In this edition of the CCA provider newsletter:
In our Spring Provider Newsletter, find tips on managing COVID-19 fatigue and learn more about how doulas can support equitable maternity care. We’re also sharing the latest information about the new CCA medical necessity guidelines, updates on our unique member support programs, and more.
A Message from Doctor Robert MacArthur, CCA Chief Medical Officer
It’s hard to remember what it was like before the COVID-19 pandemic. Over the past two years, the way we socialize, work, and live our lives has changed. Many of us are experiencing fear, anxiety, depression, or loneliness. We’ve lost our sense of stability and security and our connection to family members and friends.
COVID-19 burnout has also set in.
In my role as chief medical officer at CCA, I’ve seen firsthand the physical and emotional impact of pandemic burnout on healthcare workers. After two long years, you may be tired of social distancing from those you love and putting yourself at risk on the frontlines.
Your feelings are normal. But even as mandates and restrictions are lifted throughout the country, staying vigilant will be critical. By breaking through those feelings of pandemic fatigue, we may finally have a chance at putting this chapter behind us.
Getting back to normal
In a recent statement, Dr. Anthony Fauci said that the full-blown pandemic phase of COVID-19 may be ending. As of this month, over 200 million people in the United States are fully vaccinated. This has led to a decrease of infections and hospitalizations in many parts of the country. These are great signs of progress, and provide a glimmer of hope that we may soon be reaching the endemic stage of the virus.
However, as you know, COVID-19 will likely be with us for years to come. While staying vigilant is important, getting through the pandemic burnout will also require a healthy dose of self-care. More than ever, it’s important to stay focused on your health and well-being.
What else can you do to avoid the effects of COVID-19 fatigue?
Here are suggestions for staying positive and safe in the weeks, months, and years to come.
- Maintain a healthy lifestyle. When you’re feeling stressed or overworked, it’s easy to fall back on unhealthy habits, such as overeating and avoiding physical activity. To overcome burnout, it’s important to continue with a healthy diet and, if you’re able to, exercise as often as possible. Even a short walk a few times a week can help.
- Set boundaries. When you’re away from work, spend time doing the things you enjoy. If possible, try to refrain from checking email or completing paperwork off the clock.
- Talk to supervisors and coworkers. Talking openly with others about how the pandemic is affecting your work can help you identify factors that may be causing stress. Then you can work together to find a solution. Your supervisor may also be able to tell you about mental health resources that are available through your employer.
- Find ways to remain social. When it comes to staying connected, look for ways to meet safely in person or virtually. Seeing or hearing the people you love most—children, grandchildren, siblings, and friends—is a great way to de-stress.
- Reduce stress. There are simple ways to keep stress and anxiety at a minimum. You’ll find that deep breathing and a little mild stretching can work wonders. Also, look for safer ways to keep doing the activities you enjoy. If you’re feeling stuck, try a new hobby.Learning something new will give you a sense of accomplishment and growth, which can reduce stress and anxiety.
- Avoid triggers. Social media and TV can deliver a daily dose of fear and frustration that will only increase your feelings of burnout. Staying informed is important, but be sure to pick and choose the right sources and frequency of information. Think to yourself, “Is this information coming from an expert source? Is this information helpful to me?”
- Stay positive. It’s important to remind yourself of all the challenges you’ve overcome the past two years. Consider keeping a journal of positive things that happen to you or things that make you feel grateful. This practice can help you break through the mental fog, and you may discover that you’re experiencing some positive changes during the pandemic.
Count on CCA to provide uncommon care®
Here’s one final word of reassurance. I want you to know that CCA is here for you during these challenging times. We take responsibility for making our relationship with each provider a true partnership, and we share your dedication to assuring the highest levels of care and service for people with complex health needs. We call this uncommon care, and it’s helped us to deliver uncommon results for our members—even throughout the pandemic.
No one can say for sure how much longer the pandemic will be affecting our lives. But one thing is certain: we are all going through this together, and we will get through it together.
Thank you for placing your trust in CCA.
CCA remains dedicated to improving care for individuals who are dually eligible for MassHealth and Medicare and have complex medical, behavioral, and social determinant of health needs. Below are several new policies effective May 7, 2022:
- Home health services
- Home modifications
- Home oxygen
- Non-covered benefits
- Non-emergent transportation
- Repairs and modifications
- Vertical platform lift
- Water-circulating pumps
A complete list of medical necessity guidelines is available here.
CCA News & Updates
Colleen Senterfitt, CMM, CCA senior director of clinical quality and specialties, discusses the CCA doula program and the critical gap doulas can fill. Doulas serve as trusted resources for mothers throughout labor, birth, and the postpartum period. They do not give medical advice or make medical decisions; they help the mother and family to make informed decisions. Families who have been served by the CCA doula program value the information and support they received.
Read the full article in the CCA Newsroom.
CCA Senior Medical Director Wayne S. Saltsman, MD, PhD, CMD, CPE, and CCA Clinical Research Manager Meghan Malone-Moses, MPH, discuss the benefits of palliative care at all stages of critical illness. Palliative care is a proactive approach to overcoming illness issues that can lead to further decline. It helps to anticipate changing needs and wishes and to promote a fuller life.
Read the full article in the CCA Newsroom.
In mid-February, CCA launched the first of three pilot programs for the upcoming CCA Engagement Center. Over the following weeks, more group programs will be launched, both in-person and virtually. Be sure to check out future CCA Provider Newsletters for more news on the opening of our Engagement Center!
Tuesdays: CCA Primary Care Boston from 11 am to 12:30 pm
Thursdays: Virtually on Zoom from 11 am to 12:30 pm
The Self-Management and Recovery Training (SMART) Recovery Group is facilitated by recovery coaches. The program is a result of a partnership between CCA and Eliot Community Human Services recovery coaches.
SMART Recovery is a fresh approach to addiction recovery, created for individuals and family members seeking a self-empowering way to overcome addictive problems. This transformative method of recovery teaches practical tools that encourage lasting change by moving from addictive substances and negative behaviors to a life of positive self-regard and willingness to change.
Therapeutic Support Group
Tuesdays and Thursdays at CCA Primary Care in Boston from 1 pm to 2:30 pm
This is a structured social group facilitated by CCA behavioral health clinicians that will focus on a range of real-life topics. The small-group approach gives everyone a chance to participate at whatever level is comfortable while receiving valuable peer connections and support.
Chronic Disease Management Modules
The first five-week module addressing heart failure started on March 14. Modules on diabetes and COPD to follow.
Cohort 1: Tuesdays from 1 pm to 2:30 pm virtually on Zoom
Cohort 2: Thursdays from 1 pm to 2:30 pm virtually on Zoom
This chronic disease program is a disease management course where members learn new information, skills, and techniques for living with heart failure. The target population for this specific course includes members who have been diagnosed with heart failure and are interested in learning more about how to better manage this condition to live a more comfortable life.
If you would like more information about these programs and how to enroll a patient, contact Provider Services at 866-420-9332 to speak with your patient’s care partner!
InstED visits help to reduce demand on emergency departments
Emergency departments are overcrowded! It is estimated that up to 67 percent of all emergency department (ED) visits are avoidable.* The CCA instED program helps reduce unnecessary ED visits by providing the urgent medical care CCA members need in the comfort and convenience of their home. This service is available 365 days a year, including weekends and holidays.
instED is a reliable resource that fills the gap between primary care and emergency care—even for your patients with significant health needs. You’ll have peace of mind, knowing your patients are cared for by specially trained paramedics. Additionally, to assist with patient care coordination, instED will keep you updated with information about the care your patients receive. To learn more, visit www.instED.us.
instED services are now available to CCA members in Rhode Island. We welcome Rhode Island providers and hope that you will begin using instED for your patients’ urgent care needs. We look forward to working with you and delivering the same quality urgent care in Rhode Island that we have been providing for years in Massachusetts.
instED Provider App now available for both Apple and Android users!
instED’s new Provider App is now available for both Android and Apple mobile phones. The app makes it easy for you to request an instED visit for your patients and allows you to track a visit from the time the request is made through the completed visit.
Features of instED’s Provider App include:
- Request a visit
- Check the status of a visit
- Receive real-time updates
- Access 365 days per year
- And more!
Download the free app by visiting our website at www.instED.us
instED Contact Information:
- To make a visit request, go to www.instED.us, download the Provider App, or call the Clinical Resource Center at 833-9-instED (833-946-7833).
- For visit or clinical questions: [email protected]
- For general questions: [email protected]
For technical support with the instED Now platform: [email protected]
* Stanton, M. W., & Rutherford, M. K. (2005). The high concentration of U.S. health care expenditures. Agency for Healthcare Research and Quality, 19, 06-0060.
instED is a wholly owned subsidiary of Commonwealth Care Alliance, Inc. The instED program is not available in all areas. Other in-home urgent care providers are available in the CCA network. For any life-threatening conditions or medical issues that need immediate attention, patients should call 911.
Hello from the Quality Department at Commonwealth Care Alliance!
It’s HEDIS season—the time of year when health plans are tasked with measuring the quality of care provided to members by their contracted providers. This year, CCA is working to support over 90 measures addressing effectiveness of care, chronic care management, and utilization. From February until May, CCA is analyzing claims data, collecting supplemental data from our own electronic health records and external providers, and reviewing medical records for hybrid measures.
What is a hybrid measure?
Hybrid measures are a subset of clinical measures that allow use of medical record data to meet compliance. There are 14 clinical indicators that can be collected through this method. These clinical indicators comprise a total of five hybrid measures.
How is information collected for the remaining 80+ measures?
CCA uses administrative data—claims/encounters, lab data, pharmacy data, and supplemental information—to complement medical record information.
How is supplemental information collected at CCA?
CCA uses a mixture of supplemental information to capture missing service data not received through other sources. This includes electronic health record data collected by CCA care providers and care management teams and files from our providers with performance incentive contracts.
How can you support the CCA HEDIS collection efforts?
- Set robust standards for documentation in medical records and ensure that these standards are followed across your organization.
- Document conversations in medical records, including those pertaining to medication management, chronic disease management, advanced care planning, and preventive screenings.
- Educate and encourage patients to schedule and complete important preventive screenings.
- Ensure that all encounters are closed and signed in a timely manner and be sure to include the credentials of the rendering provider.
How can CCA help support documentation standards?
CCA has created a suite of educational materials for our providers, located in our new Provider Portal. It details important measures and documentation examples.
To visit the CCA Provider Portal, click here.
For information on registering for the CCA Provider Portal, click here.
Access HEDIS Education Documentation Reference Guides by navigating to:
Provider Portal à Administrative Management à HEDIS and MassHealth Education Documents
The provider manuals have a fresh new look!
We know that easy access to provider resources and information makes doing business with us easier. That’s why we have updated and posted our 2022 provider manuals.
Please review the provider manuals for our policies and procedures, prior authorization and claim information, and other useful reference materials.
To access the provider manuals, use the links below.
Plan Benefits, Important Guidelines, and Helpful Tips
Effective January 1, 2022, CCA has two claims processing systems based on product as outlined below. Please ensure you are utilizing the appropriate billing addresses and payor IDs by product to minimize reimbursement delays.
Medicare Advantage Plan Claims
Please reference the Medicare Advantage (MA) Provider Manual, Section 6, “Claims and Billing Procedures,” for billing guidance, EDI claims information (including payor ID), and billing address.
Electronic Claims Submissions
- To submit original claims, or corrected claims, electronically, providers must submit claims through Change Healthcare Portal and/or your clearinghouse using the MA payor ID 14316.
- Mail MA paper claims (original/corrected) to the address below.
Commonwealth Care Alliance – MA
P.O. Box 3012
Milwaukee, WI 53201-3012
- To check the status of a claim, providers must use the QicLink Benefit Exchange
Senior Care Options and One Care Plan Claims
Please reference the Senior Care Options / One Care Provider Manual, Section 6, “Claims and Billing Procedures,” for billing guidance, EDI claims information, and billing address.
Electronic Claims Submissions
- To submit original claims, or corrected claims, electronically, providers must submit claims through EZNet Online Claims Web Portal and/or your clearinghouse using the SCO/ONC Payer ID 14315.
- Mail Senior Care Options / One Care paper claims (original/corrected) to the address below.
Commonwealth Care Alliance
P.O. Box 548
Greenland, NH 03840-0548
- To check the status of a claim, providers must use the EZNet Online Claims Web Portal.
Providers are required to confirm a patient’s CCA eligibility prior to rendering services. It’s important to remember that prior authorization and reimbursement are contingent upon a member’s active eligibility on the dates of service.
Here are several ways to quickly confirm a patient’s CCA eligibility:
Senior Care Options and One Care Plans
- Log in to the CCA Provider Portal
- Log in to the EZ NET Online Claims Web Portal
- Use the MassHealth Provider Online Service Center
- Use the NEHEN Provider Portal
- Call CCA Provider Services at 866-420-9332
Medicare Advantage Prescription Drug Plans
On January 1, 2022, Commonwealth Care Alliance began limiting coverage of name-brand incontinence supplies. Members receiving name-brand incontinence supplies are being transitioned to generic products. There is no action required by the referring provider for this switch. If a member has a clinical reason to continue using name-brand incontinence products, the ordering provider will have to send a letter of support explaining the medical necessity for continued use of name-brand incontinence supplies, together with a prescription for name-brand products that states, “no substitutions.” Please fax the letter and prescription to us at 617-608-5629.
If you have any questions, please contact Provider Services via email at [email protected] or by phone at 866-420-9332.
Keep in Touch and Help Patients Find You
You can find key resources to support CCA members in our updated Provider Manual, section 1 ‘Key Contact Information’. This includes an up-to-date contact list available online.
- View the Massachusetts Senior Care Options / One Care Provider Manual.
- View the Massachusetts Medicare Advantage Prescription Drug Provider Manual.
- View the Rhode Island Medicare Advantage Prescription Drug Provider Manual.
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] and attach a Provider Information Change Form, which can be found at https://www.mass.gov/doc/proposed-draft-provider-information-change-form/download
If you are a registered user for the CCA Provider Portal, you can send HCAS enrollment forms, demographic update requests, and a medical roster with your individual provider information. The medical roster template and HCAS forms are available on the portal for your convenience.
How to Register for the CCA Provider Portal
Please visit this link and follow the steps outlined: https://commonwealthcarealliance.healthtrioconnect.com/public-app/content/provider/payorPage.page?xsesschk=b627d71e10cf4e9684ddb6d16dcbdd79&pptitle=provider_registration_guidance