Commonwealth Care Alliance
Menu

Provider Manual

As part of our commitment to supporting our provider partners, we have created this resource to offer you comprehensive information about our plans.


In addition to detailed program information, you will find our policies and procedures, referral and claim information, and other useful reference materials that we hope will make working with our staff and members as simple as possible.
 
 
On this page
1 of 1

Provider Manual

Section 1: Key Contact Information

 

Contact

Telephone & Fax

Web / E-mail

Claims Office
P.O. Box 22280
Portsmouth, NH 03802-2280
Tel: 800-306-0732 ----
TTY Massachusetts Relay Service Tel: 800-439-2370
(TTY 711)
 

Claims

Refunds and escalations
  • Corrected Claims
Tel: 800-306-0732  
Claims status
  • Claim receipt, check run
Tel: 800-306-0732  
New providers, contracting, and EDI
  • Electronic billing set up or problems
Tel: 800-306-0732
 
ccaedisupport
@pcgus.com

Member Services

General questions
  • Initial contact 
Member appeals
  • Service denials - Process; how to respond
Member benefits
  • Member information; coverage 
Member eligibility
 
Tel: 866-610-2273

Fax: 617-426-1311
memberservices
@commonwealthcare.org
MassHealth Tel: 888-665-9993  

Member Enrollment

Outreach and Marketing
  • Referrals for potential members
Tel: 866-610-2273

Fax: 617-830-0534
rkatzman
@commonwealthcare.org

Clinical Operations

Clinical Decision Support Team and prior authorization
  • Benefit and service authorizations
Tel: 866-610-2273

Fax: 855-341-0720
 
 

Dental Program Administrator: Scion

  • Claims to be processed
  • Member eligibility
  • Claims issues
  • Provider relations
Tel: 855-434-9243 www.ccadentists.org

providerservices
@sciondental.com

Pharmacy

General questions
 
Tel: 866-610-2273

Fax: 857-246-8891


ccapharmacy
@commonwealthcare.org

Provider Network

Provider Relations
  • Training, orientation, general questions
Tel: 866-610-2273

Fax: 617-517-7738
providerrelations
@commonwealthcare.org
Provider Enrollment
  • New provider enrollment, provider date edits
  pnmdepartment
@commonwealthcare.org
Provider contracting
  • Requests to become a Commonwealth Care Alliance provider
  • Medical or Behavioral Health
  ccacontracting
@commonwealthcare.org

Compliance

Concerns and reporting
  • Fraud, waste, and abuse and compliance concerns
Tel: 800-826-6762
Compliance Hotline **anonymous**
ccacompliance
@commonwealthcare.org

**not anonymous**

Third Party Liability

COB, third party, Q & A Tel: 617-960-0441
ext. 1904
tplcoordinator
@commonwealthcare.org
Keep Reading

1 of 1

Resources for Providers