Winter 2022: Volume 5, Issue 1

CCA has expanded its product offering, bringing its uncommon care^® model to more people with significant medical, behavioral health, and social needs.

Effective January 2022, CCA has expanded its existing product offering in Massachusetts with two new Medicare plans. Additionally, in its first-ever expansion outside its home state, CCA is now offering three new Medicare plans in Rhode Island. Learn more about our new plans below.

CCA Health Medicare Value and CCA Health Medicare Preferred:

Available in both Massachusetts and Rhode Island, our new Medicare PPO plans are designed for individuals who are eligible for Medicare but who narrowly miss Medicaid eligibility.

• Click here for benefits information for patients in Massachusetts
• Click here for benefits information for patients in Rhode Island

 CCA Health 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.

• Click here for benefits information for patients in Rhode Island

For questions about our new Medicare 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 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. Plus, based on the patient’s needs, they may qualify for community-based support that helps them live safely and independently at home.

• Click here to refer a patient in Massachusetts
• Click here to refer a patient in Rhode Island

We are excited to announce that Southcoast Health System joined the CCA network on January 1, 2022.

Southcoast is a multi-site health system composed of three partner hospitals and several primary, specialty, and ancillary care services. Located in the southeastern portion of Massachusetts, Southcoast serves Bristol and Plymouth counties as well as parts of Rhode Island.

Southcoast will participate in the CCA Senior Care Options plan, the CCA One Care plan, and our newly added CCA Medicare plans.

Starting January 2022, CCA will delegate routine hearing and vision services to NationsHearing and VSP. You will receive communication from these vendors over the coming weeks. To continue to serve CCA members, including members who have joined our new CCA Medicare 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.html

It is estimated that up to 67% of all emergency department (ED) visits are avoidable.* The CCA instED program helps reduce unnecessary ED visits by allowing our members to receive the urgent care they need in the comfort of their home.

instED is a reliable resource that fills the gap between primary care and emergency care—even for patients with significant health needs. With instED, you’ll have peace of mind knowing your patients are cared for by highly trained paramedics, and that you’ll be kept informed of the care they receive.

To learn more, visit www.instED.us.

Introducing instED’s New Provider App for Android!

instED’s new Provider App for Android makes it easy to request an instED visit for your patients and track a visit from the time the request is made through the completed visit. Download the free app at www.instED.us today. The IOS version will be available on the Apple store January 2022.

Features of instED’s Provider App include:

• Request a visit
• Check the status of a visit
• Receive real-time updates
• Access 24/7, 365 days per year
• And more!

instED Contact Information:

• To make a visit request: go to www.instED.us, download the Provider App for Android, or call the Clinical Resource Center at 833-9-instED (833-946-7833).
• For general questions: [email protected].
• For technical support with the instED Now platform: [email protected].

* Stanton, M. W., & Rutherford, M. K. (2005). The high concentration of U.S. health care expenditures. Agency for Healthcare Research and Quality, 19, 06-0060.

instED is a wholly owned subsidiary of Commonwealth Care Alliance, Inc. The instED program is not available in all areas. Other in-home urgent care providers are available in the CCA network. For any life-threatening conditions or medical issues that need immediate attention, patients should call 911.

Beginning in January 2022, all CCA members will be eligible for one $25 gift card per plan year after a completed annual wellness visit (annual physical exam). CCA will contact the members after we process a completed claim for these visits.

The following codes are used to determine if members are eligible to receive their annual gift card:

• For members under 65: Annual Physical Exam (99385, 99386, 99395, 99396)
• For members over 65: Annual Physical Exam (99387 & 99397)
• Welcome to Medicare Visit IPPE (G0402)
• Initial Annual Wellness Visit (G0438)
• Subsequent Annual Wellness Visit (G0439)

Launched in March 2021, the CCA CCSM programs for heart failure, COPD, and diabetes have already made a difference in the lives of your members:

• 118 members enrolled in the CCSM programs
• 65 members completed the program
• Improved self-management was evidenced by lower hospital readmission rates

What members say:

• Members who were surveyed and completed at least one of the CCSM programs gave an average satisfaction rating of 6/5 for the program and the support they received from their CCA care team
• Members and caregivers who participated in the interview stated that the program increased their confidence and helped prepare them to manage their condition

If you would like more information about the CCSM programs and how to enroll a patient, contact Provider Services at 866-420-9332 to speak with your patient’s care partner!

CCA is continuing to evolve and improve our overall claims payment accuracy. As administrative and clinical claims processes become more complex, we are refocusing our efforts with people, processes, and technology.

Our objective is to continually build, strengthen, and mature our Payment Integrity team and its functions to identify additional areas of cost savings and cost avoidance. We will continue to improve our front-end edits and processes so that claims pay correctly the first time. This effort is not only to improve our overall claims accuracy but also to strengthen our relationship with our provider partners.

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.

As a reminder, CCA has contracted with Performant to perform post-pay audits. Any communication regarding medical record submissions, appeals, or requests for information for Performant-related audits should be sent to Performant directly.

CCA is committed to partnering with you to continuously improve our processes. Our prior authorization process is essential for appropriate utilization of services for claims review and payment.

In accordance with your provider agreement with CCA, and consistent with industry standards, certain services require prior authorization to be obtained before being rendered. Providers are also required to bill the appropriate CPT/HCPCS code(s) for the date of service.

CCA has implemented reimbursement provisions consistent with the Massachusetts Executive Office of Health and Human Services (EOHHS)/MassHealth guidance that allows providers to distinguish between general home care services (G0299 – direct skilled nursing services of a registered nurse (RN) in the home health setting or hospice setting) and medication administration (T1502/T1503 – administration of oral, intramuscular, and/or subcutaneous medication by healthcare agency/professional, per visit).

 CCA authorizes an umbrella code for general nursing services (G0299). Under the umbrella code, providers should bill for the appropriate CPT/HCPCS service provided: general nursing services (G0299/G0300) or medication administration (T1502/T1503).

Providers are reminded that auditing activities specifically targeting these services (either pre-pay or post-pay) may result in claim denials/retractions if it is determined the level of service was inappropriate based on the coding used for those services documented in the member’s medical records.

For additional information, please refer to the 2022 CCA Senior Care Options/One Care Provider Manual, Section 4, “Prior Authorization Requirements,” and click on the Prior Authorization Requirements table link to view the list of codes.

The manual can be found at https://www.commonwealthcarealliance.org/ma/providers/provider-manual-home/.

CCA wants to ensure that your authorization requests are processed accurately and in a timely manner. Below are some helpful tips and best practices you can use to ensure successful prior authorization requests.

Use the updated CCA prior authorization form located on our website at https://www.commonwealthcarealliance.org/ma/providers/forms-and-referrals/. This “fillable” form has the information that is needed to enter your PA request. Note that all items indicated with an asterisk (*) are required fields.

Some commonly incomplete field include:

Provider fields:

Include both name and NPI number of the following providers:

• Requesting provider
• Servicing provider
• Servicing facility—this should represent the location where the requesting services are being provided

Diagnosis and service codes:

Note that we are unable to process a request without this information.

• CPT/ HCPCS codes
• Number of units for each code requested
• Dates of service
• ICD-10 diagnosis codes that are applicable to the request

Clinical documentation

To support your request, attach all clinical information in order for us to complete a thorough medical necessity review. An omission of the supporting information will result in an outreach to the requesting provider and a delay in processing the authorization.

Requesting changes or adjustments to current authorization

Document on the PA request form that this is request for change or adjustment to a previously authorized service. This will prevent delays in completion of this request.

Requesting a copy of the decision letter

Refer to the provider portal or call CCA Provider Services at 866-420-9332, Monday to Friday, 8 am to 6 pm.

You can find key resources to support CCA members in our updated Provider Manual. This includes an up-to-date contact list available online.

• View the Massachusetts Senior Care Options / One Care Provider Manual Contact List.
• View the Massachusetts Medicare Advantage Prescription Drug Provider Manual Contact List.