Beat the Heat with the Summer Edition of CCA Provider News!
CCA’s Summer Provider e-Newsletter contains the latest COVID-19 updates and a look at how we’re supporting members during the pandemic. You’ll also find information on the newly launched Provider Services Line and self-service options.
CCA Claims is working diligently to quickly address the many CMS and EOHHS changes as a result of the COVID-19 public health emergency. To ensure we align with guidance from CMS and EOHHS, we:
- Created a billing FAQ for providers to reference
- Are reviewing claims associated with COVID-19 to avoid erroneous denials
- Implemented a COVID-19 Payment Policy
- Updated the Telemedicine Payment Policy
For any questions, please call our Provider Services line at 866-420-9332.
During the COVID-19 pandemic, CCA is adhering to the state mandates related to provider enrollment (please see below). Additionally, all facility recredentialing can be extended if you are not able to abide by your current due date. Please contact the credentialing department at [email protected] to request the extension.
Flexibility and Relief for State Medicaid Agencies: The national emergency declaration enables CMS to grant state and territorial Medicaid agencies a wider range of flexibilities under section 1135 waivers. States and territories are now encouraged to assess their needs and request these available flexibilities, which are outlined in the Medicaid and CHIP Disaster Response Toolkit. Examples of flexibilities available to states under section 1135 waivers include:
- The ability to permit out-of-state providers to render services
- Temporary suspension of certain provider enrollment and revalidation requirements to promote access to care
- Allowing providers to provide care in alternative settings
Provider Enrollment Flexibilities: CMS will temporarily suspend certain Medicare enrollment screening requirements including site visits and fingerprinting for non-certified Part B suppliers, physicians and non-physician practitioners. In addition, CMS will allow licensed providers to render services outside their state of enrollment. CMS will also establish a toll-free hotline for providers to enroll and receive temporary Medicare billing privileges.
To support our Provider Network and ensure they have the best experience possible, we have launched a new dedicated Provider Services line. Effective July 6, 2020, providers can call the Provider Services line at 866-420-9332 Monday through Friday from 8:00 a.m. to 6:00 p.m. to get help with payment status, authorization inquiries, and more. Providers also have 24/7 access to self-service options, such as member eligibility and claim status.
To learn more about the Provider Services line and self-service options, visit our Provider Resources page.
With the initiation of the HEDIS project, Commonwealth Care Alliance must measure the quality of care provided by its contracted providers each year. During this process, CCA reviews thousands of physicians’ records for evidence of the completion of recommended preventative screenings (breast, colorectal, and cervical cancer) and optimal management of chronic conditions, such as diabetes and cardiovascular disease.
With a successful HEDIS in mind, CCA encourages providers to consider the following general tips for patient care and documentation. Disease-specific guidance will be offered in upcoming editions of the Provider Newsletter.
- Document all the care you provide your patients clearly and accurately in the medical record.
- Document all discussions in the patient’s medical record, including discussions around the importance of medication management, chronic disease management, preventive screenings, and advance care planning.
- Ensure that all medical record entries include the date, patient’s name, and the credentials of the service provider.
- Document all medication reviews and medication reconciliations as such.
- Document, or be sure to file, all test results (lab, imaging, etc.), eye exam results, or specialist visits in the patient’s chart.
- If you are not using electronic medical records, consider creating a manual tracking process for preventative screenings and chronic disease management activities (e.g., HbA1c, blood pressure and eye/foot exams for diabetics; bone density imaging for patients with osteoporosis, etc). If you are using electronic medical records, create a flag to track these activities in your system.
- Place posters and educational messages in treatment rooms and waiting areas to help motivate patients to initiate discussions with you about preventive screenings.
- Contact patients to remind them of necessary screenings and upcoming appointments.
- Consider extending your office hours beyond the standard 9-5 model to accommodate the needs of more of your patients.
- Be sure to schedule the patient’s next visit at the end of their current appointment, especially for those with chronic illness.
CCA’s Consumer-Centered Quality department engages with members in various ways to gather their insights about how CCA care and services can best support them in their efforts to live healthily and independently. Our Member Voices program uses advisory councils, focus groups, phone interviews, and online communication to hear from members. Though we are not meeting in person during the coronavirus pandemic, we are still engaging members over the phone and online around multiple subjects.
This spring marks the third year of the Member Experience Survey program, which measures member experience with key touchpoints (such as onboarding, or post-discharge care) as CCA consumers. We use this information to ensure that we are structuring our programs to best meet the needs of our members.
Phone calls including live agents and recorded voice interviews and surveys will run through November 2020. We currently make calls in English and Spanish. Topics may include, but are not limited to:
- Experience after a qualifying event, such as becoming a new member, being discharged from an acute care facility, or entering the palliative care program.
- Ongoing experiences, such as care planning, responsive care, and long-term services and supports.
CCA is aware of concerns about scam calls disproportionately targeting vulnerable populations. Our calls will come from a local Massachusetts phone number or an 800 number. The caller will always identify themselves as calling on behalf of Commonwealth Care Alliance. We will never ask the member to provide personal information, such as their diagnosis, financial information, or other identifying information. We ask them to simply confirm that they are the member that we are trying to reach by name.
If you or a patient has a question or concern about these calls, please contact CCA Member Services at 866-610-2273 (TTY 711).
Commonwealth Care Alliance (CCA) is committed to working with our provider partners to provide the highest quality, individualized care to the members we so proudly serve. As part of these efforts, we:
- Provide coverage for the full cost of diagnostic tests for COVID-19. Members who meet Centers for Disease Control and Prevention guidelines for testing will have no co-pay, coinsurance, or deductibles for these tests.
- Allow CCA members to refill their medications early without being rejected for filling too soon. This will help ensure they have an adequate supply of medications, so they can remain at home during the COVID-19 outbreak.
- Removed all administrative barriers, such as prior authorizations and referrals, for medically appropriate care for COVID-19.
- Permit qualified providers to deliver clinically-appropriate, medically-necessary CCA-covered services to CCA members via telehealth. Providers are encouraged to use appropriate technologies to communicate with individuals and should ensure the same rights to confidentiality and security as provided in face-to-face services to the extent feasible.
- Cover all medically necessary COVID-19 treatment at doctor’s offices, emergency rooms, and urgent care centers within the United States or internationally. Consistent with the guidance issued by the Massachusetts Department of Insurance, this will include the cost of vaccination, once a COVID-19 vaccine is available.
- Launched a Member Support program that provides each of our members with $100 in non-benefit related funds to cover the costs of basic daily needs, including food, over-the-counter medications, and personal care items.
- Donated $50,000 dollars to our Commonwealth’s food banks.
CCA is prepared to help during these unprecedented and challenging times as your priorities shift and resources become scarce. CCA can partner with your practice to provide clinical oversight and care coordination in the community for patients that are dually eligible for MassHealth and Medicare with complex medical, behavioral, and social needs. Through our Senior Care Options program for individuals 65+ and our One Care Program for individuals 21-64, we can work together to ensure your patients receive the support and services required to keep them living safely and independently in their homes. We would be happy to speak to you in more detail about how we can support your more medically compromised patients.
Patients with diabetes and their health care providers are often so focused on controlling hyperglycemia that they overlook life-threatening consequences of hypoglycemia.
CCA recognizes this and is taking proactive approaches to help members with diabetes:
Professional Continuous Glucose Monitoring (CGM) using the Abbott Libre Pro. The patient wears a quarter-sized sensor patch for 5 to 14 days. CCA’s care team place the sensor on a patient in their home and return to remove it at the completion. The results are blinded during this time to the member or anyone in contact with them, to accurately evaluate them in their normal state and not influence their behavior. Results with glycemic pattern analysis are sent to the PCP securely to be included in the patient’s medical record.
This sample CGM report is on a patient who may or may not be aware of their regular hypoglycemic episodes.
This report is a valuable tool for medication management by the clinical provider.
This color print graph is also a helpful visual patient teaching tool.
Glucagon user support. To help some of our highest risk members with diabetes, CCA conducted a survey campaign to those who currently have a Glucagon prescription for management of severe hypoglycemic episodes. We found that many members did not understand the appropriate use of Glucagon, including when to use it and how much.
CCA has added BAQSIMI© nasal powder to the formulary for emergency rescue medication for the treatment of hypoglycemia. It is much easier to use than a multistep glucagon injection, especially for those who live alone.
BAQSIMI is now available in all pharmacies. BAQSIMI is a prescription medicine used to treat very low blood sugar (severe hypoglycemia) in people with diabetes ages 4 years and above.
Providers are required to confirm a patient’s CCA eligibility prior to rendering services. It’s important to remember that a prior authorization is contingent upon a member’s active eligibility on the dates of service.
Here’s how to quickly confirm a patient’s CCA eligibility:
Keeping your information up-to-date in our Provider Directory helps your practice by making it easier for our members to find 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.