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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.

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Other Reports, Templates10/4/2024NOABD and Prior Authorization Sample Evaluation Criteria Redlined, 2025
Other Reports, Templates10/4/2024NOABD and Prior Authorization Sample Evaluation Criteria Clean version, 2025
Other Reports, Templates10/4/2024OHA Model NOAR Redlined, 2025
Other Reports, Templates10/4/2024OHA Model Post-service NOABD Clean version, 2025
Other Reports, Templates10/4/2024OHA Model Pre-service NOABD Clean version, 2025
Other Reports, Templates10/4/2024OHA Model Pre-service NOABD Redlined, 2025
Other Reports, Templates10/4/2024OHA Model Post-service NOABD Redlined, 2025
Other Reports, Templates10/4/2024OHA Model NOAR Clean version, 2025
Other Reports8/16/2024THW Integration and Utilization DATA Report Template, 08-2024
Other Reports8/16/2024THW Payment Grid Template, 08-2024
Other Reports8/16/2024THW Integration and Utilization DATA Report Template, 08-2024
Other Reports, Templates7/9/2024Language Access Taglines_OHP Medicaid CCO Letters_15 languages
Other Reports6/12/2024HRSN Guidance Document, 06/2024
Other Reports6/7/2024Health-Related Social Needs Guidance Document
Other Reports4/19/2024DSN Provider Specialty Matrix, April 2024
Other Reports4/19/2024DSN Provider Specialty Matrix, April 2024
Other Reports3/29/2024Member Notice Template Self-Evaluation Checklist for CY 2024
Other Reports3/29/2024Subcontractor Performance Report Evaluation Criteria with Guidance, 2024
Other Reports2/28/2024Member Notice Templates Attestation, 02-28-2024
Other Reports2/27/2024Health-Related Social Needs Guidance for March 2024 implementation
Other Reports2/14/2024DSN Provider Specialty Matrix, February 2024
Other Reports1/1/2024Subcontractor and Delegated Work Report, 01-2024
Other Reports1/1/2024Subcontractor and Delegated Work Report Attestation, 01-2024
Other Reports1/1/2024Subcontractor and Delegated Work Report Attestation, 01-2024
Other Reports1/1/2024DSN Provider Capacity Report Instructions, CY 2024
Other Reports1/1/2024DSN Provider Capacity Report Template and Instructions, CY 2024
Other Reports1/1/2024Subcontractor Performance Report Evaluation Criteria, 2024
Deliverable, Other Reports1/1/2024Member Notice Template Self-Evaluation Checklist for CY 2024
Other Reports12/29/2023Delegation Authorization and Signature Form, 12/29/2023
Deliverable, Other Reports12/27/2023Grievance and Appeal System member notice templates attestation, 12-27-2023
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