Many clients have reached out to us and asked for help with initiating an APPEAL... as their hours have been cut in a big way... we want to help and will do all that we can to assist you, but we're not the best persons for that, but have learned of an office that can help and we want to share the information with you. Please give them a try.
The Office of the State Long Term Care Ombudsman is available to assist members and families with the appeal process, any issues that individuals need help with regarding their CCC Plus health plan. They are also known as CCC Plus Advocates, they do not work for the health plans or DMAS, they are an independent entity.
The contact information for the CCC Plus Advocate is
To provide Virginians high quality healthcare and supports by coordinating the benefits of Medicare and Medicaid into a single, person-centered program.
Commonwealth Coordinated Care is a new initiative to coordinate care for individuals who are currently served by both Medicare and Medicaid and meet certain eligibility requirements. The program is designed to be Virginia’s single program to coordinate delivery of primary, preventive, acute, behavioral, and long-term services and supports. In this way, the individual receives high quality, person centered care that is focused on their needs and preferences.
The goals of this initiative include: improved quality and health outcomes, streamlined Medicare and Medicaid requirements, increased accountability, reduced burden for enrollees and providers, providing care in each individual’s setting of choice, and reduced avoidable services. Supplementary benefits will include care coordination, interdisciplinary care teams, and person-centered care plans.
For more information about the Virginia Medicaid "CCC PLUS" program, please click on the words, CCC PLUS highlighted herein or the appropriate bar below, by participating Insurance Company:
If you're having issues with AUTHORIZATIONS... please contact your insurance company and speak with your care manager to find out what's going on. The care coordinator should be able to tell you if paperwork is need, if your medicaid has been interrupted, if an error has been made, etc. We, as your service facilitator does not have access to this information like the insurance companies does (even though many of them tell you that we do)... often times they tell you that they sent you something or your service facilitators... as we (the client and us) we learn that neither of us received anything. SO LET'S WORK TOGETHER AS A TEAM, ALWAYS CHECK WITH US, YOUR INSURANCE COMPANY AND THE PAYROLL COMPANY TO STAY ON TOP OF YOUR CASE, AS YOU AND YOUR AIDE AS THE MOST TO LOSE. In many cases we will have information, especially those who have PPL as your payroll company and we have full access to their system. Persons with Consumer Direct Care Network and Aces$, we do not have the same access to client information. If your authorizations has ended, it is the insurance company assigned (one of the aboved) to your case that has to put the authorization back in the system which updates the PAYROLL COMPANY'S who cuts checks. Normally, when authorizations run out, the insurance company is awaiting documentation from the Service Facilitator (to speed up the process, call the rep. assign to you and let them know as the insurance company may not have advised us yet). If there's a Medicaid issue, you may need to contact Medicaid to recertify your account which is normally required annually. (PPL is only the payroll company and does not know the status of one's authorizations, so please do not expect them to give you the correct information as they do not know the status of the insurance company and/or Service Facilitator's process on your account. Please find your insurance company and their phone number on your insurance card, which would be one of the companies listed above.
If your're having issues with PAYROLL... please contact your payroll company for more information. In most cases, if you as an attendant or a client's attendant hasnt been paid, there are no authorizations in their system. AUTHORIZATIONS are sent by the INSURANCE COMPANIES ONLY... we send visit documentation to the insurance companies and they are responsible for sending authorization (hours to be paid) to your payroll company. The payroll company has nothing to do with the authorizations... the only receive authorizations and follow directions to pay. Please find your payroll company's phone number on the folder left with you during your initial visit... or go to the PAYROLL tab on this website to get their number.
ALL REQUESTS FROM THE INSURANCE COMPANIES FOR DOCUMENTATION MUST BE SENT VIA FAX OR EMAIL... PHONE REQUESTS ARE NOT GUARANTEED AN IMMEDIATE RESPONSE... MOST REQUESTS ARE ANSWERED WITHIN 3 BUSINESS DAYS.
Many have asked how to change insurance companies so that we may take their cases, please note that we do not accept AETNA or UNITED. Please note that you can not opt in and/or out from one insurance company to another unless it's open enrollment, which is normally from October to December of each year. In special circumstances, you can call Commonwealth Coordinated Care Helpline at 1-844-374-9159 (TTY: 1-800-817-6608) Monday - Friday from 8:30a - 6:00p who will make the determination as to whether not your special circumstance warrants change.
If you're new to the Consumer Directed Services, you can change your insurance company within 30 - 90 days of the start of care date.
Guidelines can change at any given time... it is recommended to check out DMAS' Website first, then that of a particular insurance company or call the CCC Helpline.
Click on Logistacare Link above to go to their website.
Contact Numbers and Emails:
HOME VISIT REP. (Pending):
HOME VISIT REP./SF:
HOME VISIT REP.:
HOME VISIT REP./SF:
HOME VISIT REP./SF:
Office Hours w/Phone Coverage:
Mon. - Thurs.
9:00a - 2:00p
You'll reach our office assistant or routed to one of our members… if he/she is not available, please try again later as we all work in the field as well.
Home Visit Rep./SF:
Mon. - Fri.
9:00a - 6:00p
(If you know who your "Home Visit Rep./SF is, they're often available to you seven (7) days a week and outside normal business hours.)
Charlotte Comfort, Owner
Mon. - Thurs.
By Appointment Only