The Home Care Alliance continues to engage regularly with Commonwealth Care Alliance (CCA) on operational and claims issues affecting member agencies.

CCA is a nonprofit health plan serving individuals with complex medical and social needs, including many MassHealth members and dually eligible beneficiaries. Because of the acuity of the population it serves, CCA-authorized care plans often require multiple daily visits, making accurate claims processing critical for providers.

During our most recent monthly call with CCA, the Alliance raised concerns on behalf of members regarding errant denials of twice-daily (BID) visits, which had been incorrectly flagged as “duplication.” As previously shared with membership, these denials were not consistent with approved care plans.

Following additional discussion, CCA acknowledged that BID visits are valid when authorized and should be reimbursed. CCA is actively working to resolve the issue systemwide and will be issuing more formal guidance to providers.

In the interim:

• Providers should continue submitting BID visit claims, using a modifier on one of the two visits
• CCA plans to proactively reach out to providers whose claims were denied in error
• Affected providers will be asked to resubmit claims with the appropriate modifier for reprocessing

This issue is an example of the Alliance’s ongoing advocacy and payer engagement on behalf of members. Through regular payer calls, escalation of systemic issues, and direct follow-up with managed care organizations like CCA, the Alliance works to reduce administrative burden, clarify expectations, and protect appropriate reimbursement for home care services.

We will continue to keep members informed as CCA distributes additional guidance and implementation details.