HCA met with CCA on Billing & Authorization Issues
HCA met with CCA on Billing & Authorization Issues
CCA Acknowledges Provider Challenges, Commits to Corrections and System Improvements
HCA Meets with CCA on Provider Billing, Authorization, and Communication Issues
CCA acknowledged several provider concerns and committed to corrections, clarification, and follow-up action.
The Alliance met this week with Commonwealth Care Alliance (CCA) to address the ongoing billing, authorization, and communication challenges impacting many home care agencies. The discussion was constructive and transparent, and CCA acknowledged several areas where internal processes have contributed to provider burden.
Key Highlights
Overpayment Notices Will Be Corrected
CCA confirmed that overpayment notices tied to admission and discharge-day visits were based on flawed methodology. CCA will remove these claims from the calculations and issue revised notices within the next few weeks. CCA instructed HCA to inform agencies to hold off on responding to the current notices until new notices are released.
Duplicate Visit Denials and Modifier Confusion Under Review
HCA raised providers’ concerns about BID visit denials, particularly T1502 claims being rejected as duplicates unless an XE modifier is used despite no prior guidance. CCA agreed this requires clarification and will escalate the issue internally and with MassHealth, as MassHealth is rejecting these visits for CCA but not for fee-for-service.
Prior Authorization Mismatches
HCA informed CCA that agencies have reported authorizations that did not align with their clinical requests. For example, agencies submitted requests for seven skilled nursing visits and seven MAV visits per week, only to receive approval for one skilled nursing visit per week and 13 MAV visits instead. CCA acknowledged these discrepancies and the inconsistent interpretation by reviewers and is actively investigating.
System and Communication Improvements
CCA acknowledged HCA’s concern, raised by agencies, that there is currently no secure, reliable way to submit documentation, especially for high-volume disputes. CCA agreed to work directly with providers on using secure email channels in the interim. It will also add clearer instructions to its notices so agencies know exactly how to submit materials safely. In addition, CCA is developing an electronic portal that will eventually allow providers to upload large volumes of patient records, but that system is not yet in place.
Transition to CareSource
With the June/July transition approaching, CCA emphasized its commitment to resolving these issues quickly and is preparing a comprehensive provider manual and spring training session.
HCA’s Ongoing Advocacy
The Home Care Alliance continues to advocate on behalf of members, pressing for clear communication, consistent authorization practices, fair claim adjudication, and systems that reflect real-world home care operations. CCA’s willingness to engage directly with providers is a constructive step. The Alliance will remain closely involved as follow-up actions move forward.