MAY 2024

At Colorado Access, we are committed to caring for you and your success as you serve our members. Our monthly Provider Update highlights essential information and resources to support you as a contracted provider with us.

We will not send a Provider Update in June; our next edition will be in July.

Behavioral Health Policy Changes Coming July 1, 2024

The Department of Health Care Policy and Financing (HCPF) is adding new coverage as of July 1, 2024, including health diagnosis codes for substance use disorder (SUD) and mental health, as well as supportive housing services. Read more here.

Contract Amendments for State Fiscal Year (SFY) 2024-2025

Regional Accountable Entity (RAE) primary care medical provider (PCMP) contract amendments for SFY 2024-2025 will be sent out this week, the week of May 13. They must be electronically signed and returned to us by June 30, 2024, to avoid forfeiture of funds for the months the amendment is not executed.

Peer Services Documentation Standards Education Training

We are excited to announce a new training focused on documentation standards for peer services. This training must be completed by a licensed provider and/or peer supervisor within your organization. It can be downloaded and shared with other peer staff at routine trainings. Only one person from your organization should enroll in the course on our Learning Management System. Click here to complete the enrollment form.

Checking Credentialing Status

You can now check the status of those approved for credentialing at your clinic. When you log into the provider portal, click "Reports." You will find a report at the bottom of the page with a list of credentialed providers under the clinic tax ID number and the approval/effective date. If you have any questions about credentials, please email credentialing@coaccess.com. 

Medicare Opt-Out

Newly-eligible licensed marriage and family therapists (LMFTs), licensed professional counselors (LPCs), and licensed addiction counselors (LACs) were able to enroll in Medicare as of November 1, 2023, and could start billing Medicare as of January 1, 2024. Behavioral health services provided to Medicare members by these practitioners will no longer be allowed to use the HO modifier on claims submitted to the Regional Accountable Entities (RAEs) as of April 1, 2024, and will be required to file claims with Medicare first when Medicare covers the service.

Practitioners eligible for Medicare cannot opt out of Medicare if they choose to serve members enrolled in Medicare and Health First Colorado (Colorado's Medicaid Program). The HO modifier can be used only on claims submitted directly to an RAE without a Medicare denial when an enrolled Medicare provider supervises an unlicensed behavioral health practitioner.

Referring National Provider Identifier (NPI) Listing

Claims are suspending or denying for some provider types if a valid NPI is not listed. Learn more here.

Disenrollment Due to Missing Revalidation

To remain an active provider, you must revalidate with Health First Colorado at least every five years. You will be emailed instructions six months before the revalidation date. If you failed to revalidate by the deadline in 2023, you were disenrolled starting May 1, 2024.

Covered Benefits

For Immunization Providers: Code 90611

Common Procedural Terminology (CPT) code 90611 is now a covered benefit for members age 18 and older, effective for dates of service on or after April 1, 2024. Claims previously submitted will be reprocessed. Click here for more information on coverage, rates, and age ranges for Health First Colorado and CHP+ immunizations.

If you have any questions about the vaccine policy, please email Christina Winship at christina.winship@state.co.us. Contact the provider services call center if you need help with claims and billing.

For Laboratory Service Providers: Testing for Sexually Transmitted Infections (STI)

STI laboratory testing is a covered benefit without limitations under Health First Colorado. Click here to learn more.

If you have any questions, please email Sarah Kaslow at sarah.kaslow@state.co.us.

Public Health Order: Syphilis Testing During Pregnancy

The Colorado Department of Public Health and Environment (CDPHE) has issued a statewide public health order after reports of cases of congenital syphilis tripling in the United States and more than quadrupling in Colorado over the past five years. Public Health Order 24-01, issued on April 25, 2024, addresses the growing need to expand access and identify recommended measures for syphilis testing during pregnancy and directs that medical providers offer testing at all health care facilities. Licensed medical professionals must evaluate and treat pregnant people and offer them syphilis testing unless a documented syphilis test has already occurred that meets the testing requirements or if the patient declines testing. Testing must be offered:

• At the initial prenatal visit or during the first trimester of pregnancy (one to 12 weeks gestational age)

• During the third trimester of pregnancy (28 to 32 weeks gestational age)

• At the time of delivery

• When there is a fetal death after 20 weeks gestational age

• When a pregnant patient goes to an emergency room or urgent care center at the intervals or events listed above

• At a correctional facility (prison, jail, or juvenile detention center) at the intervals or events listed above

This public health order intends to ensure that syphilis testing is offered by all Colorado health care providers, including Health First Colorado providers who provide care to members who are pregnant.