Commonwealth Coordinated Care

Frequently Asked Questions

How will I be notified regarding the disposition of my service authorization request (SAR)?

Anthem will send the provider a letter.

Humana/Beacon will notify the provider in writing follow up by phone.              

Virginia Premier will send the provider a letter and follow up by phone.

What is the process for submitting reauthorizations?

Note: All 3 MCOs will honor the Service Authorizations issued by Magellan & will reimburse for services up to the expiration date.

Anthem will send the provider a letter.

Humana/Beacon will honor open authorizations provided to the MCO’s in the medical transition report from DMAS. The majority of new authorizations will be created through the integrated care team process. Providers should refer to their provider manual for information on services that require authorization.              

Virginia Premier will send the provider a letter and follow up by phone.

I understand that I may need to submit specific CCS3 data elements to MCOs for their use as they complete the Health Risk Assessment (HRA), but how do I do that, and which MCOs are requesting the data?

Anthem is NOT requesting these data elements.

Humana/Beacon is not routinely requesting these data elements at this time; however, they hope that CSBs will work with them on a case-by-case basis if there is a need for these data.

Virginia Premier will contact the CSB by phone and request the information.  The CSB is expected to relay the data by phone or FAX to Virginia Premier within 3 business days.

How are the MCOs contacting CCC enrollees in order to complete the HRA?

Anthem is currently phoning enrollees and completing the HRAs over the phone. CSBs may need to assist the Anthem Care Managers to coordinate the time/place for the call to the enrollee.

Humana/Beacon is contacting the CSBs to collaborate on the time/place for completing the HRA. The CSB may need to accompany the enrollee to the appointment.  For members in TCM, it may be helpful for the TCM to accompany the member during the assessment process. In many cases, the Humana/Beacon care manager may come to the CSB to help facilitate the completion of the assessment in collaboration with the TCM.

Virginia Premier is contacting the CSBs to collaborate on the time/place for the HRA. The CSB may need to accompany the enrollee to the appointment.  The MCO may also meet with the enrollee at a CSB setting.

Do I need to get prior authorization for Intensive Community Treatment (ICT)?

Anthem does NOT require prior authorization for ICT ASSESSMENT but DOES require prior authorization for ICT SERVICES.

Humana/Beacon does NOT require prior authorization for the ICT ASSESSMENT, but does require prior authorization for ICT SERVICES.

This issue has not come up in interactions with Humana/Beacon or Virginia Premier, but their response will be added if necessary.

What billing code should I use for MCO-approved clinic and state plan option (SPO) services?

All three MCOs will accept existing CPT billing codes.

What billing code should I use for Enhanced Care Coordination (ECC) if my CSB is providing ECC as a service?  Note: The CCC Steering Committee has recommended that the MCOs allow the CSBs to use the CPT code H0023 with the modifier HK.

Anthem is in the process of reviewing the recommended code and will notify CSBs prior to billing for ECC.

Humana/Beacon in the process of reviewing the recommended code and will notify CSBs prior to billing for ECC.               

Virginia Premier has approved the new recommended billing code for ECC.

How do I bill for transportation?

CSBs authorized as Medicaid transportation providers will continue to bill Logisticare for CCC enrollees assigned to Anthem.

CSBs authorized as Medicaid-funded transportation providers will continue to bill in accordance with their contract with Logisticare for CCC enrollees assigned to Humana/Beacon.

Virginia Premier contracts directly with authorized Medicaid transportation providers.  CSBs that have a transportation contract with Virginia Premier should submit related billing to directly to Virginia Premier. 

Can I bill for Targeted Case Management (TCM) when the CCC enrollee is hospitalized in a local facility?

Medicaid regulations prohibit the billing of TCM when an individual is admitted to an inpatient facility.

Can I bill for ECC when an individual is hospitalized in a local/state facility

If a CSB is has contracted with an MCO to provide ECC, the CSB may provide and bill for ECC during the time that the CCC enrollee is hospitalized in a local/state facility.

What is the impact of hospitalization in a state facility on an individual’s eligibility for and enrollment in CCC?  

CSB consumers who are enrolled in CCC will be automatically dropped from the program and will lose their Medicaid benefits when they are admitted to a state facility. The consumers will need to reapply for Medicaid and reenroll in the CCC following discharge from the hospital, which may take 60-90 days. 

What kind of training does my staff need if they are serving CCC enrollees?

The mandatory training for staff who are serving CCC enrollees is located at http://www.vacsb.org/required-ccc-training.  Please read the CCC training procedures document located on that page carefully before proceeding with the training.

Is this training be required annually?

The Training and Development Work Group of the CCC Steering Committee is working to find definitive answer to this question based on the three way contract between DMAS, CMS and the MCOs

I see an attestation form on the CCC Required Training website, but I’m not sure how to fill it in correctly.

The attestation form needs to be completed and submitted to each MCO to verify compliance with the training requirement. 

The Agency NPI number is sufficient for all staff providing services to CCC enrollees.  The NPI number must be inserted into every cell that has a name in it so that the NPI number will remain associated with the individual’s name in the event the information is sorted and/or aggregated and then sorted.

List the staff’s role at the CSB, essentially his/her job title in the ICT role field.

Who is required to take the training?

Every staff person who is providing services to CCC enrollees must take the required training.  Be sure to read the guidance document located on the website above before beginning the training as it may save some staff from having to take every component of the training.  Prioritize the staff listed in the guidance document; however, any staff person who will be providing service to a CCC enrolled individual should take the training.

How do we complete the training attestation for new staff and what is the time frame in which the training needs to be completed from date of hire?

The training and attestation should be submitted in the same way throughout the life of the demonstration.  If there are changes to the contacts provided in the guidance document, the MCOs will make the VACSB aware so that we can make changes to the information provided online.

The MCOs have not laid out specific time frames for the completion of the training that are tied to an individual’s hire/start date.  Training should be completed prior to the first MCO initiated Interdisciplinary Care Team meeting.

New staff come and go at different points in the month, the MCOs have agreed to accept monthly attestations for individuals who are either new to the CSB or new to serving CCC enrollees.  If no update is warranted, the MCO does not need a submission.

Who can I contact at each MCO when I need assistance with a CCC enrollee and vice versa?

Each MCO is preparing a list of its Care Managers and will forward that list to VACSB when it is completed.

Virginia Premier has completed its list and it can be downloaded HERE.

VACSB will forward an updated contact list to MCOs that delineates the info for the CSB CCC Coordinator, the CSB administrative contact person, and the CSB Finance Director.

Do I have an opportunity to ask my questions directly to DMAS and the MCOs?

YES!  DMAS hosts weekly conference calls for behavioral health providers and representatives from each of the MCOs are present on the calls to take your questions.  The calls are scheduled from 11:30 – 12:00 on Fridays.  Dial In:  1-866-842-5779; Conference Code:  8047864114, followed by the # key.

You can also email DMAS at ccc@dmas.virginia.gov with your questions.

DMAS keeps a log of all of the questions raised on the provider calls.  That log can be requested via email at the address above.

Are there resource documents that cover the basics?

Yes.  Download this resource packet with information for executive-level leadership and case management staff.  In addition, DMAS has created a provider resource guide.

Where can I find the new Service Authorization Request Forms that were approved by all three MCOs?

Here (MHSS), Here (ICT) and Here (PSR).