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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.
New Claims System Update
We have noticed a claims trend where providers are billing a mismatched NPI/TIN combination when billing their claims and/or missing a rendering provider. Our new claims system is better equipped to catch this billing error. For this circumstance, claims are being denied appropriately per billing standards. These claims can be corrected and resubmitted for payment. If you have questions about this or have other claims issues, please contact your provider network services manager. Click here to learn how to resubmit a corrected claim.
You can also learn more on our provider learning management system (LMS).
Public Health Emergency (PHE) Update
Under the recently-passed FY 2023 Omnibus Bill, the COVID-19 PHE does not end, and is now separate from continuous Medicaid coverage. Continuous Medicaid coverage will end on March 31, 2023.
The Department of Health Care Policy and Financing (HCPF) will take the entire 14 months (including noticing) allowed for renewals. New federal poverty levels will be active starting in May, so members that are renewed in May will be renewed under these new levels.
As more updates become available, we will continue to share what this means for you.
New Provider Reporting Tool
We have a new form on our website for members, providers, or staff to report issues finding providers, including missing or incorrect provider information, appointment or service access issues. The form is in the “Find a Provider” section of our website.
We value your input. This anonymous form will help us make sure that our network can serve our members. If you have any questions about the form, please call us at 866-833-5717.
Provider Services Call Center Update
When you call the HCPF provider services call center, you will need to give your Health First Colorado (Colorado’s Medicaid program) provider ID (Medicaid location ID) and, when applicable, your National Provider Identification (NPI) to discuss any protected health information (PHI), like eligibility verification or claims. Make sure that any billing companies you use have both the NPI and your specific provider ID for each location and provider type.
Health First Colorado Member Rights to Timely Access to Behavioral Health Services
All Health First Colorado members have the right to get services in a timely and coordinated manner. If a provider is unable to offer medically necessary behavioral health services to a member within seven days, the provider should educate the member on their right to get services in a timely manner, and either:
- Refer the member to their Regional Accountable Entity (RAE) for access and service coordination. This is not considered a “dismissal” or “termination” of a member, and the fee-for-service dismissal policy does not apply to timely access issues. Health First Colorado managed care contracts specify what the RAE duties are in responding to wait time issues and taking the necessary actions to ensure that all covered behavioral health and substance use disorder services are given to members with “reasonable promptness.”
- Each RAE must ensure that their network is sufficient so that members are given non-urgent, symptomatic behavioral health services within seven days of a member’s request.
- Schedule an appointment outside of the seven-day timeframe, based on the member’s right to choose a provider, and the member’s consent. When the member exercises their right to wait for services from a provider they choose, provision of service delivery is allowable.
If you have any questions about this, please contact the member’s RAE. Click here to view contact information for the seven RAEs in Colorado.
Benefit Update: Multi-User Breast Pump Loaner
As of January 1, 2023, when billing for multi-user breast pumps, use procedure code E0604 with modifier RR.
The multi-user breast pump is a continuous rental item that will not be converted to purchase. It may be rented for up to two years. Prior authorization requests (PARs) are required for this item. Prescriptions should include information on why the member cannot use a single-user pump. You are also required to supply members you prescribe this item to the necessary material and training on appropriate cleaning, storage, and use.
There must also be a single-user collection kit specifically made for the corresponding pump given to each user. This is not billed separately. If the users need additional accessories and supplies during the usage period, including replacement parts, this should not be billed separately; this is inclusive of the monthly rate.
The Food and Drug Administration (FDA) must approve all rented pumps as a multi-user breast pump. Electric and manual single-user breast pumps are still a covered benefit, and do not need PARs.
Members may get a breast pump as early as their 28th week of pregnancy. Deliveries prior to 28 weeks qualify for a breast pump immediately following the birth (per Early and Periodic Screening, Diagnostic and Treatment (EPSDT) policy).
If you have any questions, please email Haylee Rodgers at haylee.rodgers@state.co.us.
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