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CCO Contract Forms

Overview

The coordinated care organization (CCO) contracts require CCOs to submit various reports. Templates, related forms and documents for these reports are listed here.

Financial Reports

  
  
2017 Exhibit L Financial Reporting Template.xlsx2017 Exhibit L Financial Reporting Template
2017 Medical Loss Ratio Rebate Instructions.pdf2017 Medical Loss Ratio Rebate Instructions
2017 Medical Loss Ratio Rebate Template.xlsx2017 Medical Loss Ratio Rebate Template
2018 Exhibit L Financial Reporting.xlsx2018 Exhibit L Financial Reporting
2018 MLR Instructions.docx2018 MLR Instructions
2018 MLR Rebate Template.xlsx2018 MLR Rebate Template

 

Other Reports

 
  
  
2017-CHIP-ProgressReport-Guidance-Template.docx2017-CHIP-ProgressReport-Guidance-Template
2018 DSN Provider Capacity Report and Narrative Report.xlsx2018 DSN Provider Capacity Report and Narrative Report
Affiliated Medicare Advantage Plan Report, 10-1-2014.docAffiliated Medicare Advantage Plan Report, 10-1-2014
Attestation of Revision and Submission of Contractually Required Reporting, 10-1-2014.docAttestation of Revision and Submission of Contractually Required Reporting, 10-1-2014
Claim Count Verification Acknowledgment and Action Form, 10-1-2014.docClaim Count Verification Acknowledgment and Action Form, 10-1-2014
Data Certification and Validation Report Form, 10-1-2014.docData Certification and Validation Report Form, 10-1-2014
Enrollment Reconciliation Certification - Discrepancies Found, 10-1-2014.xlsxEnrollment Reconciliation Certification - Discrepancies Found, 10-1-2014
Enrollment Reconciliation Certification – No Discrepancies, 10-1-2014.docEnrollment Reconciliation Certification – No Discrepancies, 10-1-2014
Grievance Report, 10-1-2015.xlsGrievance Report, 10-1-2015
Hepatitis C DAA Risk Corridor - Final Definition of Adequate Case Management.pdfHepatitis C DAA Risk Corridor - Final Definition of Adequate Case Management
Hospital Adequacy Report, 10-1-2014.docHospital Adequacy Report, 10-1-2014
Measures and Outcomes Tracking System (MOTS), 10-1-2014.docMeasures and Outcomes Tracking System (MOTS), 10-1-2014
Pharmacy Expense Report - Proprietary Exemption Request, 10-1-2014.docPharmacy Expense Report - Proprietary Exemption Request, 10-1-2014
Pharmacy Expense Report, 10-1-2014.docPharmacy Expense Report, 10-1-2014
Physician Incentive Plan Disclosure Form, 10-1-2014.docxPhysician Incentive Plan Disclosure Form, 10-1-2014
Procedure and Request Form - LTPC Determinations, Age 17 and Under - 10-1-2014.docProcedure and Request Form - LTPC Determinations, Age 17 and Under - 10-1-2014
Procedure and Request Form - LTPC Determinations, Age 18-64 - 10-1-2014.docProcedure and Request Form - LTPC Determinations, Age 18-64 - 10-1-2014
Procedure and Request Form - LTPC Determinations, Neuropsychiatric Treatment - 10-1-2014.docProcedure and Request Form - LTPC Determinations, Neuropsychiatric Treatment - 10-1-2014
Signature Authorization Form, 10-1-2014.docSignature Authorization Form, 10-1-2014
 

Resource Documents - Referenced in the CCO Contract

 

2015-2017 Transformation Plan Progress Report Templates

 
  
AllCare-BenchmarkRptTemplate
CHA-BenchmarkRptTemplate
CPCCO-BenchmarkRptTemplate
EOCCO-BenchmarkRptTemplate
FamilyCare-BenchmarkRptTemplate
Health Share-BenchmarkRptTemplate
IHN-BenchmarkRptTemplate
JCC-BenchmarkRptTemplate
PrimaryHealth-BenchmarkReportTemplate
PS-CG-BenchmarkRptTemplate
PS-CO-BenchmarkRptTemplate
Trillium-BenchmarkRptTemplate
Umpqua-BenchmarkRptTemplate
WOAH-BenchmarkRptTemplate
WVCH-BenchmarkRptTemplate
Yamhill-BenchmarkRptTemplate
 

Transformation and Quality Strategy Documents

To learn more, please visit OHA's Transformation and Quality Strategy page.

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