Yamhill Community Care Organization (YCCO) serves OHP members in Yamhill County and some ZIP codes in Polk and Washington counties. It publishes an ABA-specific prior-authorization form and a code-level PA list.
YCCO’s PA list (active and termed codes as of January 29, 2026) shows 0362T, 0373T, 97151, 97152, 97153, 97154, 97155, 97156 and 97158 as "Applied Behavioral Analysis" codes requiring PA since January 1, 2022, with no termination date; the list notes the Prioritized List can require review for other codes too. Since November 15, 2025, "Providers are required to initiate all referral and PA requests," through the CIM portal or by fax. Non-participating providers must request prior authorization for all services.[4][2][3]
The YCCO ABA Prior Authorization Request (fax 503-850-9398) asks for requesting and servicing provider NPIs and whether each holds an active DMAP (OHP) number, ICD-10 codes with the diagnostic evaluation, treatment plan and recent progress notes, and an addendum used "for both initial and concurrent requests" with the program setting (home, facility/clinic, school, other) and hours per week. 97151 is "up to 32 units for initial, up to 24 units for reassessment," with more allowed only with documentation under OAR 410-172-0770(1); 97152, 0362T and 0373T need clinical justification. Non-contracted providers need an out-of-network exception and must say whether they accept DMAP rates.[4][2][3]
OHA’s managed-care billing rule binds every CCO, Yamhill Community Care 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 Yamhill Community Care (YCCO), and what they have to bring. Each maps onto something intake should ask on the first call.
YCCO publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials.[3][7][15]
YCCO sets no recency rule; it wants "recent progress notes." The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)).[3][7]
YCCO asks for an evaluation "by qualified professional" and cites OAR 410-172-0770, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism.[3][7][6]
YCCO names assessment tools for treatment planning (VB-MAPP, ABLLS-R, FBA, functional analysis) but no diagnostic instrument, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status such as the Vineland (OAR 410-172-0770(1)(b), (g)).[3][7]
YCCO adds no referral rule beyond its form’s PCP field and the OAR 410-172-0770 citation, 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)).[3][7][6]
YCCO publishes no ABA 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]
YCCO cites OAR 410-141-3835 for its authorization process and publishes no shorter clock: notice within 7 calendar days for standard requests and 72 hours for expedited, with one 14-day extension.[2][11]
YCCO’s ABA documents add nothing on other insurance, 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 Yamhill Community Care (YCCO) 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.
YCCO’s ABA form describes 97153 as technician treatment "receiving 1 hour of supervision for every 5 to 10 hours of direct treatment." The state floor also applies: interventionists supervised at least 5 percent of service hours, with direct supervision monthly (OAR 824-040-0010); assistant behavior analysts and interventionists are not directly payable (OAR 410-172-0760(4)).[3][13][6]
97151 up to 32 units for an initial assessment and 24 for a reassessment; requests above that need documentation. Treatment units are requested by hours per day, days per week or hours per week on the addendum; no weekly cap is stated.[3]
YCCO publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[3][8]
The ABA addendum asks for the program setting: home, facility/clinic, school or other. It does not exclude any setting.[3]
The form lists requesting provider, servicing provider and servicing facility, each with TIN, NPI and DMAP status. 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)).[3][6]
Not addressed in YCCO’s ABA form or PA page, beyond describing 97155 as usable "for Direction of Technician (Supervision) face-to-face with one patient."[3]
Ask the plan: YCCO Customer Service, 855-722-8205, or your YCCO provider agreement.
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.
Yes. 97151 and 97152 are on YCCO’s PA list; the initial 97151 is limited to 32 units unless documented need supports more.
Through the CIM portal or by faxing the YCCO ABA PA form with its addendum and a complete treatment plan to 503-850-9398. Providers must start every request themselves.
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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