Columbia Pacific CCO (CPCCO) is a CareOregon-affiliated OHP CCO for Clatsop, Columbia and Tillamook counties. CareOregon’s Behavioral Health Utilization Management Procedure Handbook (July 2026) covers CPCCO members, and CPCCO’s forms page links that handbook and an ABA treatment authorization form.
The rules are the same CareOregon rules that apply in Jackson County. Assessment authorizations for CPCCO members are "approved without the requirement of clinical documentation" because of the smaller region and provider network. Treatment requests need a documented ASD or Stereotypic Movement Disorder diagnosis by an MD, DO, PhD or PsyD using ADOS, CARS-2 or an educational diagnosis, and a comprehensive plan with baseline data and graphs, caregiver goals, school and Early Intervention services, the diagnosing clinician’s credentials and date of diagnosis, prior ABA providers, assessment data and six-month units by code. Members 13 or older and requests over 25 hours a week go to a CareOregon Medical Director. Standard decisions within 7 calendar days, expedited within 72 hours. BH UM: 503-416-3404.[2][3][4][11]
CPCCO’s posted ABA form is the 2019 JCC/CPCCO treatment authorization form, which still prints a 14-day determination window; the July 2026 handbook and OAR 410-141-3835 set 7 calendar days.[2][3][4][11]
OHA’s managed-care billing rule binds every CCO, Columbia Pacific CCO included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff.[1]
The questions that decide whether a family can start with Columbia Pacific CCO, and what they have to bring. Each maps onto something intake should ask on the first call.
No age cap; requests for members 13 or older require Medical Director review. OHP rules require ABA beyond Guideline Note 75 when medically appropriate, including at 13 and older, and under 21 EPSDT bars age-group-wide denials.[2][7][15]
No recency rule; the plan must give the diagnosing clinician’s credentials and date of diagnosis.[2]
An MD, DO, PhD or PsyD.[2]
ADOS or CARS-2 (or an educational diagnosis by an MD, DO, PhD or PsyD).[2]
CareOregon adds no referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)).[2][7][6]
CareOregon’s ABA guidance publishes no telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification.[2][9][10]
Standard requests within 7 calendar days of receipt, expedited within 72 hours, up to 14 more days on extension (CareOregon handbook, July 2026).[2][11]
CareOregon’s handbook adds nothing on other insurance for CPCCO, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules.[2][14][17]
Coverage decides whether Columbia Pacific CCO pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
CareOregon publishes no ABA supervision ratio, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005).[2][6][13]
No numeric cap; requests above 25 treatment hours a week require Medical Director review, and units are requested per six-month authorization by CPT code.[2]
CareOregon’s handbook sets no session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[2][8]
CareOregon publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)).[2][6]
Not addressed in CareOregon’s BH UM handbook or the CPCCO ABA form.[2][4]
Ask the plan: CareOregon Provider Customer Service, 800-224-4840 (option 3), or your provider agreement.
Not addressed in CareOregon’s ABA guidance.[2]
Ask the plan: CareOregon BH UM, 503-416-3404: ask which settings and place-of-service codes CPCCO pays for ABA.
120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication.
Submit an authorization through CareOregon Connect; CareOregon approves CPCCO assessment requests without requiring clinical documentation.
CareOregon’s behavioral health utilization management team (503-416-3404).
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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