Policies and Forms

This site is under development as we transition to Providence Plan Providers for physical health services. Most of the policies and forms are in the provider portal CIM under Provider Services.

This page includes medical policies, forms and medical management guidelines for both physical and behavioral health.

Policies – General

Policies – Pharmacy

Forms – Pharmacy

Please fax PBM auth requests to 503-574-8646 or toll-free 800-249-7714.


Use the Provider Portal to verify a member’s eligibility with Yamhill Community Care Organization.

Authorization Guidelines and Forms-Medical

To submit a prior authroization request for medical services you can either use the electronic system (CIM), or you can download a from to fax your request to the UM Team. The link is below in the authorization request forms.

Tips for Submitting a PA

Medical Authorization Request Forms

You can also find this information on the Provider Services tab in CIM.  Provider Portal

YCCO PA Procedures List Effective 01012019
Medical-Services PA-Request
Transplant PA Request

Diagnostic and Treatment Procedures – CPT Code Grid

  • For a complete list, please see Provider Services tab in CIM.

DME – Authorization & Code Lists

  • For a complete list, please see Provider Services tab in CIM.

Frequently Asked Questions (FAQ’s)
Transition FAQ for Providers
Authorization and Referral FAQ 2.15.19

Miscellaneous Policies and Forms

There are certain circumstances when a member needs health related services to improve the overall their quality of life. Sometimes these services are not covered under the prioritized guidelines. If you feel you have a YCCO member that needs such services, please read the attached policy and complete the request form for consideration of additional support. Please fax completed forms to 503-376-7524.
Flex Funds Request

At Yamhill Community Care Organization, we strive to make our community a great place to live in. We know that a healthy lifestyle isn’t just about seeing your doctor occasionally. There are many other different ways to improve the way you live. Yamhill CCO’s Community Health Hub is a group of people focused on finding our members the services they need.
Community Health Hub referral form

UM Policies

Behavioral Health Provider Forms

Chemical Dependency Forms

Mental Health Forms

Yamhill County Family and Youth Wraparound Services

Wraparound is a planning process that follows a series of steps to support youth and their families accomplish the goals needed in order to reach their vision.