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 (Dual Demonstration) program, which ran from August 2014 through December 2017.  Separately, but in the same collection effort, Virginia Premier would like to close out older CCC Plus claims for dates of service form August 1, 2017 through December 31, 2018.

To that end, Virginia Premier is asking nursing home providers to submit all outstanding claims for which the provider believes proper adjudication has yet to occur. This might include overpayments (for example, patient pay issues or improper payments of Part A claims), underpayments, or even valid unprocessed/pended/denied claims. Any unresolved claims issues for which the provider is seeking resolution should be included for the Dual Demonstration and CCC Plus programs for the time period specified above). Claims which were or currently are under appeal should not be included.

Virginia Premier is seeking this information via this spreadsheet, with one tab for the Dual Demonstration and one tab for CCC Plus. Key pieces of information are the claim reference number (if it exists and is easy to provide), the member id/name, dates of service, brief description of the claim (Part A, Part B, custodial, etc.) and issue. To the extent you have the additional  information requested on the template, please include it in your submission.

This information is requested to be encrypted and returned to Virginia Premier at VPHPLTSSProviderServices@virginiapremier.com by COB Friday, September 13, 2019. Multi-facility companies can report all facilities on the same spreadsheet, but it is imperative to distinguish those facilities by NPI. In any case, a facility or company primary contact (name, phone number and email address) should be identified for follow-up once the Virginia Premier project resolution team has the opportunity to research the various claims.

To the extent the claim can be resolved remotely by Virginia Premier, it will do so and provide summary information back to each submitter via spreadsheet at the claim level. It is possible Virginia Premier will need to visit on-site with relevant staff to resolve some of these claims. 

If a spreadsheet is not provided by September 13, then Virginia Premier will consider that as an acceptance of payment and additional reviews will not be completed for that provider. Spreadsheets received by September 13 will be considered final and additional claims will not be considered.  Virginia Premier will send a receipt confirmation to the designated facility/company contact within two business days of your submittal. ; if you do not see this confirmation email, please contact Rebecca Frango.

In the next week, Virginia Premier will also be sending a spreadsheet to each facility/company identifying all claims and adjustments resulting from the SCIO audits in both the Dual Demonstration and CCC Plus. To the extent these claims were adjusted to a $0 payment due to the provider not responding to the auditor’s request for information or in error by Virginia Premier, you should include those claims in your submission to be adjusted to the default RUG rate for that period.

Virginia Premier will conduct the claims reviews and update the submitters as quickly as updates are available. This close out project is a high priority and Virginia Premier would like to resolve all claims in this project by December 1, 2019, depending on the volume received.

If you have questions about this request, please contact Rebecca Frango at (540) 344-8838, ext. 55876 or email rebecca.frango@virginiapremier.com.

Additional Resource
Virginia Premier Dual Demo and CCC Plus Claims Clean-Up Spreadsheet