Together we can support a healthy community

YCCO collaborates with a network of medical, dental and behavioral health specialists as well as social support partners.

We all work together for the good of our patients and the health of our community. 

Info about the Behavioral Health Provider Qualified Directed
Payment is located below in +Provider updates 

Provider updates

2023 Behavioral Health Provider Qualified Directed Payment (QDP)

In 2022, the Oregon Health Authority (OHA) sought and received additional funds via House Bill 5202. The OHA submitted requests for authorization, to the Centers for Medicare and Medicaid Services (CMS), to implement changes in the Oregon Health Plan (OHP) Fee-for-Service Fee Schedule and to implement a new Qualified Directed Payment structure. These two approaches support increased payments for both Open Card Fee-For-Service payments and CCO payments. The two different structures are:

OHP Fee-for-Service Fee Schedule (often referred to as DMAP rates): Changes to the OHP Fee-for Service Fee Schedule is the vehicle being used to increase rates for services provided to Open Card members (OHP members who have not been assigned to a CCO).

Qualified Directed Payments (QDP): To increase continuity of payment levels across CCOs, the OHA has added QDP requirements to each CCO’s contract. This new language outlines four (4) different “tiers” for payment. Effective January 1, 2023, through December 31, 2023, the approved payment mechanism is called a “Directed Payment.” Approval of this payment mechanism is authorized through CMS regulation (42 CFR 438.6). 

Overview of Tiered Qualified Directed Payments

Tier 1: Increases payment for treatment services delivered by qualifying provider types. This Tier applies to Providers who meet one or more of the following service categories:

• Assertive Community Treatment (ACT)

• Supported Employment Services (SE)

• Outpatient Mental Health Treatment and Services (OPMH)

• Outpatient Substance Use Disorder Treatment and Services (OP SUD)

Payment rates will be calculated based on whether the Behavioral Health (BH) Qualifying Provider derives its Behavioral Health revenue primarily from providing services to individuals enrolled in Oregon’s Medicaid and Children’s Health Insurance Program (CHIP) programs. A BH Participating Provider is regarded as “Primarily Medicaid” if at least fifty percent (50%) of their revenue came from providing Medicaid services in the prior Contract Year.

All qualified Providers will default to the Medicaid Non-Dominant rate (15%) increase unless the Provider submits a complete qualifying Attestation Form.

If you believe that you qualify for Tier 1 “Primarily Medicaid” level of payment (30%) complete the Primarily Medicaid Provider Attestation Form which is here: 

2024 Provider Medicaid-Focused Attestation Form 

Upon completion of the Primarily Medicaid Provider Attestation Form, please submit the document to YCCO Provider Relations at providerrelations@yamhillcco.org

Tier 2: The Integrated Co-Occurring Disorder (ICOD) Services payment increase is applicable for BH Participating Providers approved by OHA for provision of integrated treatment of Co-Occurring Disorders (ICOD) pursuant to OAR 309-019-0145. Programs will need to have previous and current Behavioral Health Certification of Approval and meet requirements that OHA will add to Oregon Administrative Rule 309-019-0145.

Payment increase(s) vary by category:

  • 10% of the State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate effective Jan. 1, 2023, for covered non-residential services provided by providers below a master’s level, including peer service providers.
  • 20% of the Medicaid fee schedule rate in effect on Jan. 1, 2023, for covered non-residential services for master’s level providers.
  • 15% of the Medicaid fee schedule rate in effect on Jan. 1, 2023, for residential services providers.  

To receive increased payments, qualifying providers must follow OHA established directions for submission of claims. This includes the requirement that a COD diagnostic combination must be present on each qualified encounter. *OHA will provide detailed diagnosis code lists in a separate COD implementation guide.

Additionally, OHA approved ICOD Providers will be required to add applicable modifiers to claims filed in order to receive the increased rate for qualifying services.

For non-residential ICOD Providers:

  • Master’s level provider: use modifier HO for eligible services to receive the additional 20%.
  • All other providers: use modified HH for eligible services to receive the additional 10%. 

For qualified residential ICOD Providers/Services:

·       H0010, H0011, and H0018: Use modifier HH (Other conditions: Must be a licensed SUD Program)

·       H0019: Use modifier HH (Other conditions: None)

·       H2013: Use modifier Not HK (Other conditions: None)

If you believe that you qualify for Tier 2 Integrated Co-Occurring Disorder (ICOD) Services payment complete the OHA approval process which can be found at: www.oregon.gov/icd

Tier 3: Increase for OHA Authorized Providers who are approved by OHA as a Provider of Culturally and Linguistically Specific Services (CLSS). The percent that a payment is increased for a qualifying service is based on whether the Provider is delivering services in a rural or non-rural area.

Eligible providers will fall into one of five categories:

1. CLSS Organization, an organization which delivers CLSS BH services to its clients.
2. CLSS Program, a program which exists within a larger organization and that delivers CLSS BH services to its clients.
3.  CLSS Individual Provider, an individual who delivers CLSS services to their clients.
4.   Individual Bilingual Provider, an individual provider who delivers direct care BH services in a language other than English.  (Not Interpretation)
5.   Individual Sign Language Provider, an individual provider who delivers direct care BH services in sign language. (Not Interpretation)

OHA approved CLSS Providers will be required to add applicable modifiers to claims filed in order to receive the increased rate for qualifying services.

·       CLSS Rural provider modifier: TN

·       CLSS non-rural provider modifier: U9

If you believe that you qualify for Tier 3 Culturally and Linguistically Specific Services (CLSS) payment complete the OHA CLSS Behavioral Health Provider application process which can be found at: https://www.oregon.gov/OHA/HSD/OHP/Pages/BH-Rate-Increase.aspx

Tier 4: Assurance that applicable providers are paid no less than Behavioral Health Oregon Medicaid fee-for-service (FFS).

No additional action is needed by Providers.

For additional information and resources, please see:

       Qualified Directed Payment Overview

        OHA Provider Webinars https://www.oregon.gov/oha/HSD/OHP/Pages/BH-Rate-Increase.aspx

     2023 Medicaid Behavioral Health Provider Directed Payment Increase Information

Questions about this program or your eligibility, please contact Yamhill Community Care ProviderRelations@yamhillcco.org

Behavioral Health Transition 2022
Transition Reminder and PA MN Review 110121
YCCO BH PA Grid 110121
BH Provider FAQ with YCCO contract_10.08.21

New PCP Assignment Policy active January 1st, 2021

View PCP Assignment and Engagement FAQ


With a healthy early start in life and the services we provide, our members can overcome many barriers to health.

We work with community, government and social agencies to address issues like homelessness, hunger and addictions. We also work with providers like you to share electronic medical records and manage measurable outcomes for programs which focus on specific community issues.

Provider Resources to help you provide the best care!

Provider information is available 24/7 through
the Provider Portal (CIM)

The Portal makes it convenient to access patient eligibility, review claims/payment information, submit a claim, check on the status of a referral, or submit one and has information regarding prior authorizations.

Please note: all prior authorizations are to be submitted through the portal. 

Go to Provider Portal(CIM)

Need access?

If you are a new provider who needs access to the portal, or if you are an established provider with portal questions, please submit an online request below or call Customer Service at 855-722-8205.

Request access

Submitting a claim is easy

Submit electronically using the provider portal or by logging in directly to CIM. If you need assistance on submitting a claim submit call Customer Service at 855-722-8205.

Claims can also be mailed to:

Yamhill Community Care
PO Box 5490
Salem, OR 97304

Go To Provider Portal (CIM)

To receive electronic claims payments and/or remittances please register with Payspan. You will need a Registration Code and PIN in order to register. Please contact PaySpan Provider Services at 877-331-7154, Option 1 for assistance.

Clinical guidelines keep
you current

These guidelines, based on best practices, support the excellent care of our OHP members. These resources can help identify health and lifestyle issues. They will also help providers and patients learn and use the best treatment methods.

Physical health

Physical health guidelines can help providers choose the best treatment for medical conditions.

Get guidelines

Dental health

Yamhill Community Care contracts with Capitol Dental Care for member dental care. Guidelines have been adopted.

Get guidelines

Behavioral health

These behavioral health guidelines identify different levels of care and corresponding treatment for OHP members.

Get guidelines


Community Health Guidelines

Opiate Prescribing

Adopted from Oregon Pain Guidance, these guidelines cover treatment of chronic pain among OHP members.

Get guidelines

Prescription Drug Monitoring Program

The Oregon Prescription Drug Monitoring Program (PDMP) is a tool to help healthcare providers and pharmacists provide patients with better care in managing their prescriptions. It contains information provided by Oregon-licensed retail pharmacies.

OHA PDMP Website Page


These guidelines aim to increase community-wide childhood and adolescent vaccination rates in Yamhill County.

Centers for Disease Control: https://www.cdc.gov/vaccines/

Oregon Health Authority Vaccines and Immunizations:


Oregon Health Authority Alert Immunization Information System:



Patient-Centered Primary Care Home Program (PCPCH)

Any health care practice that provides comprehensive primary care and meets the key standards can become a recognized Patient-Centered Primary Care Home, including:

  • Physical health providers
  • Behavioral, addictions and mental health care providers with integrated primary care services
  • Solo practitioners
  • Group practices
  • Community mental health centers with integrated primary care services
  • Rural health clinics
  • Federally qualified health centers
  • School-based health centers

If you are interested in learning more about PCPCH recognition, please visit the page linked below.

OHA PCPCH website page


Value-Based Payment

Value-based payment (VBP) is one of the Oregon Health Authority’s (OHA’s) primary strategies for achieving the triple aim of better health, better care and lower costs for all Oregonians.

YCCO Quality Pool Distribution 2022

To learn more about VBP please visit the OHA website page linked below.

OHA Value Base Care website page

Metrics & Performance

Since July 2020, YCCO has used PhTech’s AYIN Insights platform to offer our providers access to real-term updates on incentive metrics performance.  It is fully integrated as a feature within CIM, and it’s key features include graphical visualizations of metrics performance and the ability to review and export gap lists of members who apply to each metric.  Access to this platform is available at no cost to any YCCO provider.

  • Providers interested in gaining access to this platform should contact YCCO at providerrelations@yamhillcco.org with the following information:
    • Full Name
    • Email Address and Phone Number
    • Clinic Name and address
    • Clinic NPI and TIN
    • Job Title
  • A provider-focused tutorial of basic Insights functions can be found here.
  • Current Insights users with questions or feedback about the platform should reach out direct to YCCO at Providerrelations@yamhillcco.org


The Collective Platform

EDIE: EDIE technology provides real time alerts that allow emergency department clinicians to identify individuals who are frequent utilizers of the emergency department or who have active care guidelines or security events noted in the Collective platform. EDIE also provides alerts on individuals who have triggered the Prescription Drug Monitoring Program (PDMP) criteria. All hospitals in Oregon have adopted EDIE and are receiving notifications.

Collective platform: The Collective platform is a complementary product to EDIE that enables hospital event information (ED and inpatient admissions and discharges) to be sent to health plans, CCOs, primary care, behavioral health, post-acute and specialty providers for specified member or patient populations. This information provides the ability to rapidly identify at risk patients or members and support them in getting the right care through improved care coordination.

Visit the Collective Platform

For information on how to get access to The Collective Platform please e-mail providerrelations@yamhillcco.org


Report Fraud, Waste & Abuse

Medicaid fraud is against the law and should be reported. Fraud covers providers charging for services that weren’t provided or patients using another person’s ID to get OHP benefits. You can report fraud, waste or abuse of Medicaid benefits electronically or via phone or mail.

Report provider fraud:

Medicaid Fraud Control Unit (MFCU)
Oregon Department of Justice
100 SW Market Street
Portland, OR 97201

Phone: 971-673-1880
Fax: 971-673-1890

OHA Program Integrity Audit Unit (PIAU)
3406 Cherry Avenue NE
Salem, OR 97303-4924
Phone: 888-372-8301

Fax: 503-373-1525 ATTN: HOTLINE

Report member fraud: 

DHS/OHA Fraud Investigation
P.O. Box 14150
Salem, OR 97309
Phone: 1-888-FRAUD01 (1-888-372-8301)
Fax: 503-373-1525 ATTN: HOTLINE

YCCO Compliance & Ethics Hotline:

Providers may also report potential fraud, waste and abuse to YCCO directly. YCCO has an anonymous Compliance & Ethics Hotline available 24/7 in which anyone may leave a voicemail message. This voice mailbox is monitored daily. If you would like to make a report anonymously, you may call toll free (844) 989-2845.

Do you need to make an anonymous report for a violation stated in the Yamhill Community Care Code of Conduct policy? You can file your anonymous report through Ethics Point by clicking here. 


Contracting With YCCO

If you would like to become an in-network provider with YCCO please submit your request electronically at the link below or by emailing providerrelations@yamhillcco.org. Please include in your request your name (if different than the provider name), provider name with licensure, NPI, tax ID,  an email address and telephone number you can be reached.

For more information on YCCO credentialing can be found in the YCCO Credentialing Policy and Procedure.

YCCO Credentialing Policy