Skip to main content
Oregon.gov Homepage

CCO Contract Forms Archive

To view documents from past contract years:

Click the "Effective Date" field to display documents and due dates for a specific contract year. 

For documents from older contract years, email the CCO Contract Administrator.

  
  
  
Other Reports7/1/2020Hepatitis C Direct-Acting Antivirals
Other Reports6/1/2020Mental Health Parity Analysis, 06-2020
Other Reports3/6/2020Fraud Waste and Abuse Deliverables Review Template 03-2020
Financial1/1/20202020 MLR Rebate Template
Financial1/1/20202020 Exhibit L Financial Reporting Supplemental SE
Financial1/1/20202020 MLR Instructions
Financial1/1/20202020 Exhibit L Financial Reporting Template for CCOs
Financial1/1/2020Form A - Statement Regarding the Acquisition or Control of or Manage with a CCO
Financial1/1/2020Form D: Prior Notice of a Transaction: Exhibit 4 – OAR 836-027-0160 (rev. 9-1-15)
Financial1/1/2020Form C: Summary of Changes to Registration Statement: Exhibit 3 – OAR 836-027-0012 (rev. 9-1-15)
Financial1/1/2020Form B: Insurance Holding Company System Annual Registration Statement: Exhibit 2 – OAR 836-027-0010 (rev. 9-1-15)
Financial1/1/2020OAR 836-027-0140: Exhibit 6, Form F: Enterprise Risk Report
Financial1/1/2020Model Depository Agreement for CCOs
Financial1/1/2020Model Depository Agreement for Sub-Capitated Counterparty
Other Reports1/1/2020CANS Data Request Worksheet
Other Reports1/1/2020Claim Count Verification Acknowledgment and Action Form, 10-1-2014
Other Reports1/1/2020Data Certification and Validation Report Form, 10-1-2014
Other Reports1/1/2020PIL Monthly Reporting Template
Other Reports1/1/2020PIL Reporting Instructions
Other Reports1/1/2020Enrollment Reconciliation Certification – No Discrepancies, 10-1-2014
Other Reports1/1/2020Enrollment Reconciliation Certification - Discrepancies Found, 10-1-2014
Other Reports1/1/2020Grievance and Appeals Log - Version 3.5
Other Reports1/1/2020Health Equity Infrastructure FAQ 03-2020
Other Reports1/1/2020Grievance System Report
Other Reports1/1/2020Health Equity Plan Guidance 03-2020
Other Reports1/1/2020Grievance System Reporting Instructions
Other Reports1/1/2020Hep C DAA Risk Corridor - Final Definition of Adequate Case Management
Other Reports1/1/2020Language Access Quarterly Report Instructions 03-2020
Other Reports1/1/2020LTPC Determinations for Ages 17 and Under - Request Form, revised 1-14-2020
Other Reports1/1/2020LTPC Determinations for Ages 18-64 - Request Process and Form, revised 10-1-2014
1 - 30Next

Your browser is out-of-date! It has known security flaws and may not display all features of this and other websites. Learn how

×