The recurring calls with CCC Plus managed care organizations (MCOs) to identify and troubleshoot claims processing issues will cease after this week. At this juncture,...
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DMAS received updates on the CCC Plus managed care organization (MCO) directories contact lists by region. Please share this updated information with the appropriate staff...
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The deadline for the Virginia Premier 2019 Claims Clean-Up project to reconcile any outstanding CCC Plus claims issues for calendar year (CY) 2019 is November...
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VHCA-VCAL provided information from Virginia Premier in March on a project to “settle” all claims issues from calendar year 2019. Virginia Premier is now moving...
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Virginia Premier has notified VHCA-VCAL that it is still experiencing problems with its group email inboxes. For the final roster billing for the $20 COVID...
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Virginia Premier is experiencing technical difficulties with emails as it transfers to the Sentara network. Group email boxes are not working properly. To avoid delays...
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DMAS has asked VHCA-VCAL to relay a series of updates on the Medicaid $20 per day add-on. The updates address the May Fee-for-Service (FFS) rosters,...
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Virginia Premier is available to work on 2019 claims clean up and has provided instructions for providers. We have also been notified that HMS has...
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DMAS published a Medicaid Memo on provider flexibilities related to COVID-19 on April 22, 2020. The memo includes CCC Plus-specific items related to consent and...
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Providers may have recently received a letter stating that Optima Health will be retracting money paid for services rendered to Optima Health Community Care members....
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DMAS has requested all health plans suspend timely filing requirements for nursing facility crossover claims back to the beginning of the CCC Plus program until...
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DMAS has re-surveyed the six CCC Plus managed care organizations (MCOs) for updated DMAS-80 submission contacts, including designated fax numbers and escalation staff should additional...
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Virginia Premier has asked VHCA-VCAL remind members that it has set up a dedicated fax line to receive DMAS 80 forms and a dedicated phone...
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Two CCC Plus health plans, Virginia Premier and Magellan, have recently indicated systemic nursing facility claims issues that both, while different, seem to be related...
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VHCA-VCAL has heard from several members that audits of Anthem CCC Plus claims, undertaken by their contractor HMS, have been extremely problematic. Specifically, the scope...
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Virginia Premier has issued a Provider Update on LTSS Screening. The plan has updated its fax number to facilitate paperwork processing for screenings. Virginia Premier...
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Optima and Virginia Premier have announced that Optima is seeking 80 percent ownership of Virginia Premier. Officials from Virginia Premier have informed VHCA-VCAL that the...
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VHCA-VCAL has been made aware of recent concerns over NF residents’ consent for the purchase of dental coverage. The cost associated with needed dental services is...
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On the most recent set of CCC Plus claims issues calls, DMAS asked if providers were experiencing any issues with CCC Plus billing for individuals...
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September 13, 2019 is the deadline to submit spreadsheets with any outstanding Virginia Premier CCC claims issues and any outstanding Virginia Premier CCC Plus claims...
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For some time now, VHCA members, DMAS, and the six CCC Plus managed care organizations (MCOs) have been conducting periodic calls to identify and resolve...
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In an effort to provide more specific issue resolution for nursing facility (NF) claims under CCC Plus, Virginia Premier has established a specific inbox for NF...
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As we announced earlier this month, Virginia Premier is working to closeout any claims issues from the Dual Demonstration (CCC), which ran from August 2014...
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Virginia Premier, in consultation with VHCA-VCAL, has determined it would like to run a project to close out any remaining claims issues from the CCC...
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DMAS is hosting a training session for nursing facilities on how to use the new Automated Enrollment and Disenrollment (AE&D) Portal (aka, “LTC Portal”) on...
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According to the Department of Medical Assistance Services (DMAS), nursing facilities (NFs) will be able to bill the managed care organizations (MCOs) directly for the...
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The Centers for Medicare and Medicaid Services (CMS) offer Resources for Integrated Care that supports providers integrating benefits for people receiving both Medicare and Medicaid....
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Medicaid reimbursement for hospice services provided in a nursing facility (NF) will change effective July 1, 2019. Legislation passed by the General Assembly will...
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[caption id="attachment_105874" align="alignright" width="407"] Payment for Services Committee[/caption] VHCA-VCAL members and staff will again present their concerns about CCC Plus implementation to Department of Medical...
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Work on CCC Plus logic for Part A crossover claims processing has unveiled an issue that the Department of Medical Assistance Services (DMAS) now believes...
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Effective February 1, 2019, Virginia Premier will operate utilizing one Virginia Premier Payer ID: VAPRM or the Exchange Program ID: 251VA. This change is intended...
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To assist with the CCC Plus Managed Care Organizations' (MCO) efforts to clean up the Medicare Part A bad debt, members should provide Steve Ford...
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With the end of the 2018 provider fiscal year and the deadline for cost reports, the Department of Medical Assistance Services (DMAS) has issued guidance...
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Now that CCC Plus is fully implemented statewide across all eligible populations, enrollees can choose their plan annually during open enrollment. The open enrollment period...
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With the latest round of conference calls on the CCC Plus program, it became evident that claims processing issues persist. VHCA-VCAL is disappointed at the...
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DMAS will hold its final provider conference call on care coordination under CCC Plus on September 25 from 1:00 – 1:45 pm. Call-in number: 1-866-842-5779...
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On September 19, VHCA-VCAL provided comments to the Department of Medical Assistance Services (DMAS) recommending changes for the January 1, 2019 CCC Plus contract revision....
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CMS has issued a memorandum on the Survey Process for Reviewing Home Dialysis Services in a Long Term Care (LTC) Facility. The memo, QSO-18-24-ESRD covers...
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Virginia Premier has distributed its Provider Resource Tool and asked VHCA-VCAL to share it with members. It includes various procedural items and contact information for...
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The Department of Medical Assistance Services (DMAS) will continue its new series of provider conference calls on care coordination under CCC Plus. The next call...
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We have heard from many of you that you are receiving contracts or addendums to your CCC Plus contracts pertaining to the Medallion 4.0 program...
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The CCC Plus Care Management Unit of the Department of Medical Assistance Services (DMAS) will be sponsoring twice monthly conference calls starting July 10. These...
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Virginia Premier CEO Linda Hines has provided VHCA-VCAL with a letter outlining the steps it is taking to resolve the remaining nursing facility payment issues...
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VHCA-VCAL is aware that at least one CCC Plus managed care organization (MCO) has issued an addendum to its provider agreement and appears to have...
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Last week we informed you that VHCA-VCAL provided comments to the Department of Medical Assistance Services’ (DMAS) draft revisions to the CCC Plus contract. In...
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In response to feedback from VHCA members during the biweekly claims processing conference calls about paper claims being rejected on the front end and not...
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VHCA-VCAL submitted comments to the Department of Medical Assistance Services (DMAS) as the agency requested comments in advance of potential revisions to the CCC Plus...
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Although the managed care organizations (MCOs) in the CCC Plus program paid over $120 million in April to catch-up on the backlog of unpaid claims...
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As a result of the project to resolve unpaid CCC Plus claims in March, the six managed care organizations (MCOs) processed $128 million in nursing...
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Friday, March 16 is the deadline for nursing centers to submit their outstanding receivables to the managed care organizations (MCOs) participating in CCC Plus to...
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As we shared with nursing center members on March 8, VHCA-VCAL has worked closely with the Department of Medical Assistance Services (DMAS) to find a...
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“Please don’t go it alone if you are having difficulty with CCC Plus,” Tammy Whitlock, DMAS Division Director for Integrated Care advised VHCA-VCAL members at...
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As I write, we are officially six months into the launch of the CCC Plus program. As with any government program, there have been bumps...
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VHCA-VCAL continues to hear from members that claims adjudication under CCC Plus has been inconsistent and slow, in varying degrees among the six managed care...
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As we have previously reported, Optima Health has had issues processing CCC Plus claims due to its lack of a relationship with Availity. Effective tomorrow,...
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We are continuing to work through claims issues with the six managed care organizations (MCOs) under CCC Plus since the program went live in August. ...
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We have become aware that providers are having difficulty with claims processing one of the CCC Plus managed care organizations (MCOs), Optima Health. Because Optima currently...
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The Department of Medical Assistance Services (DMAS) has asked VHCA-VCAL to share two updates with providers. First, beginning next week the agency will be substituting...
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As Commonwealth Coordinated Care Plus (CCC Plus) continues its phased roll-out across the state, we wanted to provide two additional updates for the program this...
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The Central Region went live for coverage under Commonwealth Coordinated Care (CCC) Plus on September 1. Next up will be the Western/Charlottesville Region on October...
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Effective September 1, the Central Virginia region will go live for coverage under the roll out of the mandatory Medicaid long term services and support...
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We have reactivated the Issue Log first set up in 2015 to help track and resolve member problems with the Commonwealth Coordinated Care (CCC) Plus...
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Anthem HealthKeepers Plus, a CCC Plus MCO, has asked VHCA-VCAL to inform you that it is hosting another series of webinars to orient providers to...
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In our continuing effort to keep you up-to-date on the developments related to the Commonwealth Coordinated Care (CCC) Program and the launch of CCC Plus,...
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In our continuing effort to keep you up-to-date on the developments related to the launch of the Commonwealth Coordinated Care (CCC) Plus program, we have...
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[caption id="attachment_80223" align="alignright" width="300"] Click picture for a larger view.[/caption] As August 1 approaches, we are inching closer to the beginning of the Commonwealth Coordinated...
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The Department of Medical Assistance Services (DMAS) has announced that all six health plans participating in CCC Plus, the mandatory Medicaid managed care delivery system,...
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The Department of Medical Assistance Services (DMAS) has scheduled a series of town halls and webinars in preparation for the launch of the Commonwealth Coordinated...
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On May 8 the Department of Medical Assistance Services (DMAS) issued a provider memo on the new direct and indirect operating base rates and an...
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On March 28 the Commonwealth Coordinated Care (CCC) Advisory Committee met to be briefed on the latest developments related to the shift to managed care...
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The Department of Medical Assistance Services (DMAS) is moving forward with the switch from the current RUG-III 34 grouper to the RUG-IV 48 grouper for...
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