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.Determine patient eligibility
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
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.
FamilyCore ReferralsFamilyCore is a community services network that connects parents with a broad support system to meet challenges head-on and to nurture strong families with children ages 0–5. Providers can refer their patients to Yamhill FamilyCore or patients can refer themselves. The online form can be found here and is available in spanish. Providers can also download the FamilyCore program icon link for their desktops below. FamilyCoreProgram
Physical healthFind 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 PA list (active and termed) as of 1142022 MEDICAL PA FORM TIPS FOR SUBMITTING A PA TRANSPLANT PA REQUEST TRANSITIONS OF CARE PA FORM
Diagnostic and Treatment ProceduresFor 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)
- If procedure code and diagnosis are funded and above the line, then no prior authorization 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 prior authorization 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 prior authorization request via CIM and note on the request “benefit exception review for medical necessity consideration”.
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 HealthTo submit prior authorizations for behavioral health, use the forms and information listed here. Behavioral health includes chemical dependency, mental health and wraparound services. Behavioral Health Updates Yamhill Community Care (YCCO) is integrating behavioral health and physical health administrative functions through the expansion of its existing contract with Providence Plan Partners (PPP), effective January 1, 2022. To learn more about our behavioral health integration please click on the FAQ document below. BH Provider FAQ Tech Resource_12.03.21 YCCO BH PA Grid 01072022 Beginning January 1st, 2022 the following fax forms must be used: ABA Fax Form – YCCO BH HLOC Fax Form – YCCO BH Outpatient Fax Form -YCCO TMS Fax Form – YCCO
Wraparound servicesWraparound 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.
- 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.
- Learn more about the barrier resolution process.
Dental HealthFind 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. Pharmacy PA Form
Traditional Health WorkersIf you are a THW provider and are interested in joining our provider network please email us at firstname.lastname@example.org. Download the documents below to learn how to become a THW provider with YCCO in your specific area of service. CHW Billing Guidance_FINAL 2021 Doula Billing Guidance_YCCOFINAL_2021 PSS Billing Guidance_FINAL 2021 PWS Billing Guidance_Final 2021
Wellness Programs for MembersPersistent Pain Program: The PPP is an 8-week class combining pain management education and movement therapy. PPP Program Materials: BrochurePersistent Pain Program Referral Form medical release
POLICIES AND FORMS IN ONE PLACE
-Health Related Services
-Non-Emergent Medical Transportation (NEMT)
-Diagnostic Treatments & Pocedures
WELLNESS PROGRAMS FOR MEMBERS
-Persistent Pain Program