Commonwealth Coordinated Care (CCC) Update

The Virginia Health Care Association (VHCA) continues to monitor the claims processing issues experienced with each of the CCC Medicare/Medicaid Plans (MMPs).  In discussions with the Department of Medical Assistance Services (DMAS) and the MMPs this week, the MMPs have asserted that the claims that had been affected by systematic issues have either processed through to payment or are in process and should produce payment in the next week to week and a half.  As such, we have increased scheduled discussions with the MMPs and DMAS, and need your feedback regarding the receivables you expect and the payments you receive relative to the backlog of claims.  As always, feedback on this issue should be sent to Steve Ford at steve.ford@vhca.org.  It is important that we hear whether or not you are experiencing any relief regarding outstanding claims, the extent of that payment, etc., as we have already begun some discussion of other interim measures to ensure the financial viability of our members during this “fix” period.

In those same conversations, there were concerns raised by the MMPs regarding CCC claims not including the RUGs assignment, dates of service, etc.  We have not substantiated this concern, nor does it intuitively make sense given we have not been made aware of payment issues with Medicaid FFS (which one would expect for these submission issues), nonetheless, we would advise that you double check that the necessary information for payment under the RUGs-specific reimbursement methodology is being produced on claims submitted to the MMPs.  

Further, all three MMPs have asserted that their systems have been corrected and are capable of accepting electronic claims.  If you have been holding claims while waiting for the MMPs’ systems to be fixed, we would advise that you submit claims as you would in the normal scope of business.  This will either start the payment process for those claims, or identify further issues with the MMPs systems and/or your claims submission practices so that these additional issues can be addressed.

We will update the membership on this issue through this newsletter and through additional means as the issue continues to evolve.