Virginia

Provider materials

Humana Gold Plus Integrated, VA Commonwealth Coordinated Care Plan

Important reminder

Humana Commonwealth Coordinated Care (CCC) membership will transition to Commonwealth Coordinated Care Plus (CCC Plus) effective Jan. 1, 2018.

The Virginia Commonwealth Coordinated Care (CCC) program ended on Dec. 31, 2017. All CCC enrollees were transitioned to the Commonwealth Coordinated Care Plus (CCC Plus) program effective Jan. 1, 2018. Please note the following important payment information affecting your patients participating in Medicaid consumer-directed services:

To ensure payment for dates worked on or before Dec. 31, 2017, all time sheets must be submitted to PCG, Public Partnerships (PPL) by Feb. 2, 2018. CCC time sheets submitted after the Feb. 2 deadline will not be paid. Please refer to this memo from the Department of Medical Assistance Services (DMAS) for additional details. Questions may be emailed to CCCPlus@dmas.virginia.gov.

Humana’s Commonwealth Coordinated Care (CCC) membership will transition to Commonwealth Coordinated Care Plus (CCC Plus) effective January 1, 2018. Humana is committed to ensuring continuity of care for our existing CCC membership. Humana will work closely with the Department of Medical Assistance Services (DMAS) to transition members to their new CCC Plus plan by January 1, 2018, the transition date defined by DMAS for currently enrolled CCC members. You are a valued and critical partner in ensuring a smooth and seamless transition for our members. Our provider partners, health plans and the Department are working behind the scenes so that members will have very little abrasion throughout this transition from CCC to CCC Plus. We look forward to our continued partnership in serving Virginia’s most medically fragile citizens.

Here are some important items we would like to share at this time:

  • Benefits of Members Staying in CCC Through the Transition:
    • We appreciate your help in keeping our members enrolled in their health plan until January in order to ensure a seamless CCC to CCC Plus transition for both members and providers.
    • It is important to note that if CCC members “disenroll” from CCC, they will be transferred back to Medicaid Fee-For-Service. Members who are transferred back to Medicaid Fee- For- Service will be required to re-submit requests to KePRO for current service authorizations.
  • Enrollment and Eligibility:
    • Humana’s CCC membership does not need to select a CCC Plus plan or take any action at this time.
    • On January 1st all currently enrolled Anthem and Virginia Premier CCC members will be passively enrolled into Anthem and Virginia Premier CCC Plus for their Medicaid benefits. Humana CCC members will be passively enrolled into CCC Plus plans, using the “intelligent assignment. Members will receive a formal notification from DMAS and their current CCC plans this fall advising them of the actions needed to prepare for their transition.
    • Prior to January 1st, if members “disenroll” with their current CCC plan, they will be placed into Medicaid Fee-For-Service and will not be able to enroll back into the CCC program. For continuity of care purposes, it is of greatest benefit for providers, members and families to ensure members do not lose eligibility through overdue renewals, etc.
    • In January 2018, CCC members will receive a ‘CCC Plus member card’ within 10 days of enrollment and informational welcome packet from their health plan within 30 days. The packet will include relevant contact information for member services.
  • Continuity of Care:
    • CCC Plus plans are required to honor service authorizations for Medicaid covered services up to a 90-day period from both Medicaid Fee-For-Service and outgoing CCC Plans.
    • CCC networks and contracted providers will largely remain the same going into CCC Plus to ensure the greatest continuity of care for our members.
  • Member and Stakeholder Education for CCC Plus:

Your role in this process is vital to ensuring continuity of care for your patients. Find information about the CCC Plus program at http://www.dmas.virginia.gov/Content_pgs/mltss-home.aspx. Additionally, DMAS has created the following CCC Plus email address for inquiries and concerns: cccplus@dmas.virginia.gov.

Effective Jan. 1, 2017, for claims with dates of service (DOS) Jan. 1, 2017, and onward, long-term services and supports (LTSS) providers need to follow new guidance for claims submission:

  • To submit claims online through the Availity Web Portal (registration required), select “Humana LTC” as the payer after login.
  • To submit claims through a clearinghouse, use payer ID 61115. If a different payer ID is used, claims will be rejected or denied.
  • To submit paper claims, send them to the following address:

Humana LTSS Claims P.O. Box 14732 Lexington, KY 40512-4732

For more information, refer to the new provider billing guide:

Long-term Services and Supports (LTSS) Provider Billing Guide (1.07 Mb) – Effective Jan. 1, 2017

The documents below highlight the key points related to Humana’s Virginia Demonstration policies and procedures and is an extension of participating health care providers’ contracts. It is intended to be a guideline to facilitate and inform health care providers on what the Virginia Demonstration program is about, what Humana needs from health care providers and what health care providers can expect from Humana.

Virginia Commonwealth Coordinated Care (CCC) Appendix Bulletins

Medicare-Medicaid preauthorization and notification list

The document below lists services and medications for which preauthorization may be required for Humana dual Medicare-Medicaid members in Virginia. Please review the detailed information at the top of the lists for exclusions and other important information before submitting a preauthorization request.

Previous versions of the list can be found here.

Humana Gold Plus Integrated Prescription Drug Guide

Cultural Competency Program Information

Compliance requirements for health care providers

Humana and the state of Virginia require that all entities that participate with dual Medicare-Medicaid plans and Medicaid plans, including those contracted with subsidiaries, complete the following training materials:

  • Cultural Competency Training
  • Health, Safety and Welfare Education Training
  • Medicaid Provider Training
  • Humana Orientation Training
  • Compliance and Fraud, Waste and Abuse Training

The information below is provided to help you complete these requirements:

Frequently asked questions and answers

This document provides additional information regarding the compliance requirements and Web access.

Compliance Requirements for Health Care Providers – Frequently Asked Questions and Answers (302Kb)

Humana.com instructions

This document covers how to complete the required compliance requirements on Humana.com, how to register on Humana.com, how to create a new user, how to assign the compliance business function to another user and how to update an organization's tax identification number (TIN).

How to Complete the Training Requirements via Humana.com (97Kb)

Availity.com instructions

This document covers how to complete the compliance requirements on Availity.com, how to register on Availity.com, how to create a new user, how to assign the compliance business function to another user and how to update an organization's TIN.

How to Complete the Training Requirements via Availity.com (120Kb)

If your organization is unable to register on Humana.com or Availity.com (link opens in new window) , refer to the following document:

Training Requirements for Health Care Providers Who Are Unable to Register (193Kb).

Long-term services and supports (LTSS) provider portal

Elderly or disabled with consumer direction (EDCD) waiver and custodial or intermediate-care nursing facility providers who need information regarding eligibility, authorizations and claims status can access the LTSS provider portal.