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Payment Policies

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.

Clinical Guidelines

The CCA Clinical Guidelines represent the current standard of care for management of specific diseases and were developed based on guidance from key healthcare organizations, such as the American Heart Association, the American Nurses Association, the Asthma and Allergy Foundation of America, and more.

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.