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If you have any questions regarding the information in CCA’s provider manual, please email Provider Relations at [email protected].

Section 1: Key Contact Information

Key Contact Information

ContactTelephone & FaxWeb / E-mail
Claims Office
P.O. Box 548
Greenland, NH 03840-0548
Tel: 800-306-0732—-
TTY Massachusetts Relay ServiceTel: 800-439-2370
(TTY 711)
 


Claims
Claims Customer Service
Refunds and escalations
Corrected Claims
Tel: 800-306-0732 
Claims status, claim receipt, check runTel: 800-306-0732 
New providers, contracting, and EDI
Electronic billing set up or problems
Tel: 800-306-0732ccaedisupport
@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
MassHealthTel: 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: 866-420-9332

Fax: 855-341-0720
 


Dental Program Administrator: SKYGEN
Claims to be processed
Member eligibility
Claims issues
Provider relations
Tel: 855-434-9243www.ccadentists.org

NetworkDevelopment
@skygenusa.com

 


Pharmacy
General questionsTel: 866-420-9332

Fax: 857-246-8891

ccapharmacy
@commonwealthcare.org


Provider Services
Covered Services
Authorization Status
Service Request and Appeals Status
General questions
Tel: 866-420-9332


 
 


Provider Network
Provider Relations
Training, orientation, general questions


 
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
Fax: 617-517-7738ccacontracting
@commonwealthcare.org


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

**not anonymous**


Third Party Liability
COB, third party, Q & ATel: 617-960-0441
ext. 1904
tplcoordinator
@commonwealthcare.org


Interpreter Services
Provider may contact the CCA’s Provider Services department at 866-420-9332, along with the member and they will be connected to the appropriate interpreter telephonically.

Please have the following information available: Members name and ID number. Provider Services is available during the hours of 8:00 a.m. to 6:00 p.m. (Monday thru Friday). For assistance after business hours and weekends, please call CCA’s Member Services at 866-610-2273.
 
Member Services is available during the hours of 8:00 a.m. to 8:00 p.m. (Monday thru Friday) 8:00 a.m. to 6:00 p.m. (Saturday and Sunday) to assist members with interpreter services.
Provider Services
Tel: 866-420-9332

Member Services
Tel: 866-610-2273