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 center payments.  However, a substantial amount of denied or pended claims,  which have not been fully addressed, remain. In response to this and additional concerns with current processing, VHCA-VCAL met with Department of Medical Assistance Services (DMAS) staff on April 23.  Members are reporting both delayed and incorrect payments continue.  Some MCOs are still partially relying on manual intervention using the provider-produced spreadsheets to process claims—this is an unsustainable and unacceptable process.  VHCA-VCAL emphasized the imperative to address the underlying claims processing issues to ensure the MCOs are meeting their obligations under the CCC Plus contracts. 

Following this week’s meeting with DMAS, VHCA-VCAL is identifying next steps in the process to establish a date certain on when corrections to the claims systems will be implemented that address both the backlog and current submissions.  We will share further details as they are available. 

In the meantime, please contact Steve Ford with any questions about the CCC Plus program.