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.

All documents on this page are for the CCO 2.0 contracts effective October 1, 2019, for coverage effective January 1, 2020, regardless of specific contract year, unless the year is specifically indicated.

For contract year 2023 due dates, please refer to Exhibit D, Attachment 1 of the 2023 contract.
For contract year 2022 due dates, please refer to Exhibit D, Attachment 1 of the 2022 contract.
For contract year 2021 due dates, please refer to Exhibit D, Attachment 1 of the 2021 contract.
For due dates and documents for prior contract years, please refer to the CCO Contract Forms archive.

View CCO contract announcements

Financial Reports

Other Reports

URL
Affiliated Medicare Advantage Plan Guidance, 09-2022
Affiliated Medicare Advantage Plan Report, 09-2022
Allowed Amount Guidance Document, 01-2023
Attestation Form for Previously Approved Documents, CY 2023
Behavioral Health Directed Payment FAQ for CY 2023
Behavioral Health Directed Payment Guidance Document for CY 2023
Behavioral Health P&P Evaluation Criteria, 12-2021
CANS Data Request Worksheet
Care Coordination Report Template, 05-2022
Claim Count Verification Acknowledgment and Action Form, 10-1-2014
CMS DUR Survey FFY 2022 – INFORMATIONAL COPY
Comprehensive Behavioral Health Plan Evaluation Criteria and Guidance Document Crosswalk, 05-2022
Comprehensive Behavioral Health Plan Progress Report Evaluation Criteria, 04-2022
Comprehensive Behavioral Health Plan Progress Report Evaluation Criteria, 04-2022
Comprehensive Behavioral Health Plan Progress Report Guidance, 04-2022
Data Certification and Validation Report Form, 10-1-2014
DSN Narrative Evaluation Q&A, CY 2023
DSN Narrative Evaluation Tool and Reporting Template, CY 2023
DSN Provider Capacity Feedback and OHA Response to Reporting, CY 2023
DSN Provider Capacity Report Instructions, CY 2023
DSN Provider Capacity Report Template and Instructions, CY 2023
Enrollment Reconciliation - Discrepancies Found Report, 05-2021
Enrollment Reconciliation - Discrepancy Reporting Guide, June 2021
Enrollment Reconciliation Certification - Discrepancies Found, 05-2021
Enrollment Reconciliation Certification - No Discrepancies Found, 05-2021
Family Connects Oregon Guidance, 10-2021 (Updated 2/24/2022)
FWA Annual Assessment Report - Attestation for Previously Submitted Documents, 11-2022
FWA Audit Report Template for CY 2023, 01-2023
FWA Deliverables Review Template, CY 2023
FWA Fraud Waste and Abuse FAQ 2023
FWA Program Integrity Glossary of Terms, 01-2022
FWA Referrals and Investigations Report Template for CY 2023, 01-2023
Grievance and Appeal System Policies and Procedure Review - Guidance for MCEs_2023
Grievance and Appeal System Policies and Procedures Evaluation - 2023
Grievance and Appeal System Reporting FAQ 2023
Grievance and Appeals Log 2023
Grievance System Code Tables 2023
Grievance System Report 2023
Grievance System Reporting Instructions 2023
Health Equity Plan Evaluation Tool, 04-2023
Health Equity Plan Guidance Document, 04-2023
Health Equity Plan Template, 04-2023
Health Equity Plan Training and Education Reporting Template, 05-2021
Hep C DAA CY 2023 Case Management Data Template
Hep C DAA Risk Corridor – Final Definition of Adequate Case Management, 2023
HIT Roadmap Guidance, Evaluation Criteria, and Report Template 2023 – Option A
HIT Roadmap Guidance, Evaluation Criteria, and Report Template 2023 - Option B
HIT Roadmap Guidance, Evaluation Criteria, and Report Template 2023 – Option C
IIBHT Quarterly Report Template 2023
Indian Health Care Program Payments, 01-2023
Intensive Care Coordination Policy & Procedure Evaluation Criteria, 12-2021
Language Access and Interpreter Services Report Instructions, 09/2022
Language Access Self-Assessment Survey (Reference Copy), 12-2022
Language Access Taglines_OHP Medicaid CCO Letters_15 languages
Language Self-Assessment - Reference Copy, 12-2020
Language Self-Assessment Template, 12-2021
LTPC Determinations for Ages 17 and Under - Request Form, revised 1-14-2020
LTPC Determinations for Ages 17 and Under - Request Process, revised 12-31-2019
LTPC Determinations for Ages 18-64 - Request Process and Form, revised 10-1-2014
LTPC Determinations for Neuropsychiatric Treatment - Request Process and Form, revised 10-1-2014
LTSS CCO-Specific Guidance: Annual MOU and Reporting, 11-2022
LTSS Memorandum of Understanding Guidance, CY 2020-24
LTSS Memorandum of Understanding Template, CY 2020-24
LTSS MOU Guidance on Sharing Information 12-2020
LTSS MOU Report Template - CY 2022
MCE Material Reviews - Submission guide
MCE Signature Authorization Form, 05-2021 (PDF)
MCE Signature Authorization Form, 05-2021 (Word)
Measures and Outcomes Tracking System (MOTS), 10-1-2014
Medicare - Attestation for Automated Crossover Claims, 12-2021
Member Handbook CCO Model Handbook_Final 2023
Member Handbook Evaluation Criteria_Final 2023
Member Handbook Submission and Review Guidelines_Final 2023
Member Materials - Annual Letters Evaluation Criteria
Member Notice Template Evaluation Criteria_2023
Member Notice Template Submission and Review Guidelines 2023
Mental Health Parity Analysis Attestation Form, 04-2021
Mental Health Parity Analysis Protocol, 04-2021
Minimum Standards for DUR Programs, effective 10-2019
Minimum Standards for DUR Programs, effective 7-2021
NEMT Call Intake Script Evaluation Criteria. 2023
NEMT Policies and Procedures Evaluation Tool for CY 2022
NEMT Policies and Procedures Evaluation Tool for CY 2023
NEMT Policies and Procedures Guidance for CY 2023
NEMT Policies and Procedures Procedures Guidance for CY 2022
NEMT Reporting Template - Technical Specifications, 12-2020
NEMT Reporting Template, 12-2020
NEMT Rider Guide Submission and Review Guidelines 2023
NEMT Rider Guide_Evaluation Criteria_Final 2023
NOABD and Prior Authorization Sample Evaluation Criteria 2023
PBM Market Check Report Template, 03-2023
PBM Pay for Performance Template Instructions, 03-2021
PBM Pay for Performance Template, 03-2021
PBM Readiness Checklist (PDF)
PBM Readiness Checklist (Word)
PCPCH Reporting - Reference Copy, 12-2022
Personal Injury Liens Policies and Procedures Evaluation Criteria, 11-2022
Personal Injury Liens Requirements - Policy and Procedure Guidance , 11-2022
PIL Monthly Reporting Template
Preferred Drug List Template
Quality Pool Distribution Plan Template, 05-2023
Redaction Log, 06-2022
SOC P&P Evaluation Criteria, 12-2021
Subcontractor and Delegated Work Report Attestation, 01-2023
Subcontractor and Delegated Work Report, 01-2023
System of Care Statewide Steering Committee Report Template, 03-2020
Third-Party Liability Notification and Reporting Guidance, 11-2022
Third-Party Liability Recovery P&P Evaluation Criteria, 11-2022
THW Deliverables Guidance and Evaluation Criteria, 08-22
THW Deliverables Instructions and Plan Update Template, 08-2022
THW Integration and Utilization Data Report Template, 08-2022
TPL Reporting Guidance
Wraparound Policy & Procedure Evaluation Criteria, 12-2021