---
title: "Yamhill Community Care ABA coverage: the intake guide."
url: "https://carelu.com/payers/yamhill-community-care"
markdown_url: "https://carelu.com/payers/yamhill-community-care.md"
state: OR (Oregon)
payer: Yamhill Community Care (YCCO)
kind: Medicaid managed care plan (MCO)
parent_program: Oregon Health Plan (Coordinated Care Organizations)
description: "How Yamhill Community Care covers ABA for OHP members in Yamhill County and parts of Polk and Washington: which ABA codes need prior authorization, its ABA PA form and unit limits, supervision expectations, and what intake should collect."
last_reviewed: October 2026
---

# Yamhill Community Care ABA coverage: the intake guide.

_Payer Guide · Yamhill Community Care · Last updated October 2026 · 16 primary sources_

> Yamhill County CCO: PA on 97151–97156, 97158, 0362T, 0373T; its own ABA PA form caps the initial 97151 at 32 units and asks for program setting.

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.

This plan administers the **Oregon Health Plan (Coordinated Care Organizations)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Oregon Health Plan (Medicaid) guide](https://carelu.com/payers/oregon-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes: YCCO’s PA list (as of 1/29/2026) carries 97151, 97152 and 0362T as active "Applied Behavioral Analysis" codes, and its ABA form has an "Initial Assessment" request type (97151 up to 32 units initial, 24 for reassessment) [4][3]
- **Prior auth for treatment**: Yes: 97153–97156, 97158 and 0373T are on the PA list; requests use the YCCO ABA PA form with a complete treatment plan (97157 is not on the list) [4][3]
- **Autism diagnosis required?**: Yes. The ABA form asks for ICD-10 codes with "diagnostic evaluation, treatment plan, and recent progress notes by qualified professional" and cites OAR 410-172-0770; the OHP rule requires ASD on the HERC ASD line or stereotyped movement disorder with self-injury [3][7]

## At a glance

- **Covers ABA?:** Yes, under OHP rules
- **Service area:** Yamhill County; parts of Polk and Washington
- **Prior auth:** 97151–97156, 97158, 0362T, 0373T (PA list as of 1/29/2026)
- **Assessment units:** 97151 up to 32 units initial, 24 for reassessment
- **Submit via:** CIM portal, or fax the ABA PA form to 503-850-9398
- **Decision clock:** Per OAR 410-141-3835 (7 days standard, 72 hours expedited)

## Prior authorization at YCCO

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]

## Claim filing and payment rules for Yamhill Community Care

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]

## Intake gates

The questions that decide whether a family can start with Yamhill Community Care (YCCO), and what they have to bring.

- **Age limit**: 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]
- **Diagnosis recency**: 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]
- **Who may diagnose**: 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]
- **Diagnostic tools required**: 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]
- **Referral required?**: 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]
- **Telehealth**: 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]
- **Prior-auth decision time**: 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]
- **Other insurance (who pays first)**: 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]

## Delivery and billing rules

Coverage decides whether Yamhill Community Care (YCCO) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: 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]
- **Daily limits / MUEs**: 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]
- **Session-note signature**: 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]
- **Place of service**: The ABA addendum asks for the program setting: home, facility/clinic, school or other. It does not exclude any setting. [3]
- **Bill as provider**: 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]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: 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.

## What intake should collect for Yamhill Community Care (YCCO)

- **Member ID:** Confirm YCCO; some Polk and Washington ZIP codes belong to it.
- **Diagnostic evaluation:** Attach the evaluation (meeting OAR 410-172-0770), treatment plan and recent progress notes.
- **DMAP numbers:** Requesting and servicing providers’ OHP enrollment status is asked on the form.
- **Program setting and hours:** Home, clinic, school or other, with hours per week by code.
- **Other insurance:** Bill commercial coverage first; OHP is the payer of last resort.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### What is Yamhill Community Care’s timely filing limit for ABA claims?

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.

### Does Yamhill Community Care require prior authorization for the ABA assessment?

Yes. 97151 and 97152 are on YCCO’s PA list; the initial 97151 is limited to 32 units unless documented need supports more.

### How do I submit an ABA request to YCCO?

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.

## Primary sources

1. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, DMAP 143-2024, eff. 01/01/2025): §§ (1)(a)–(c), (6), (8)(b), (8)(d)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
2. [Yamhill Community Care — Prior Authorizations (provider guidelines, policies and forms)](https://yamhillcco.org/for-providers/guidelines-policies-and-forms/prior-authorizations/)
3. [Yamhill Community Care — ABA Prior Authorization Request and ABA Authorization Request Addendum (form dated 05/28/2024)](https://yamhillcco.org/wp-content/uploads/2025/11/YCCO-ABA-PA-Form-3-Fillable-Form.pdf)
4. [Yamhill Community Care — PA list, active and termed codes, as of 01.29.2026 (Behavioral Health tab)](https://yamhillcco.org/wp-content/uploads/2026/03/YCCO-PA-list-active-and-termed-as-of-01.29.2026-1.xlsx)
5. [OHA — Coordinated Care Organization (CCO) Plans (CCO list by county, read from the page’s CCO Plan Details list)](https://www.oregon.gov/oha/HSD/OHP/Pages/Plans.aspx)
6. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)
7. [OAR 410-172-0770 — Individual Eligibility for Applied Behavioral Analysis Treatment (OHA, DMAP 12-2017)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0770)
8. [OAR 410-172-0620 — Documentation Standards, Medicaid behavioral health (OHA, eff. 6/26/2015)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0620)
9. [OAR 410-172-0850 — Telemedicine for Behavioral Health (OHA, DMAP 67-2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0850)
10. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
11. [OAR 410-141-3835 — CCO Service Authorization (OHA, eff. 07/01/2026)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3835)
12. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, eff. 01/01/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
13. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
14. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
15. [OHA — EPSDT Provider Guide (March 2026)](https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Provider-Guide.pdf)
16. [Yamhill Community Care — Provider News & Alerts (monthly provider newsletter archive)](https://yamhillcco.org/for-providers/provider-news-alerts/)
17. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.