Commonwealth Care Alliance, Inc.’s (CCA) top priority is, and will always be, serving people with the most significant medical, social, and behavioral health needs. After months of careful review and deliberation, CCA has made the decision that we will only offer Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) and Medicare-Medicaid Plan (MMP) plans in 2025, namely our Senior Care Options (SCO) and One Care plans in Massachusetts. We will exit all Medicare Advantage plans in California, Michigan, and Rhode Island as well as our Medicare Advantage PPO plans in Massachusetts at the end of 2024.
CCA will continue to proudly deliver best-in-class care to our members who participate in our long-standing plans for individuals who are dually eligible for both Medicare and Medicaid in Massachusetts through our SCO and One Care plans. CCA will also continue to serve the patients who participate in our various clinical delivery and care management programs, the providers who participate in our Accountable Care Organization (ACO) and Provider Organization (PO) in Michigan, and the individuals and families who participate in our community-based programs.
We understand our network providers may have some questions about this change specific to our Medicare Preferred (PPO) and Medicare Value (PPO) products.
- Claims submissions on or after January 1, 2025: Please continue to submit claims as you normally do today, through the Availity portal, HealthAxis, or your clearinghouse.
- Claims processing: Your standard vendor will continue to be available to you and will process claims for dates of service through December 31, 2024.
- For questions on continuity of care and patients with services or procedures scheduled on or after January 1, 2025: Contact your patient’s new payer regarding prior authorizations and other needs. If your patient is in the middle of an inpatient stay that crosses over into 2025, CCA will process the crossover claim(s).
As always, we thank you for the care you bring to CCA members every day and look forward to continuing and growing our partnership for years to come in support of our SCO and One Care members.
If you have questions, please don’t hesitate to reach out to our Provider Services team for assistance at 866-420-9332, 8:00 a.m. to 5:00 p.m., Monday through Friday.