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.

Learn more about Health-Related Social Needs

Health-Related Social Needs

Health-Related Social Needs (HRSN): The social and economic needs that impact an individual’s ability to maintain their health and well-being.

Learn More About Oregon’s HRSN Services:

Clinically Appropriate Climate-Related Devices: Climate-related benefits: (available March 2024) include air conditioners for heat risks, air filters to protect against wildfire smoke, and home modifications to protect people from extreme weather.

Clinically Appropriate climate-related devices for Members residing in their home or non-institutional primary residence include:

  • Air conditioners for individuals at health risk due to significant heat,
  • Heaters for individuals at increased health risk due to significant cold,
  • Air filtration devices and, as needed, replacement air filters for individuals at health risk due to compromised air quality,
  • Mini refrigeration units as needed for individuals for medication storage, and
  • Portable power supplies (PPSs) for individuals who need access to electricity-dependent equipment (e.g., ventilators, dialysis machines, intravenous equipment, chair lifts, mobility devices, communication devices, etc.) or are at risk of public safety power shutoffs (PSPS) that may compromise their ability to use medically necessary devices.

Housing benefits (available November 2024) include help with the cost of rent, utilities, and other bills, help finding a place to live, and help with changes to make peoples’ homes safer and more accessible.

Food Benefits:(available in January 2025) include prescriptions for fruits and vegetables and covering the cost of meals, nutrition education, medically-tailored meals for 6 months, meals or pantry stocking for pregnant individuals, children and youth under 21, and young adults 19-26 years old with special health care needs (YSHCN) for 6 months

Outreach & engagement benefits: include help finding medical and nonmedical benefits.

To be eligible for Climate-Related Devices, a Member must meet all of the following requirements:

  1. A current OHP member and Yamhill CCO A or B member
  2. Be one or more of the eligible groups below:
    • Adult or youth discharged from residential and acute care mental health and substance use programs within the past 12 months
    • Adult or youth released from incarceration within the past 12 months
    • Involved in Oregon’s child welfare system at some point in member’s life
    • Transitioning from Medicaid-only to dual coverage (receiving both Medicaid and Medicare) within the next 3 months or past 9 months.
    • Members who are houseless or at risk of becoming houseless
    • Young adult, aged 19-26, with Special Healthcare Needs (starting in 2025)
  3. Meet at least one of the below clinical risk factors: (Table 1)
    • Younger than 6 years old.
    • 65 years old or older.
    • Currently pregnant.
    • Have a sensory, physical, intellectual, or developmental disability.
    • Need assistance with activities of daily living (ADLs), instrumental activities of daily living (iADLs), or am eligible for long-term services and supports (LTSS).
    • Receive in-home hospice care.
    • Have complex physical health needs, like a chronic heart or lung condition, kidney disease, diabetes, or a condition that makes me at risk for blood clots or a stroke.
    • Have multiple sclerosis.
    • Have Parkinson’s.
    • Have had a spinal cord injury.
    • Have schizophrenia.
    • Have bipolar disorder.
    • Have an alcohol or substance use disorder.
    • Have major depressive disorder and have needed crisis services, hospitalization, or residential treatment in the past 12 months
  4. Social risk factor: A Member meets the HRSN Climate Device Social Risk Factor requirement if they reside in their own home or a non-institutional, non-congregate primary residence and has a need that will be aided by one of the following devices: air conditioner, heater, air filtration device, portable power supply (PPSs), and/or mini refrigeration units.
    1. Examples of climate-related needs:
      • Have a health condition that makes extreme heat, cold temperature, poor air quality, or power outage particularly challenging or dangerous
      • Individual is currently without a heater, air conditioner, air filter, mini-refrigerator for medications, or a portable power supply that works enough to meet my needs.
    2. Examples of Housing-related needs:
      • Require services to navigate, obtain, and sustain housing tenancy or create an accessible and health home environment
    3. Examples of nutrition-related needs:
      • Experience marginal food security, including having anxiety over food sufficiency or shortage of food in the house
(Condition must have been active in the past 12 months. Members must meet age or pregnancy criteria at the time of eligibility determination, as relevant.)
Climate DeviceClinical Risk Factor
Air Conditioner, Air Filtration Device, Heater
Schizophrenia spectrum and other psychotic disorders 
Bipolar and related disorders 
Major depressive disorder with an acute care need in the past 12 months including a suicide attempt, crisis services utilization (emergency department, mobile crisis team, etc.), acute psychiatric hospitalization, or residential treatment 
One or more of the following substance use disorders: alcohol use disorder, hallucinogen use disorders, inhalant use disorder, opioid use disorder, stimulant use disorder 
Major neurocognitive disorders 
Chronic lower respiratory condition including chronic obstructive pulmonary disease (COPD), asthma requiring regular use of asthma controlling medications, restrictive lung disease, fibrosis, chronic bronchitis, bronchiectasis 
Chronic cardiovascular disease, including cerebrovascular disease and heart disease 
Spinal cord injury 
In-home hospice 
Any sensory, physical, intellectual, or developmental disability that increases health risks during extreme climate events 
Child less than 6 years of age and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• Malnutrition• Dehydration or is currently breastfeeding• Child maltreatment as defined by the CDC (https://www.cdc.gov/violenceprevention/pdf/CM_Surveillance-a.pdf)Is a child with a special healthcare need (CYSHCN) as defined by HRSA (https://mchb.hrsa.gov/programs-impact/focus-areas/children-youth-special-health-care-needs-cyshcn#i)• An acute or chronic respiratory conditionA respiratory or gastrointestinal infectious disease, or becoming febrile with an infectious illness• Low birth weight of <2500 grams 
Air Conditioner, Air Filtration Device, HeaterPregnant and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• An acute or chronic respiratory condition• Infection• High-risk pregnancy as defined by the NIH (https://www.nichd.nih.gov/health/topics/high-risk/conditioninfo)• History of previous pregnancy, delivery, or birth complication including gestational diabetes, preeclampsia, preterm labor, preterm birth, placental abruption, newborn low birth weight, stillbirth• Abuse or interpersonal violence• Malnutrition• Hyperemesis gravidarum and other causes of dehydration
Air Conditioner, Air Filtration Device, HeaterAdult 65 years and older and currently has, has a history of, or is at risk for at least one of the following:• Heat stroke or heat exhaustion• Hypothermia, frostbite, or chilblains• Malnutrition• Dehydration• Currently taking medications that impact heat tolerance, including for upper respiratory infections, allergies, COPD, muscle spasms, blood pressure, diuresis, diarrhea, constipation, anti-inflammation, mental health conditions, and sleep• Abuse or neglect• A respiratory or gastrointestinal infectious disease, or becoming febrile with an infectious illness• Mental health condition• Two or more chronic health conditions
Air Conditioner, HeaterChronic Kidney diseaseDiabetes mellitus, requiring any medication, oral or insulinMultiple SclerosisParkinson’s DiseasePrevious heat-related or cold-related illness requiring urgent or acute care, ex) emergency room and urgent care visits
Air Filtration DeviceIndividual requires home oxygen use: home oxygen, oxygen concentrators, home ventilator
Mini Refrigerator·         Individual uses medications requiring refrigeration. Examples include but are not limited to medications for diabetes mellitus, glaucoma, and asthma; TNF inhibitors
·         Enteral and parenteral nutrition
Portable Power SupplyIndividual needs durable medical equipment (DME) requiring electricity for use. Examples include but are not limited to:• Oxygen delivery systems, including concentrators, humidifiers, nebulizers, and ventilators• Intermittent positive pressure breathing machines• Cardiac devices• In home dialysis and automated peritoneal dialysis• Feeding Pumps• IV infusions• Suction pumps• Power wheelchair and scooter• Lift systems and electric beds• Breast pumps for first 6mo post-partum• Other DME medically required for sustaining life
Individual requires assistive technologies requiring electricity necessary for communication or ADLs.
Any DeviceOther conditions approved through an individual review for medical exception aligned with OHA’s

To access the HRSN Request/PA Form, click here

You must submit the YCCO Information Sharing Authorization Form with the PA to access this form click here.


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