The Commonwealth Care Alliance (CCA) payment policies are designed to assist providers when submitting claims. These policies are updated regularly, based on guidance from applicable federal and state regulations, to promote accurate coding, billing, and policy clarification.
CCA’s Clinical Guidelines represent the current standard of care for screening and/or management of specific physical, psychiatric and behavioral health conditions for which there are special considerations that apply to the complex health and adverse social situations of our members. They adhere to recommendations and guidelines upheld by nationally recognized primary and specialty care health experts and advocacy groups.
Medical Necessity Guidelines
Our Medical Necessity Guidelines specify the medical necessity and appropriateness of healthcare services for the purpose of determining coverage under the applicable health plan, federal and state regulations and coverage criteria, and Change Healthcare criteria. They adhere to standards adopted by national accreditation organizations such as the National Committee for Quality Assurance (NCQA).
Behavioral Health Performance Specifications
The CCA Behavioral Health Performance Specifications are designed to help our behavioral health providers deliver services that drive clinical excellence, ethical and professional integrity, integration of all medical and behavioral health needs, member accessibility, and cultural sensitivity.