CCO Contract Forms Archive

Financial Reports

Other Reports

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.

Category	Effective date	URL
Other Reports	4/19/2024	DSN Provider Specialty Matrix, April 2024
Other Reports	2/14/2024	DSN Provider Specialty Matrix, February 2024
Other Reports	1/26/2024	HRSN Guidance Document for 3/1/2024 Implementation
Other Reports	1/1/2024	Subcontractor and Delegated Work Report Attestation, 01-2024
Other Reports	1/1/2024	Subcontractor Performance Report Evaluation Criteria, 2024
Deliverable, Other Reports	1/1/2024	Member Notice Template Self-Evaluation Checklist for CY 2024
Deliverable, Other Reports	12/27/2023	Grievance and Appeal System member notice templates attestation, 12-27-2023
Deliverable, Other Reports	12/27/2023	Grievance and Appeal System P&Ps Attestation, 12-27-2023
Other Reports	12/8/2023	Indian Health Care Provider Reimbursement Guidance for 2024, 12-2023
	12/1/2023	DSN Provider Specialty Matrix, 12-2023
Other Reports	11/30/2023	Attestation for PA Determinations for SUD Services - 2023
Other Reports	6/2/2023	Member Handbook CCO Model Handbook 2024
Other Reports	6/2/2023	Member Handbook Submission and Review Guidelines 2024
Other Reports	6/2/2023	Member Handbook CCO Model Member Handbook Redline Changes List 2024
Other Reports	6/2/2023	Member Handbook Evaluation Criteria 2024
Other Reports	5/25/2023	Indian Health Care Provider Reimbursement Guidance for 2023, 05-2023
	4/28/2023	System of Care Statewide Steering Committee Quarterly Report Template, 04-2023
Other Reports	4/14/2023	Health Equity Plan Training and Education Reporting Template, 05-2021
Other Reports	4/14/2023	Health Equity Plan Template, 04-2023
Other Reports	4/14/2023	Health Equity Plan Guidance Document, 04-2023
Other Reports	4/14/2023	Health Equity Plan Evaluation Tool, 04-2023
Other Reports	3/10/2023	NOABD and Prior Authorization Sample Evaluation Criteria 2023
Other Reports	2/14/2023	DSN Provider Capacity Report Template and Instructions, CY 2023
Other Reports	2/14/2023	DSN Provider Capacity Report Instructions, CY 2023
Other Reports	2/10/2023	Grievance System Code Tables 2023
Other Reports	1/31/2023	Subcontractor and Delegated Work Report, 01-2023
Other Reports	1/31/2023	Subcontractor and Delegated Work Report Attestation, 01-2023
Other Reports	1/30/2023	IIBHT Quarterly Report Template 2023
Other Reports	1/27/2023	Hep C DAA CY 2022 Case Management Data Template
Other Reports	1/10/2023	FWA Referrals and Investigations Report Template for CY 2023, 01-2023

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