcements” section of this page:



                   Regions: Central Oregon, Columbia Gorge, & Marion-Polk CCO regions (Deschutes, Crook, Jefferson, North Klamath, Hood River, Wasco,

                   Marion and Polk Counties)


                   Non-Emergent Ambulance Providers

                  (844) 287-6697 Toll-free for questions related to Non-Emergent Ambulance transports

                   Send 405T forms via secure email to:

                   If unable to send a secure email, fax form to: (855) 848-8638


General Contact Information:

(855) 397-3619 Toll-free for Central Oregon

(855) 397-3617 Toll-free for Columbia Gorge

(844) 544-1397 Toll-free for Marion-Polk


(800) 735-2900 TTY for Central Oregon

(800) 735-2900 TTY for Columbia Gorge

(844) 288-3133 TTY for Marion-Polk



Monday – Friday 9:00am – 5:00pm (For Routine Trips)

Closed all major holidays

7 days a week, 24 hrs a day (For Urgent and Discharge Trips)


RideSource (Lane Transit District)

Region: Lane County


                     Non-Emergent Ambulance Providers

                     Fax 405T Forms to: (541) 345-2769


Contact Information:

(541) 682-5566 Local

(877) 800-9899 Toll-free

(800) 735-2900 TTY



Monday – Friday 7:00am – 5:00pm

Closed all major holidays