Grievances & Appeals

Grievances and Appeals System Overview

Assurances through the Grievance System Members and/or Providers are assured the following through the grievance system:

Grievances, complaints, appeals, and contested case hearings are kept confidential and have a timely and appropriate resolution.
No punitive action will be taken against any Provider who files a grievance, appeal, request a contested case hearing or request expedited resolution of an appeal on behalf of a Member.
Yamhill CCO will include in each notice of resolution with the determination not found in favor of the Member that they may present the grievance to OHP Client Services Unit (CSU) toll free at 800-273-0557 or OHA’s Ombudsman at 503-947-2346 or toll free at 877-642-0450.
Yamhill CCO and any Provider whose authorizations, treatments, services, items, quality of care, or requests for payment are involved in the grievance, appeal or hearing may use the information without the Member’s signed release for purposes of:
- Resolving the matter; or
- Maintaining the grievance or appeals log as specified in 42 CFR 438.416.
Yamhill CCO will not take punitive action against any Provider who requests an expedited (fast) resolution or supports a Member’s grievance or appeal.
Grievances may be filed directly with Yamhill CCO by emailing: Appeals@yamhillcco.org or with the Authority. If filed with the Authority, it will be forwarded to Yamhill CCO promptly.
Yamhill CCO has 30 days to resolve all grievances.

For more information, please refer to the YCCO Provider Handbook, Section 9.7.

Providers contact YCCO directly for all complaints.

Contact Information: