APRIL 2025

At Colorado Access, caring for you and your success is our top priority as you serve our members. This monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us.

Accountable Care Collaborative (ACC) Phase III Updates

Accountable Care Collaborative (ACC) Phase III will begin in July 2025, and we want to keep you informed on what you need to know. Please make sure to check this section each month for updates that may affect you. Stay updated about previously shared information from Colorado Access here.

• April 2025: The Department of Health Care Policy and Financing (HCPF) ACC Phase III webpage now has the contracts, organization names, and region map. To learn more about changes made from the request for proposal to the contract, view the presentation from the March Program Improvement Advisory Committee (PIAC) meeting here.

Thursday, April 17, 12:00 p.m.: Learn more about the upcoming Medical Home Payment Model that launches July 1, and get a breakdown of our payment structure. Register here.

Thursday, April 24, 2025 at 12:00 p.m.: Enhanced care partners (ECPs), please join us to learn more details about the ACC Phase III Payment Model. Register here.

If you have any questions or need more information, please email practice_support@coaccess.com.

Physical and Behavioral Health

State Behavioral Health Services (SBHS) Manual

The April 2025 version of the SBHS manual has been released. Read the new version here.

Revalidation Reminder: Name Matching

The name submitted during revalidation must be identical across the Application Tracking Number (ATN), provider documentation, and verification databases. ATNs will be denied if the name does not match across all documentation and verification databases. If you need to update a name, you must submit a maintenance request. After confirming that the name matches, then you can submit the revalidation application. Learn more here.

Health First Colorado (Colorado’s Medicaid program) Behavioral Health Updates Newsletter

The latest edition of the Health First Colorado Behavioral Health Updates newsletter is available here.

Pharmacy Benefit Management System (PBMS) Fall 2025 Transition

The Department of Health Care Policy & Financing (HCPF) is transitioning some parts of the PBMS from Prime Therapeutics (formerly Magellan) to MedImpact in fall 2025. What you need to know about this transition:

• The Opioid Risk module is not changing and will continue to be managed by OpiSafe.

• MedImpact will implement and manage four new PBMS modules:
  
  

  1. The core PBMS

  2. Rebate

  3. Preferred drug list

  4. Real-time benefit tool

• The Bank Identification Number/Processor Control Number (BIN/PCN) for the pharmacy claim submission will remain the same. Pharmacies will submit their claims as usual.

Contact information for the PBMS, including the call center phone number, fax number, and mailing address for paper claims, will change. HCPF will provide this information closer to the transition date.

News From HCPF

Child Health Plan Plus (CHP+) Transplant Benefit Update

CHP+ is low-cost health insurance for children and pregnant people whose households earn too much to quality for Health First Colorado, but not enough to pay for private health insurance. As of July 1, 2025, the maximum lifetime benefit for major organ transplants for one million dollars per member is being removed per a federal final rule. Learn more on the CHP+ webpage, and if you have any questions, please email hcpf_chpplus@state.co.us.

Health Care Common Procedure Coding System (HCPCS) Updates for 2025

The latest Special Provider Bulletin is now available here with information on HCPCS updates for 2025.

Medicaid Impact

HCPF is monitoring any potential changes in federal revenue reduction and budget cuts that may impact Medicaid, the state budget, and members, and will provide updates as necessary. As the U.S. Department of Health and Human Services (HHS) indicated they are rescinding the policy on Public Participation in Rule Making (Richardson Waiver), time for HCPF and the state to respond to federal rule, policy, and funding changes may be more challenging. Read more here.

Provider Call Center Transition

On May 1, 2025, Optum will officially take over management of the Provider Services Call Center. Please note that Gainwell will continue as the vendor for the Colorado interChange and the Provider Web Portal. The Care and Case Management (CCM), Dental, Pharmacy, and Electronic Visit Verification (EVV) call centers will not change. Learn more here.

Primary Care Alternative Payment Model Structure

HCPF is introducing an updated primary care alternative payment model for primary care medical providers (PCMPs) that integrates design elements that previously operated as separate programs managed by HCPF and the Regional Accountable Entities (RAEs). The new model simplifies the program while incorporating pediatric considerations, resulting in a singular, comprehensive primary care payment structure that aims to elevate the quality of primary care services provided to Health First Colorado members. Learn more here.

Virtual Education Sessions

HCPF is hosting Zoom education sessions on the new payment structure for PCMPs. Please pre-register for one or multiple sessions:

• Session 3: Primary Care Services Payments: Wednesday, April 23, 12:00 to 1:30 p.m.

• Session 4: Shared Savings: Wednesday, May 7, 12:00 to 1:30 p.m.

Presentation materials and recordings will be posted to their website. Topics may shift as needed, but any topic shifts will be communicated by email.

Upcoming Trainings

Neurology, Endocrinology, and Pediatric Psychology Trainings 

Extension for Community Health Outcomes (ECHO) Colorado is hosting multiple training sessions on various topics:

• Access to Neurology: Collaboration in Neurologic Care
  
  

  • Thursdays from 12:00 p.m. to 1:00 p.m. for 10 weeks from April 17 through June 19

  • Learn more and register here.

• Endocrine Explained
  
  

  • Tuesdays from 12:00 p.m. to 1:00 p.m. for 11 weeks from April 1 through June 10

  • Learn more and register here.

• Pediatric Psychiatry in Primary Care: Core Essentials
  
  

  • Thursday from 7:30 to 8:30 a.m. for seven weeks from March 20 through May 1

  • Learn more and register here.

• Navigating Complexities in youth Experiencing Suicidality in Primary Care
  
  

  • Tuesdays at 12:00 p.m. from May 6 through 20

  • Learn more and register here.

News from Colorado Access

Online Directory

Is your information correct in our online directory where members search for care? Please go to our online directory, search for yourself, and check that your data is accurate. Use the form at the top of the page to report any discrepancies, or email updates to providerdatamaintenance@coaccess.com.

Medical Home Payment Model

Our Medical Home Payment Model focuses on improving care coordination and patient outcomes by incentivizing providers to deliver comprehensive, patient-centered services. The model aligns with our mission to promote better outcomes for all members while ensuring providers are equipped to offer exceptional care. Learn more here.

Primary Care Medical Provider (PCMP) Learning Series Webinars

There are two upcoming PCMP Learning Series webinars:

• Thursday, April 17: Learn more about the Medical Home Payment Model that launches July 1, and get a breakdown of our payment structure. Register here.

• Thursday, April 24: Enhanced care partners (ECPs), please join us to learn more details about the ACC Phase III Payment Model. Register here.

Find previous learning sessions here. If you have any questions or need more information, please email practice_support@coaccess.com.

Notice of Material Change to Colorado Access Standard Behavioral Health Fee Schedule

Effective July 1, 2025, there will be a material change to the standard behavioral health fee schedule for billing codes H0038 (peer services) and H2014 (skills training). There were multiple reasons for this decision – to meet current market rates and align with HCPF’s fee schedule, as well as national trends. All affected providers have been notified of this change. While the impact of the House Budget Committee proposed federal spending reductions are unknown at this time, we are not planning any other reduction in provider reimbursement. Learn more on our Provider Portal, and if you have any questions, please email provider.contracting@coaccess.com.  

Yearly Benefit Renewals for Members Covered Through Cover All Coloradans

All members must renew their health benefits yearly, including members covered under Cover All Coloradans. Some of your patients covered under this program may not expect a renewal yet because they just converted from Emergency/Family Planning Medicaid to full Medicaid benefits in November 2024. However, their renewal date is based on the date they were first eligible for Emergency/Family Planning Medicaid benefits. For example, if they first qualified for benefits in April 2024, they need to renew in April 2025, even though they converted to full Medicaid benefits in November 2024. If you have any questions, please call our customer service team at 800-511-5010. Learn more here.