Policies and forms in one place

Find all the policies, forms and guidelines you’ll need to deliver the best care possible to YCCO members.

Provider Handbook

The Yamhill Community Care Provider Handbook is The YCCO provider manual is a resource that contains information on your responsibilities as a YCCO network provider, health plan benefit information and required policies and procedures.

Should you be contracted with one of our partners you may be held to additional standards contained through their contracting process
and an additional provider manual or handbook.

YCCO Provider Handbook 2020

Health Related Services (HRS)

Sometimes a member needs special health related services to improve their overall quality of life which are not covered under the prioritized guidelines. If a YCCO member needs special services, providers can request consideration of additional support for the member

Flex Funds Request Form

Non-Emergent Medical Transportation (NEMT)

Members are eligible for non-emergency medical rides to their physical health, dental and behavioral health appointments.

To assist a member in obtaining a ride or for more on this benefit call WellRide at 844-256-5720 Monday through Friday 7:30 a.m. until 6 p.m.

Prior Authorizations

Physical health

Find all the forms and information you need here for submitting prior authorizations for physical health services, including diagnostic and treatment procedure codes.

How to submit a prior authorization (PA)

Submit a prior authorization request for medical services electronically in the provider portal (CIM), or complete the Prior Authorization Request form that can be faxed to the UM Team. Information about what services require preauthorization is located in CIM. Transplant services require a special PA Form below is the link to this form.

YCCO ACTIVE PA LIST AS OF MARCH 1ST, 2021

TERMINATED PA LIST

MEDICAL SERVICES PA REQUEST

TIPS FOR SUBMITTING A PA

TRANSPLANT PA REQUEST

Diagnostic and Treatment Procedures

For a complete list of diagnostic and treatment procedures (CPT code grid) please see the Provider Services tab in CIM. There are certain ancillary guideline notes that apply to services (e.g. tobacco cessation for elective procedures). You must submit authorizations for some types of imaging via AIM please use the link below for access and to submit a request.

Guidelines for requesting medical management service authorizations are outlined below. Initially, check current and active Prior Authorization list (see below) to see if procedure code is noted.

If procedure code is on the Prior Authorization list, then submit Prior Authorization request via CIM.
If prcedure code is NOT on the Prior Authorization list, then check prioritized line (providers can use the Line Search tool within CIM)
1. If procedure code and diagnosis are funded and above the line, then no prior authorization is needed.
2. If procedure code and diagnosis are funded and above the line, but guideline notes indicate medical criteria must be met to provide services (e.g. tobacco cessation for elective procedures), then prior authorization is needed.
3. If procedure code and diagnosis are not funded and fall below the line, or are not ranked (“no results found” in CIM), then submit prior authorization request via CIM and note on the request “benefit exception review for medical necessity consideration”.

GO TO CIM

How to get authorization for Durable Medical Equipment (DME)

Guidelines for DME are the same as all other medical management services.

Check current and active PA list within CIM or YCCO’s website
a) If procedure code is on the PA list, then submit PA request via CIM
b) If procedure code is NOT on the PA list, then check prioritized line
i) Check prioritized line (providers can use the Line Search tool within CIM)
If procedure code and diagnosis are funded and above the line, then no PA is needed
If procedure code and diagnosis are funded and above the line, but guideline notes indicate medical criteria must be met to provide services (e.g. Tobacco cessation for elective procedures), then PA is needed
If procedure code and diagnosis are not funded and fall below the line, or are not ranked (“no results found” in CIM), then submit PA request via CIM if services require a benefit exception review for medical necessity consideration

Behavioral health

To submit prior authorizations for behavioral health, use the forms and information listed here. Behavioral health includes chemical dependency, mental health and wraparound services.

Downloadable PDFs:

Chemical dependency

Behavioral Health Authorization Request Form – Chemical Dependency– Use this form to request authorization for chemical dependency treatment services

Out Of Panel Authorization Instructions – Use these instructions to request service authorization for members who need chemical dependency or mental health treatment services for the first time.

Mental Health & Physical Health Authorization Contacts for Residential Providers– Reference this list of contacts for receiving the authorization for routine mental health, chemical dependency and physical health services for members in residential treatment.

Mental health

Behavioral Health Authorization Request Form – Mental Health– Use this form to authorize mental health services.

Instructions for out of panel provider requests– Use these instructions to request service authorization for members who need chemical dependency or mental health treatment services for the first time.

Wraparound services

Wraparound services help youth and their families accomplish healthy lifestyle goals. They include a planning process with a series of steps to help young people grow up in their homes. People from various parts of a family’s life are brought together. That could include a care coordinator or a family or youth support partner who understands the challenges the youth and family are facing.

Learn more

Downloadable PDFs:

Wrap Referral Form – Use this form to request wraparound services for a member.

Barrier Submission Form– Use this form to report any barriers families may be experiencing in receiving wraparound services. Reports will be reviewed by a practice workgroup who will work to identify solutions to barriers.

Barrier Resolution Process Diagram– Learn more about the barrier resolution process.

Dental health

Find all the forms and information you need here to submit prior authorizations for dental health services administered by Capitol Dental Care by going to the Capitol Dental Care website.

Visit Capitol Dental Care

Medications Preauthorization (PA)

Some medications require preauthorization. Search for the medication in the formulary, it will indicate if the medication requires a pre-authorization.

The formulary link provides all necessary forms and additional information related to pharmacy services as well as a printable formulary.