Commonwealth Coordinated Care Claims Testing

One key element of preparation for the launch of the Commonwealth Coordinated Care (CCC) program is ensuring that providers have the ability to successfully transmit and submit claims to each of the three contracted Medicare-Medicaid Plans (MMPs) and for the MMPs to process those claims promptly and accurately.  Beginning in December 2013, VHCA began requesting that the Department of Medical Assistance Services (DMAS) require that MMPs establish the necessary resources to allow all nursing facilities to submit test claims to the health plans.  The response has been slow.  Late last week, DMAS provided a number of documents intended to serve as instructions and guidance to providers to move ahead with the testing of claims.  The claims testing information is available here.

All member facilities that anticipate participation with one or more of the MMPs are encouraged to undertake claims testing as soon as possible.  VHCA will be monitoring the status of this testing over the next few weeks and months and will work with both DMAS and the MMPs to address issues and concerns.