Fall 2021: Volume 4, Issue 4

We’re excited to announce that CCA is expanding its product offering, bringing its uncommon care^® model to more people with significant medical, behavioral health, and social needs.

Effective January 2022, CCA will complement its existing product offerings in Massachusetts with two new Medicare plans. Additionally, in its first-ever expansion outside its home state, CCA will also offer three new Medicare plans in Rhode Island.

Our new plans include:

• CCA Medicare Value and CCA Medicare Preferred: Available in both Massachusetts and Rhode Island, our new Medicare Advantage PPO plans are designed for individuals who are eligible for Medicare but who narrowly miss Medicaid income or asset thresholds.
• CCA Medicare Maximum: Available in Rhode Island, our new Dual-Eligible Special Needs Plan is designed for individuals who are eligible for both Medicare and Medicaid.

Depending on the patients’ clinical needs, CCA will continue to offer specialized support and services designed to help them live safely and independently at home.

The Annual Enrollment Period for the new plans will begin on October 15 and end on December 7. Enrollment will be effective on January 1, 2022.

We look forward to partnering with our provider network as we launch these new offerings and continue our work toward improving the health and well-being of individuals with significant needs. For questions about our new Medicare Advantage plans, including details about our service area, contact Provider Services at 866-420-9332.

Do you have a patient who may benefit from one of our new plans?
CCA Medicare Advantage plans offer all the benefits of Medicare and MORE—starting at $0. That includes prescription drug coverage, $0 primary care visits, and $0 annual dental and eye exams. Patients may even qualify for extra benefits such as transportation and $200 or more for over-the-counter health products.

Refer a patient in Massachusetts

Refer a patient in Rhode Island

Last month we launched the CCA Provider Portal, developed in partnership with industry leader HealthTrio. The portal is a self-service application that allows you to quickly and easily access important member information and complete critical administrative tasks—in real time.

If you have not registered to use the portal, we encourage you to do so as soon as possible to take full advantage of the new benefits and features available to you.

Click here to register

As part of the phase one launch of the portal, you now can:

• Verify member eligibility
• View member authorizations
• Send credentialing information
• Connect with CCA via HIPAA-compliant secure messaging at your convenience
• Receive and manage electronic CCA provider communications
• View remittance advice/explanation of payment
• View member roster reports
• Manage office staff’s access to the portal

By using the portal, you have the flexibility to manage many of these tasks independently while reducing wait time. CCA plans to continuously update the features of our portal, and we’ll keep our provider community apprised of future releases.

To register for the CCA Provider Portal:

You can find detailed instructions on how to register for the portal in the Provider Portal Registration Guide, which can also be accessed via CCA Provider Portal login page.

Existing HealthTrio Smart Connect customers will still need to register for the CCA Provider Portal. However, much of your existing HealthTrio connect information (including your personal and office information) will be pre-populated during the registration process. Refer to the registration guide for more details.

For questions about the portal or for support during registration, you can contact us at 866-420-9332. As always, thank you for your continued partnership in serving CCA members.

CCA will introduce one of the country’s most innovative care models to hundreds of thousands of eligible individuals in the Midwestern and Western United States, through multiple transactions, acquiring California’s Vitality Health Plan and a majority stake in Michigan’s Reliance Healthcare. The acquisitions follow on the heels of CCA’s entry into Rhode Island, where CCA plans are now available for the first time, and new Medicare Advantage offerings in Massachusetts.

“This expansion gives us strong footholds into new markets and strengthens our position in Massachusetts where we can advance our vision of transforming the nation’s healthcare for individuals with the most significant needs,” said Chris Palmieri, President & CEO of CCA. “There is a clear demand for choice in healthcare for individuals who have traditionally been offered extremely limited options, and we are thrilled to bring our pioneering, proven and perfected care model to individuals in California, Michigan and Rhode Island for the first time.”

Read the full press release

Starting January 1, 2022, CCA will delegate routine hearing and vision services to the vendors listed below. These vendors are in the process of contacting our network, so you may have already received communication from them. If you want to continue to serve CCA members, including our new plans, please contact these vendors to join their network.

Routine hearing (including exams and hearing aids):
NationsHearing | Phone: 800-921-4559 | Email: [email protected] | Fax: (888) 986-4243

Routine vision (including exams and eyewear):
VSP | Phone: 1-800-615-1883 | Website: www.vspproviderhub.com/working-with-vsp/be-a-vsp-doctor.html¹

instED® provides urgent care services in the comfort and convenience of your patient’s home. Visit www.instED.us¹ to learn more.

We’ve expanded our service area!

instED is thrilled to announce that we’ve expanded our service area to include more of Massachusetts. We now have 98.9% of CCA members within our service area. Our service area now covers most of Massachusetts, as seen on the map below (excluding Barnstable, Dukes, and Nantucket Counties).

New hours of operation

To better serve your patients’ needs, our service hours are now 10:00 am to 10:00 pm, seven days per week. You can continue to request a visit anytime using instED Now. We will continue to triage all visit requests and will schedule visits within this new time range.

Introducing the instED Ambassador Program

instED is proud to introduce our new Ambassador Program and welcomes the first group of instED ambassadors. The program will be a resource to all clinicians by helping increase awareness of instED’s in-home urgent care services among CCA providers and staff.

instED’s ambassadors are passionate about our mission, as well as experienced, knowledgeable, and satisfied users of the service. Collectively, their patients have benefited from our service hundreds of times, and they are happy to share their experiences using instED.

We officially kicked off the program on September 1 and welcome the following ambassadors:

• Thomas Smith, RN – Primary Care
• Patricia Corkum, NP – CCC-Springfield
• Aaron Stupple, MD – Hospital-to-Home
• Amy Munankarmi, NP – Palliative Care
• Genta Baci, MD – Hospital-to-Home

If you want to join our mission, and are interested in becoming an instED ambassador, contact us at [email protected].

Important instED updates:

If you need training on or access to instED Now, please email [email protected]. Customer Support will reach out to you to complete the process.

• To check on the status of an instED visit, log in to your instED Now account: https://instednowplatform.insted.us.¹

instED contact information:

• To make a visit request: go to www.instED.us¹ or call the Clinical Resource Center at 833-9-instED (833-946-7833)
• General questions: [email protected]
• Need technical support with the instED Now platform: [email protected]

In recent months, CCA has heard concerns from our provider community regarding claims adjustments not initiated by your office. These adjustments result in administrative burden, as the additional payments need to be processed/posted to your claims system for reconciliation purposes. Please note that the claims vendor for CCA uses Optum’s Web.Strat™ pricing tool, which is a browser-based application that offers tools to help payers, like CCA, accurately reimburse provider claims using the prospective payment methodologies. The Web.Strat application provides monthly regulatory updates, including but not limited to:

• Diagnosis codes
• UB-04 bill types
• Retroactive procedure codes
• COVID-19 vaccine procedure codes

As these regulatory updates are made available to our claims vendor, there are instances that would warrant adjustments. As mandated by Medicare/Medicaid requirements, CCA is required to process claims accurately. These routine regulatory updates enforce the validity of payments and reconcile claims payments.

If you have any questions, please contact CCA Customer Service at 800-306-0732. For EDI support, please email [email protected].

CCA is continuing to evolve and improve our overall claims payment accuracy. As administrative and clinical claims processes become more involved and complicated, we are refocusing our efforts with people, processes, and technology. This includes internal staff, new technologies, and partnerships with third-party vendors.

Our objective is to continually build, strengthen, and mature our Payment Integrity team and its functions and to identify additional areas of cost savings and cost avoidance. We also aim to enhance our provider communication, including payment policies, newsletter communications, and targeted provider education as needed. This effort is not only to improve our overall claims accuracy but to strengthen our relationship with our provider partners.

We will continue to improve our front-end edits and processes so that claims pay correctly the first time. We will also continue our post-pay audit processes. Our goal is to use data analytics and subject-matter expertise to continue to learn from these claims and find opportunities to make system corrections, produce provider communications, and have direct provider outreach.

We look forward to continuing to partner with you. We want to ensure that claims are paid correctly, by the responsible party, for eligible members, according to contractual terms, not in error or duplicate, and free of wasteful or abusive practices.

Hello from the CCA Quality team!

This quarter the Quality team is sharing important information about significant changes underway by the Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) for the collection of HEDIS information. These changes will impact our processes and affect how information is collected and shared.

Types of HEDIS data (administrative, supplemental, and hybrid)

There are three buckets of data that are tapped to fulfill HEDIS measure compliance—administrative, supplemental, and hybrid. Administrative data is inclusive of transaction data and encounter data, and it is used to identify both the eligible population for the denominator, and numerator compliance.

Supplemental data is used to capture missing service data that is not received through claims. This data can be obtained from electronically generated files from the service provider or from extractions from the legal health record.

Hybrid data is derived from the medical record. NCQA is moving away from medical record review and toward more electronic methods for gathering data. It is encouraging plans to cease the inclusion of medical record data for HEDIS by 2024.

Online materials, provider website, and structured data

The Quality team at CCA has created materials to support appropriate HEDIS information documentation for provider use. Reference guides will be made available, including examples of our internal documentation practices, which can be widely used in the provider setting. This guidance supports NCQA’s movement from medical record collection to supplemental data collection. The landing page for the Quality site that will contain this information is under development and will be available to providers shortly. When the Quality site is fully operational, a notification with a link will be sent out to providers.

Interoperability rule

In efforts to increase sharing of member data, CMS has established the Interoperability and Patient Access Final Rules—rules that require changes to provider documentation and sharing of records. This includes the HL7 Fast Healthcare Interoperability Resources Standard Patient Access rule, which allows patients to have access to claims, encounters, and private healthcare information. Providers must show compliance with this rule by July 2021. In a parallel effort to increase the sharing of patient information, a newly enacted regulation requires hospitals—both acute and behavioral health—to provide electronic patient event notifications of a patient admission, discharge, or transfer. This effort aims to improve follow-up post-discharge, improving patient outcomes and reducing the likelihood of readmission.

At Commonwealth Care Alliance, it is in our mission to improve the health and well-being of people with significant needs. The upcoming changes by CMS and NCQA support this mission by ensuring that member clinical and behavioral health information is as comprehensive and well documented as possible. Please continue to help us in our ongoing effort to bring the highest level of care to some of our most vulnerable populations.

The Complex Care Self-Management (CSSM) programs began on March 1, 2021, and are off to a great start. Over 100 members have enrolled in the programs to self-manage their COPD, diabetes, or heart failure. Both staff and members enjoy seeing the tremendous results.

Program data as of August 2021:

• 115 enrollees overall
  • 51 in heart failure program
  • 37 in COPD program
  • 27 in diabetes program
• > 45% reduction in risk of 30-day readmission (relative to risk observed prior to program start)

Preventing readmission is one of the key measures of success, and the story below is just one of many highlighting how well the programs are working for our members.

A 55-year-old CCA One Care member with 3–4 emergency room (ER) visits per week for dyspnea over a 6-week period was enrolled in the CCSM heart failure program. Within two weeks, the member had no further hospitalizations or ER visits. The member’s PCP received a letter describing the program, assessment notes, and communication of changes in member’s status from the CCA APC and care team.

“It was great to know that this program was available for my patients. The CCA team has pulled all the pieces together for this patient and for me to better understand her needs.”
– Primary care physician feedback to CCA clinician

To refer a patient who is a CCA member with COPD, diabetes, or heart failure who you think would benefit from the CCSM programs, please contact CCA Provider Services at 866-420-9332, and ask to speak to your patient’s care partner or health plan–delegated contact person.

The Executive Office of Elder Affairs (EOEA) launched an online training course for providers to prevent and eliminate discrimination based on sexual orientation and gender identity and expression. The free one-hour training is currently hosted by CADER at Boston University School of Social Work and can be found here.¹

Per Massachusetts law, Chapter 19A, Section 43,¹ all providers who contract with or receive funding from EOEA, ASAPs, MassHealth OLTSS, and those whose services are certified by EOEA must complete the training by June 2022. All new employees hired must complete the training within 12 months of their hiring date.

Please click here to view the EOEA memorandum for more information.

You can find key resources to support CCA members in our updated Provider Manual. This includes an up-to-date contact list available online, located in the downloadable provider manual under Section 1: Key Contact Information.