JULY 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.

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. 

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.

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. If you need help with claims and billing, contact the Provider Services Call Center.

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 to test. 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 pregnant members.

Access to Care Standards

We uphold and monitor Access to Care Standards for physical and behavioral health services to ensure members have timely and appropriate routine and urgent services available. If you are unable to provide an appointment within the required timeframes, please have the member call our customer service team at 800-511-5010 so we can help. If you have questions about Access to Care Standards, please email qualitymanagement@coaccess.com.

Primary Care Medical Provider (PCMP) Network Feedback

We have several upcoming opportunities for the primary care medical provider (PCMP) network to share feedback on the administrative payment models under ACC Phase III. We will review HCPF-identified priority areas, provide comprehensive overviews of potential metrics, discuss complex member populations and care coordination objectives, and encourage you to share your insights and suggestions.

All sessions will be held from 12:00 p.m. to 1:30 p.m. online:

• Pediatric focus: Thursday, August 15, and Thursday, August 29

• Adult focus: Wednesday, September 11 and Thursday, September 26

• Reproductive health focus: Tuesday, October 15 and Wednesday, October 30

We recommend that family medicine providers attend both the pediatric and adult sessions.

Your feedback and insights help us refine these models to ensure alignment with our regional goals. Click here to register. If you have any questions, please contact our payment reform team.

Access to Care Standards

We uphold and monitor Access to Care Standards for physical and behavioral health services to ensure members have timely and appropriate routine and urgent services available. If you are unable to provide an appointment within the required timeframes, please have the member call our customer service team at 800-511-5010 so we can help. If you have questions about Access to Care Standards, please email qualitymanagement@coaccess.com.

Senate Bill 21-137 

Under Senate Bill (SB) 21-137, effective July 1, 2023, members and providers can request a second medical necessity review for residential or inpatient substance use disorder (SUD) services after losing an appeal for denied or reduced services. To request a review:

• Providers: Complete the SUD request form on the ColoradoPAR portal.

• Members: Contact Health First Colorado directly. Members will need a provider to agree to request the secondary review. If a member lists you as their requesting provider, Health First Colorado will contact you to confirm your agreement.

Learn more here.

State Behavioral Health Services Billing Manual Updates

HCPF updates the State Behavioral Health Services (SBHS) Billing Manual each quarter. The latest version was released on July 1, 2024. A Manual Tracking Form on the site outlines the changes made and why they were made. Please review the form to see if the changes apply to your practice.

Audit Plan

Each Regional Accountable Entity (RAE) is contractually required to develop an audit plan every state fiscal year (SFY). For SFY 2024-2025, we will focus on specific codes and service categories including, but not limited to, H0038, H0020, H2014, use of HO modifier and unlicensed practitioners, and services provided via telehealth, as well as any additional ad hoc audits. We encourage you to develop your own internal audit system. Thank you for your collaboration in providing quality care to our members!

Learn more here.

Coverage Enrollment Window Extended

The Colorado Division of Insurance (DOI) has extended the enrollment window for people who are no longer eligible for Health First Colorado coverage after the end of the COVID-19 public health emergency (PHE) to November 30.

HealthX Portal Change

Some providers have reported reimbursement issues for members who are dually eligible for Medicare and Medicaid. Please check the eligibility portal for additional health care coverage information before scheduling appointments with new members to help avoid reimbursement issues and ensure continuity of care for members.

Behavioral Health Provider Training Opportunities

HCPF will hold a live office hour for behavioral health providers on Friday, July 26, at noon. Register here.

They also have recorded trainings on their HCPF Safety Net Providers landing page that focus on expanding benefits and services, improving access to care, and elevating quality.

Arapahoe County Vital Records

The Arapahoe County Public Health's Vital Records program issues birth and death certificates for any birth or death in the state of Colorado. They have one location in Greenwood Village and are opening a second office in Aurora to further reduce barriers to accessing services. Read more here.

New Covered Benefit – Doula Services

HCPF has added coverage for doula services for pregnant Health First Colorado members. Doulas are non-clinical trained professionals who can provide emotional, physical, and informational support and guidance before, during, and after childbirth. This new benefit enhances access to care for Health First Colorado members, aims to improve birth-related outcomes, and helps close health disparities. Health First Colorado covers 40% of births across Colorado so that this coverage will help many people.

Health First Colorado will cover services provided by doulas who practice independently and those who work in health care facilities and group practices. HCPF is actively enrolling doulas to support this new benefit.

PHE Unwind Updates

April 2024 was the last month of Colorado's 12-month Medicaid continuous coverage unwind program. HCPF has published renewal reports, and a summary is here.

HCPF has temporarily paused terminations for all reasons for Long-Term Services and Supports (LTSS) members for two months past the member's original termination date unless the termination is for a member who has moved out of Colorado or has passed away. This change will remain in effect until at least December 2024. It replaces the 60-day extension for the renewal period for Long-Term Care (LTC), individuals with Home and Community-Based Services (HCBS), and Buy-In recipients who have yet to return their renewal packet on time.

Ensuring that LTSS members maintain their coverage is a top priority for HCPF, and they are urging the Centers for Medicare & Medicaid Services (CMS) to make temporary waivers that impact LTSS members permanent.