Forms and Referrals
We want to make it easy to work together so our members, and your patients, have the best experience possible. Here you can access important provider forms and learn how to refer a patient to CCA.
Jump to: Provider Contract | Administrative Forms & Notices | Prior Authorization Forms | Other Important Forms
Refer a Patient
Together we can create a better experience and better outcomes for your patients with complex needs.
Provider Contracting
Become a Participating Provider
Interested in joining the CCA provider network? If your organization provides health care, Long-Term Services and Supports (LTSS), Home- and Community-Based Services (HCBS), behavioral health, or other member services, please complete the New Health Partner Contract Form to learn more about contracting opportunities.
Refer to the New Health Partner Contracting User Guide for step-by-step instructions.
Administrative Forms and Notices
BH Inpatient Notification of Admission Form
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CAGE Questionnaire
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CCA SCO and One Care Prior Authorization List
Coverage Requests and Determinations – Massachusetts
Learn how we make coverage decisions and how to make requests for coverage.
Itemized Bill Review Frequently Asked Questions
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Member Consent/HIPAA Authorization Form
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Mental Status Exam
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Non-Participating Providers
Non-participating providers may submit claims to CCA using the Non-Participating Provider Profile Form. CCA is unable to process claims without this information. Please be sure to attach your W-9 form when you submit this online form.
Notice of Privacy Practices – Massachusetts
Commonwealth Care Alliance is required by law to protect the privacy of your Medical Information
Optum and 6 Degrees Health Process Frequently Asked Questions
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The Patient Health Questionnaire 2 Overview (PHQ 2)
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The Patient Health Questionnaire (PHQ 9)
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Provider Roster
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Esketamine Prior Authorization Request
Out of Network ECT Authorization Request
PA Form – Repetitive Transcranial Magnetic Stimulation Request
PA Form – Cardiac Imaging
PA Form – CT/CTA/MRI
PA Form – Out of Network Psychological and Neuropsychological Assessment
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PA Form – PET – PET CT
Standard Prior Authorization Request Form
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Other Important Forms
Address for Refund Checks
Chronic Condition Provider Attestation Form
Claim Recovery Refund Check Form
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Frail Elder Waiver Provider Form
High Dollar Claims
Itemized Bill Cover Sheet
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Overpayment Recovery Form
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Need more information?
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We’re here to help.
