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OCTOBER 2023
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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.
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Colorado Department of Regulatory Agencies (DORA) Licenses Changes Licensure data issues by DORA for enrollments, revalidations, or maintenance request applications in the Department of Health Care Policy & Financing (HCPF) provider web portal previously had to be entered manually, which led to errors that increased application returns and processing times. Changes include automatic verification and
auto-population.
Learn more in the HCPF September 2023 provider bulletin.
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Gender-Affirming Care Policy UpdatesThis policy was updated on August 30, 2023, to align coverage with the most recent standards of care and allow members easier access to gender-affirming services. Learn more in the Gender-Affirming Care Billing Manual. If you have any questions, email Chris Lane at chris.lane@state.co.us.
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Share With Your Patients – Health First Colorado Listening SessionsHCPF is hosting listening sessions for Health First Colorado (Colorado’s Medicaid program) members and family members who are impacted by the criminal justice system. They want to hear about member experiences and gather feedback to help identify gaps in services and needs of this community. Staff members will ask questions about experiences enrolling in Health
First Colorado and using Health First Colorado benefits.
Read More >>
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National Institute of Mental Health (NIMNH) Spanish-Language Mental Health ResourceTo honor Hispanic Heritage Month (September 15th through October 15th), NIMH is highlighting Spanish-language mental health materials for patients, their families, health professionals, and the public. Click here to view the materials and order print versions for free.
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Verify Member EligibilityYou are required to verify member eligibility and the member's Managed Care Organization (MCO), if applicable, for each date of service, through the Provider Web Portal. Verification must be done within 365 days of the date of service. You may not bill the member if eligibility is not determined within this timeframe. Check the Provider Rates and Fee Schedule webpage before billing.
Read More >>
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Prescriber Tool Alternative Payment Model (APM)On October 2, 2023, a form was released where you can update your contact information and opt-out of the program. This information will be used to distribute provider-facing dashboards in December. You must participate in the program to access these dashboards. Opting out of this program means that you will not have a dashboard developed for you. If you opt-out, you will have the
opportunity to opt-in before the next program year starts.
Learn more here. You can also email hcpf_pharmacyapm@state.co.us to learn more.
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Certificate of Medical Necessiry (CMN) Changes for OxygenThe Medical Services Board (MSB) has removed the requirement for a CMN for long-term oxygen therapy. CMNs will not be required on long-term oxygen therapy claims with a date of service on or after October 30, 2023. If you have any questions, please email haylee.rodgers@state.co.us.
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Emergency Medicaid Services (EMS) BillingThe EMS benefit plan is limited and does not cover all services, but it does cover services necessary to treat an emergency medical condition, family planning services, and services related to family planning for people who qualify. To be reimbursed, claims must follow billing guidance from the Inpatient/Outpatient (IP/OP) Billing Manual and the Family Planning Benefit Expansion for Special Populations Billing Manual to indicate
that a covered service is intended for emergency or family planning purposes.
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New Resource for Providers Managing Chronic Pain TreatmentMany Home and Community-Based Services (HCBS) Health First Colorado members have not been able to get adequate pain management services. A new pilot program offers expanded pain consultation services and training to every primary care provider who wants support to manage chronic pain treatment for HCBS members.
Read More >>
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Free Chronic Pain Treatment TrainingsThe Chronic Pain Centers of Excellence will be providing two free one-hour virtual trainings for Health First Colorado primary care providers for managing chronic pain treatment. Included topic are risk factors, risk assessment, risk mitigation, screenings, and patient cases.
Read More >>
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Continuing Education CreditsRegistered Nurses and Advanced Practice Registered Nurses (ARPNs) – Nursing (Nursing Continuing Professional Development (NPCD) credit – will include pharmacology hours)
The University of Colorado College of Nursing is approved with distinction by the Colorado Nurses Association as a provider of nursing continuing professional development and an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. This offering for a maximum of 2.0 contract hours (2.0 pharmacology contact hours) is provided by the University of Colorado College of Nursing Office of Continuing Education.
Read More >>
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Speech Therapy and Prior Authorization Requests (PARs)On August 23, 2023, there was a speech therapy stakeholder engagement about the footnote in the 2023 long bill mandating 12 speech therapy sessions before prior authorization is required. This change will take effect in December 2023, and applies to services for both adults and children. A specific date will be announced later.
Read More >>
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Updated COVID-19 Vaccine CodesAs of September 11, 2023, COVID-19 vaccines are only reimbursable with these Common Procedural Terminology (CPT) product codes, and the corresponding administration code (90480):
91304
91318
91319
91320
91321
91322
Read More >>
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Get Higher Reimbursements for Providing Behavioral Health Services in Non-English LanguagesWe are excited to introduce a new program that will allow you to earn enhanced reimbursements for providing behavioral health services in non-English languages. Eligible outpatient providers can now bill a 10% increased rate on direct outpatient behavioral health services offered in a member’s identified language. Federally qualified health
centers, community mental health centers, and inpatient hospitals do not qualify for this incentive.
Read More >>
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Public Health Emergency (PHE) Unwind – Temporary ExtensionOn August 30, 2023, HCPF received new guidance from CMA that requires a change to the ex parte process for renewals. In the past, all members of a household that gets Health First Colorado or CHP+ benefits were reviewed at the same time through ex parte automatition, but CMS is now requiring ex parte automation reviews on an individual basis. This means that each person in the
household will now be reviewed and approved separately.
Read More >
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MOVEit Transfer Application Data BreachOn May 31, 2023, Progress Software found a problem with its MOVEit Transfer application. As a third-party vendor contracted with HCPF, IBM used MOVEit to move HCPF data files as part of the normal course of business. Progress Software publicly announced that the problem was the result of a cybersecurity incident that impacted more than 2,000 organizations around the world, including IBM. No
HCPF or State of Colorado systems were affected.
Read More >
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Provider-Carrier Disputes (Claim Appeal) Form UpdateWe have revised our provider-carrier dispute (claim appeal) form to add a request for additional information, such as an email address, to help us communicate claim determinations in a more timely manner. You can find the revised form on our website under the “Claims” heading.
For the fastest response time, please submit your provider-carrier dispute (claims appeal) on our provider portal. We will also accept submissions with the revised form by mail or email.
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Member SurveyWe conduct a biannual member survey to get feedback from members and better understand their experience, connect them to resources in real-time, and design improvements based on survey results. This survey is administered by our customer service team during routine member phone calls.
Our most recent member survey focused on how we can improve the member experience; explored how members self-describe their race, cultural, and ethnic identity without the limitations of typical demographic selection choices; and investigated how race and ethnicity affect their health care. Click here to read more about our survey results and methodology.
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