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Welcome to the Spring Edition of CCA Provider News!

Our Spring Provider Newsletter has the latest information about new Medical Necessity Guidelines, tips for HEDIS measures, the return of the Member Support Program, COVID-19 vaccinations for CCA members, and more.

The Provider Relations team supports, develops, and maintains professional relationships with providers in the CCA Provider Network, as well with non-contracted providers.

Each Provider Relations specialist works within their assigned territory or region to facilitate communication sessions with providers and to address and resolve complex provider inquiries.

If you require any training or education assistance with provider facing materials (including the CCA Provider Manual, Payment Policies, and forms), please reach out to your dedicated Provider Relations specialist.

Click here to meet the team.

CCA remains dedicated to improving the care for individuals dually eligible for MassHealth and Medicare with complex medical, behavioral, and social needs. Below are three new policies that are effective as of April 1, 2021:

A complete list of Medical Necessity Guidelines is available on the CCA website.

As CCA assesses member and provider closure of gaps in care for key HEDIS measures, we offer the following helpful hints for this month’s measures: Osteoporosis Management in Women Who Had a Fracture and Osteoporosis Screening in Older Women.

Osteoporosis Screening Overview
During the HEDIS Measurement Year (MY) 2020 updates, a new measure was added for osteoporosis screening. This measure was developed to measure a larger eligible population to screen for osteoporosis, instead of only measuring based on fracture incidence. Both measures are included in the HEDIS MY 2021 measurement set, which strive to assess the quality of care provided to members for their chronic illnesses.

Osteoporosis Management in Women Who Had a Fracture (OMW) – the original osteoporosis measure

Measure Intent
Osteoporotic fractures, particularly hip fractures, are associated with chronic pain and disability, loss of independence, decreased quality of life, and increased mortality. With appropriate screening and treatment, the risk of osteoporosis-related fractures can be reduced.

Measure Membership Inclusion Criteria
The percentage of women 67–85 years of age who suffered a fracture and who had either a bone mineral density (BMD) test or prescription for a drug to treat osteoporosis in the six months after the fracture

Measure Timeframe
Between July 1 of the year prior to the measurement year and June 30 of the measurement year
HEDIS MY 2021 for OMW= July 01, 2019–June 30, 2020

Criteria for Medical Record details

  • Evidence of a Bone Mineral Density Test:
    • If the fracture event was identified and resulted in an inpatient stay, a Bone Mineral Density Test conducted during the inpatient stay
    • Documentation of member-reported Bone Mineral Density Test with Date of Service in the legal health record
  • Osteoporosis therapy on the date of the episode, or in the 180 days after, with:
    • Bisphosphonates: Alendronate, Alendronate-cholecalciferol, Ibandronate, Risedronate, Zoledronic acid
    • Other agents: Abaloparatide, Denosumab, Raloxifene, Romosozumab, Teriparatide

Coding Criteria
Osteoporosis Screening

CPT 76977 77078 77080 77081 77085 77086
ICD10PCS BP48ZZ1 [BP48ZZ1] Ultrasonography of Right Shoulder, Densitometry
ICD10PCS BP49ZZ1 [BP49ZZ1] Ultrasonography of Left Shoulder, Densitometry
ICD10PCS BP4GZZ1 [BP4GZZ1] Ultrasonography of Right Elbow, Densitometry
ICD10PCS BP4HZZ1 [BP4HZZ1] Ultrasonography of Left Elbow, Densitometry
ICD10PCS BP4LZZ1 [BP4LZZ1] Ultrasonography of Right Wrist, Densitometry
ICD10PCS BP4MZZ1 [BP4MZZ1] Ultrasonography of Left Wrist, Densitometry
ICD10PCS BP4NZZ1 [BP4NZZ1] Ultrasonography of Right Hand, Densitometry
ICD10PCS BP4PZZ1 [BP4PZZ1] Ultrasonography of Left Hand, Densitometry
ICD10PCS BQ00ZZ1 [BQ00ZZ1] Plain Radiography of Right Hip, Densitometry
ICD10PCS BQ01ZZ1 [BQ01ZZ1] Plain Radiography of Left Hip, Densitometry
ICD10PCS BQ03ZZ1 [BQ03ZZ1] Plain Radiography of Right Femur, Densitometry
ICD10PCS BQ04ZZ1 [BQ04ZZ1] Plain Radiography of Left Femur, Densitometry
ICD10PCS BR00ZZ1 [BR00ZZ1] Plain Radiography of Cervical Spine, Densitometry
ICD10PCS BR07ZZ1 [BR07ZZ1] Plain Radiography of Thoracic Spine, Densitometry
ICD10PCS BR09ZZ1 [BR09ZZ1] Plain Radiography of Lumbar Spine, Densitometry
ICD10PCS BR0GZZ1 [BR0GZZ1] Plain Radiography of Whole Spine, Densitometry

Osteoporosis Screening in Older Women (OSW) – additional measure

Measure Intent
Osteoporosis is a serious disease in the elderly that can impact their quality of life. Osteoporosis is a bone disease characterized by low bone mass, which leads to bone fragility and increased susceptibility to fractures of the hip, spine and wrist.

Measure Membership Inclusion Criteria
The percentage of women 65–75 years of age who received osteoporosis screening.

Measure Timeframe
The measurement year, and the year prior to the measurement year; based on when the member’s 65th birthday occurred.

HEDIS MY 2021 for OSW= January 01, 2019–December 31, 2020

Criteria for Medical Record details

  • Evidence of a Bone Mineral Density Screening Coding Criteria

Coding Criteria

CPT 76977 77078 77080 77081 77085

Commonwealth Care Alliance® (CCA) was awarded the Center for Medicare and Medicaid Innovation Center’s (CCMI) demonstration program for the Hospice Value-based Insurance Design (VBID). Participation in this program allows CCA to provide medically necessary coverage for hospice services (carve-in) that otherwise would have been directed to Medicare. The program began on January 1, 2021 for eligible Senior Care Options (SCO) members who elect hospice.

The value-add of the program includes:

  • Continuity of care during the hospice transition
  • Encouraging enrollment in hospice
  • Palliative care and concurrent transitional care options
  • Strengthening hospice provider partnerships

Additional program information can be found here on the CCA website and include, but are not limited to:

  • CCA hospice FAQ
  • Transitional concurrent care SOP
  • Notification submissions (e.g. NOE)
  • CCA key contacts
  • Presentation material

Finally, CCA’s Payment Policy on the program can be found here on the CCA website.

CCA launched the Member Support Program to help our members cover the cost of basic needs during COVID-19. In 2020, thousands of CCA members used the program to order food, household products, over-the-counter medications, and personal care items.

This year, CCA members can again order up to $100 of health and wellness items they need through our partner, NationsOTC. All products are shipped directly to member homes free of charge.

The Member Support Program and the $100 credit expire on June 30, 2021. Please encourage your patients to take advantage of this program.

They should have received information in the mail with ordering instructions in March. You can also direct them to visit www.CCAgives.com or 877-237-8350 (TTY 711) to see available items and place their orders.

Note: Please use Chrome to open links above

CCA is scheduling in-home vaccine visits for our most vulnerable homebound members. We are contacting members who are eligible for in-home vaccination visits. All other CCA members must use the MassVax online scheduling tool or work with their primary care provider to schedule vaccination appointments.

CCA Complex Care Self-Management (CCSM) programs provide education and self-management tools and supports that include targeted education and services for enrolled CCA members with a high risk for admission or readmission related to the following conditions:

  • Diabetes
  • COPD
  • Heart failure

These highly prevalent conditions are associated with significant morbidity and healthcare utilization. Our goal is to improve these outcomes through proactive self-management education and support by our existing care teams, in collaboration with you, our network partners.

Graphic showing 45% of CCA members with diabetes, 32% of CCA members with Asthma/COPD, and 17% of CCA members with heart failure.

Using an evidence-based interdisciplinary approach, the CCSM programs:

  • Include weekly in-home and/or virtual visits with an Advanced Practice Clinician for assessment, self-management education, and medication management of their condition
  • Apply health coaching techniques to empower members’ self-management via tracking and monitoring of symptoms and disease parameters
  • Provide durable medical equipment (DME) to support self-assessment
  • Include evaluation and support for social determinants of health (SDOH), medication, and behavioral health needs
  • Facilitate efficiency in chronic care delivery through real-time data-driven performance evaluation and interdisciplinary team care partnership
  • Encourage communication and follow up with the PCP and specialists

Duration: Usually four weeks with flexibility based on the individual’s medical stability and demonstrated ability to self-manage. Additionally, the CCA Advanced Practice Clinician (APC) will follow up with your patient weekly by phone for four weeks to monitor and support continued success.

Communication is important to the success of our partnership. The CCA APC will fax you a letter notifying you when your patient has enrolled in the CCA CCSM Programs. In addition, you will receive a copy of routine APC visit notes and will be contacted by telephone in the case of urgent clinical concerns.

If you would like more information about how to enroll a member in the CCSM programs, please contact our provider line at 866-420-9332 and ask to speak with your patient’s care partner.

The instED® mobile integrated health solution leverages highly trained paramedics to deliver urgent medical care services to CCA members in the comfort of their own home. Proven to improve health outcomes and member satisfaction, instED provides high quality and compassionate care that reduces avoidable emergency department visits and fills the gap between primary care and emergency care for even the most complex care patients.

Graphic showing instED completed 4,500 visits in 2020; 89.3% of visits avoided an Emergency Department or inpatient admission within 3 days; and $6.38M estimated cost savings to CCA in 2020

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.

“97.37% of CCA Providers who have used instED feel that it provides a valuable service to their patients,” CCA Provider Survey, December 2020

It’s easy to request a visit from instED for urgent medical care. And don’t forget, this service is free of charge for CCA members.

To Request a Visit, use our CCA Connect system:

  1. Under “Partner Information,” select “Mobile Health Requests” from the dropdown menu
  2. Select: “Requestor Tools”
  3. Fill out Form and Submit

Or simply call: 888-255-7120

For additional information please contact us at [email protected]

The previous post office box where CCA received claim submissions closed at the end of November 2020. We have acquired a new post office box at a new location, and we have set up auto-forwarding for one year to ensure that we receive any mail sent to the retired P.O. box. This will prevent interruptions in processing claim requests.

Please update your records with the new address for all paper claims, corrected claims, and/or provider appeals:

Commonwealth Care Alliance
P.O. Box 548
Greenland, NH 03840-0548

If you have any questions, please contact CCA Customer Service at 800-306-0732.

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 Provider Manual Contact List.

Keeping your information up-to-date in our Provider Directory helps your practice by making it easier for our members to find accurate information about your practice locations. Updating your information in our health plan provider directories also helps our members:

• Get easy access to your services.
• Receive important information about your practice.

Your Assistance is Greatly Appreciated!
If you wish to provide your updated information to CCA, please email us at [email protected].

Learn more about the CMS Provider Directory regulations on our website here.

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