Commonwealth Care Alliance

Senior Care Options Program (HMO SNP)

For Providers » Frequently Asked Questions

Frequently Asked Questions

What programs do you offer?
Commonwealth Care Alliance currently offers two healthcare programs. Commonwealth Care Alliance Integrated Care Program is for Massachusetts residents aged 21 to 64 who are dually eligible for both MassHealth Standard and Medicaid. Many of the members have complex healthcare needs including chronic medical problems, intellectual or developmental disabilities, mental illness, or a history of substance abuse. Commonwealth Care Alliance Senior Care Options Program is for Massachusetts seniors aged 65 years and older who have Medicare and MassHealth Standard or just MassHealth Standard alone and who stand to benefit from a personalized, flexible care plans based on their unique needs.

What makes Commonwealth Care Alliance different from other healthcare providers in Massachusetts?
In a phrase, it’s our “model of care.” Our approach to healthcare is patient-focused. We’ve always understood the value of listening to and learning from the people we serve. Giving our members the opportunity to be participants in their own care differentiates our approach and makes a huge difference in the quality of life of the people we serve.

Is the Commonwealth Care Alliance model of care effective?
Yes, a great deal of data suggests that it is an effective model for improving healthcare outcomes and reducing costs. For example, a Lewin Associates study commissioned by the SNP Alliance found Commonwealth Care Alliance hospital admissions and days from 2009-2011 were 56% of the risk-adjusted Medicare dual-eligible FFS experience. The NCQA risk-adjusted 30-day hospital readmission rate in 2010 was 4% compared with the median Medicare Advantage program rate of 13%. The permanent nursing home placement rate for nursing home certifiable members between 2009 and 2011 was 34% of that seen in a Nursing Home Certifiable frail elder population in FFS care. The seven-year annual average total medical expense increase is 3.3 % and 2.8% for nursing home certifiable and ambulatory enrollees respectively, well below the Medicare trend. And our CMS Quality Star Ratings of 4.5 Stars ranked in the 90th percentile of all Medicare Advantage Plans and the 99th percentile of all Medicare Advantage Special Needs Plans in 2010 and 2011.

How do I become a network physician or other health care provider?
If you’re interested in becoming part of our provider network, or have any other questions or comments, please call our Provider Network Department at (617) 426-0600. The line is open Monday-Friday from 8 a.m. to 5 p.m.

Where can I find other Commonwealth Care Alliance contracted physicians and other healthcare providers?
Click here to see a comprehensive list of Commonwealth Care Alliance contracted physicians and providers.

Where do I submit claims?
Please mail paper claims to:

Commonwealth Care Alliance
P.O. Box 22280
Portsmouth, NH 03802-2280

Where do I submit dental claims?
Please mail paper dental claims to:

Commonwealth Care Alliance Claims
Dental Program
P.O. Box 508
Milwaukee, WI 53201

Where can I find a list of covered services?
Covered services are listed in provider contracts. You may also find covered services information in Chapter 4 of the Evidence of Coverage: Benefits Chart.

Where do I find Commonwealth Care Alliance provider forms?
Frequently requested forms are located in the Provider Forms & Resources section of our web site.

How do I find out about career opportunities with Commonwealth Care Alliance?
We list job openings on this website in the About Us section. Click here to find out about current openings.

Where are you located?
Our central headquarters are at 30 Winter Street, Boston, MA 02108. We also have offices located in Charlestown and Western Massachusetts. Visit our corporate site for complete locations.
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Last Updated 01/06/2017