FEBRUARY 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:

Accountable Care Collaborative Phase III Education Sessions for Primary Care Medical Providers

With Accountable Care Collaborative (ACC) Phase III, many changes are coming to improve care access for members, the member and provider service experience, and cost management to protect member coverage, benefits, and provider reimbursements.

You’re invited to two more sessions on Wednesdays from 12:00 p.m. to 1:00 p.m. to help prepare you for these upcoming changes. At each session, you will receive key updates and have an opportunity to ask questions. Topics may change as more information from the Department of Health Care Policy and Financing (HCPF) is available.

Wednesday, February 26 (For enhanced clinical partners (ECPs) only): Learn more about care coordination expectations in ACC Phase lll. Register here.

Wednesday, March 12: Learn more about quality payments and quality measures in ACC Phase III. Register here.

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

Stay updated about previously shared information regarding ACC Phase III from Colorado Access here.

Physical and Behavioral Health

End Date for Allowing First Position Modifiers on Claims

HCPF had issued guidance on removing all required first position modifiers to indicate State Plan or "B3" services in the State Behavioral Health Services (SBHS) Billing Manual, as of January 1, 2024. HCPF, RAEs, and Denver Health Medicaid Choice (DHMC) have allowed these modifiers on claims while providers updated electronic health records (EHRs), billing systems, and other workflows, but claims for services provided on or after January 1, 2025, that include State Plan or “B3” modifiers shall be denied by RAEs. EHRs and billing systems should reflect correct coding as detailed in the SBHS Billing Manual.

If you have any questions, please email your program specialist and copy hcpf_bhcoding@state.co.us.

Coordination of Benefits

Some Health First Colorado members may also have Medicare, private insurance, or other insurance. When a member has more than one type of coverage:

• Be sure you are in both networks before you provide services. You cannot bill Health First Colorado without first billing the primary payer.

• Verify both Medicaid and other coverage in the Medicaid Provider Portal.

• If you get paid by Health First Colorado or CHP+ before learning of the primary coverage, immediately bill the primary payer. When you receive payment from the primary payer, return the Health First Colorado payment and resubmit the bill as a secondary payment.

• You cannot bill a Health First Colorado member for any service covered by Health First Colorado, even if the member agrees to pay. You can bill Health First Colorado members only if a service is not covered by Health First Colorado.

Learn more in HCPF’s guidance on coordination of benefits.

Billing Tips

• For professional providers: When billing your professional services, please do not list any credentials (i.e. LPC, PhD, LCSW, LMFT, MA, etc.) in the first name or last name fields for the rendering provider, as this will cause a denial and/or a delay in payment.

• For facility providers: When billing NDC codes, please ensure that you are billing complete and valid codes to ensure your claim is not rejected and or denied.

Revalidation Dates

If you miss your revalidation date, you can revalidate up to six months after. You can find your revalidation date on the provider revalidation spreadsheet on the revalidation webpage. Use the Provider Web Portal to revalidate; do not start a new enrollment application.

Commemorative Card Series

To celebrate the upcoming 2026 celebration of the 250th anniversary of America and the 150th anniversary of Colorado, the Behavioral Health Administration (BHA) and its Recovery Cards Project will be releasing a commemorative card series focused on recovery and mental health well-being. Up to six artists will be selected and compensated for their time and effort. Interested artists can apply here by Wednesday, February 26, 2025. Please share this opportunity with your network! If you have any questions, please send an email to cdhs_bha_outreach@state.co.us.

Prescriber Tool Alternative Payment Model (APM) Update

The Prescriber Tool APM is an upside-risk-only program designed to incentivize increased and consistent use of the Prescriber Tool by Health First Colorado providers receiving fee-for-service payments for their outpatient pharmaceutical claims, specifically the Real-Time Benefits Inquiry (RTBI) module, and prescription of preferred medications where clinically appropriate. Program year two for the Prescriber Tool APM began in October 2024; the activity window began in January 2025. If you were eligible for this program, you should have received an email in mid-January 2025 with a link to complete the required activities and be eligible for payment. Learn more on their webpage. If you have any questions, please email hcpf_pharmacyapm@state.co.us.

Affidavit of Lawful Presence Update

As of February 1, 2025, a sworn statement of lawful presence is no longer required for newly enrolling direct-pay individuals. This includes all provider types in the billing individual enrollment type and enrollments through the social security number (SSN) in the atypical enrollment type. Organizations using the federal employer identification number (FEIN) are not affected by this change. Individuals within a group and ordering, prescribing and referring (OPR) provider are not direct-pay individuals and are also not affected by this change.

Provider Services Call Center Vendor Transition

The Health First Colorado Provider Services Call Center will transition from Gainwell to OptumInsight (Optum) on May 1, 2025. Learn more here.

New Criteria for Pediatric Behavioral Therapies

New criteria were posted after working with the pediatric behavioral therapy provider community that aims to ensure evidence-based, high-quality care for children and youth who require behavioral interventions. Learn more here.

Colorado Medicaid eConsult Update

Health First Colorado providers have access to a free, secure statewide eConsult platform that allows primary care medical providers (PCMPs) to communicate electronically with specialty providers and can often eliminate the need for in-person member referrals. 20 adult specialties and 16 pediatric specialties are available:

• Adult: Addiction medicine, allergy and immunology, cardiology, dermatology, endocrinology, gastroenterology, geriatric medicine, obstetrics and gynecology, hematology/oncology, hepatology, infectious disease, nephrology, neurology, orthopedics, otolaryngology (ENT), pain medicine, physical medicine/rehabilitation, psychiatry, pulmonology/sleep medicine, rheumatology, and urology.

•  Pediatric: Allergy and immunology, cardiology, dermatology, developmental pediatrics, endocrinology, gastroenterology, hematology/oncology, infectious disease, nephrology, neurology, orthopedics, otolaryngology (ENT), psychiatry, pulmonology, rheumatology, urology.

• Adult obstetrics and gynecology specialists are available to respond to eConsults for adult and adolescent patients 14 and older.

Complete the practice enrollment form or register for a monthly webinar to begin the enrollment process, and if you have any questions, send an email to coloradosupport@safetynetconnect.com.

News From HCPF

Cover All Coloradans – Expanding Health Coverage for Children and Pregnant People

Beginning January 1, 2025, under Cover All Coloradans, Health First Colorado and CHP+ now offers health coverage to children under 18 and pregnant people, regardless of their immigration status. This new initiative aims to improve health access and equity by providing free health insurance for eligible individuals who may have previously lacked coverage. These members have access to full Health First Colorado and CHP+ benefits and may seek services from providers with no action required from you.

Cover All Coloradans was established through House Bill HB22-1289 and recognizes the importance of accessible health care for all Coloradans, supporting healthier communities by offering affordable coverage to those who might otherwise be excluded. These members have access to full Health First Colorado and CHP+ benefits and may seek services from providers without additional action needed by those providers.

Program Details

• Groups who may qualify and should apply, no matter their immigration status:
  
  

  • Children age 18 and younger

  • Pregnant people

  • People whose pregnancy ends on or after January 1, 2025

• Coverage begins January 1, 2025

• Enrollment is open year-round with no cap on enrollment

• Income requirements are based on family size, standard eligibility criteria apply

Frequently Asked Questions

What does this mean for providers?

There will be no change to processes for eligibility checks or submitting claims, but there may be a potential increase in patients seeking services who do not speak English well or at all. Section 1557 of the Affordable Care Act (ACA) requires health care providers who receive federal funding to provide limited English proficiency (LEP) patients with a qualified interpreter.

Is billing for members with Cover All Coloradans eligibility different than billing for other members?

No, you do not need to do anything different when seeing these members.

Do providers have to see members eligible under Cover All Coloradans?

Yes, the Provider Participation Agreement, nondiscrimination section 3.4, represents this newly eligible population.

How will this expansion of eligibility affect providers?

You may see an increase in members seeking services and an increase in members who speak English as a second language or do not speak English at all.

We can assist with interpretation services. Please call us at 800-511-5010.

How can I help?

As a trusted provider, you play a critical role in informing eligible patients about this coverage expansion. By raising awareness and helping patients navigate enrollment, you contribute to improving health outcomes and reducing barriers to care within your community.

Learn more here. If you have any questions, please email hcpf_coverallco@state.co.us.

Improving Intensive Behavioral Health Services

HCPF has launched a new Medicaid System of Care (M-SOC) intiative to improve the health and well-being of children and youth under age 21. M-SOC is based on an evidence-based, systemic framework and aims to provide comprehensive, coordinated care for children and families to ensure that intensive services are delivered in an effective, supportive, and family-centered manner. Learn more here.

Working Adults with Disabilities Meetings

The Health First Colorado Buy-In Program for Working Adults with Disabilities allows adults with a qualifying disability "buy into" Health First Colorado, even if they work and earn too much to qualify for Health First Colorado. HCPF is hosting a virtual meeting on two different dates about updates being made to this program effective July 1, 2025. These changes will specifically impact Health First Colorado members who receive services through home and community-based services (HCBS) waivers.

• Register here for Thursday, February 20, 2025, from 11:00 a.m. to 12:00 p.m.

• Register here for Thursday, March 13, 2025, from 1:00 p.m. to 2:00 p.m.

You can also request a recording of the meeting by emailing Kyra Acuna at hcpf_stakeholders@state.co.us.

Auxiliary aids and services for individuals with disabilities and language services for individuals whose first language is not English may be provided upon request. Email Kyra Acuna at HCPF_stakeholders@state.co.us at least one week before the meeting to request accommodations.

Potential Direct Provider Payment

HCPF plans to implement a direct provider payment for Home and Community-Based Services (HCBS) under the American Rescue Plan Act (ARPA), pending approval from the Joint Budget Committee (JBC). ARPA has provided funding to states to enhance HCBS programs and services. This funding can be used to supplement existing efforts without replacing current spending on HCBS. Since 2021, HCPF has been working on 61 initiatives in line with these requirements, and all ARPA spending is scheduled to conclude by March 31, 2025. Learn more here.

What this means for you: To receive this payment, all provider claims dated July 1, 2024, through December 31, 2024, must be submitted no later than February 28, 2025. This claims data will be used to determine the provider payment equivalent to the retroactive increase for eligible services. You should not need to rebill to receive this payment, but you can only receive the enhanced rate if you submit your claims by February 28, 2025.

New From Colorado Access

Language Interpretation Services

We offer language interpretation services, including American Sign Language (ASL), for our members’ appointments. To request an interpreter, please go to coaccess.com/interpreterrequest or call us at 800-511-5010. TTY users can call 888-803-4494. We require four business days advance notice to schedule an interpreter, and two business days advance notice to cancel a scheduled interpreter.

Upcoming Trainings

Family Engagement Strategies for Early Autism Intervention

Extension for Community Health Outcomes (ECHO) Colorado is hosting a series of eight sessions aimed at supporting interventionists who work with young children (from birth through kindergarten) diagnosed with or showing signs of autism spectrum disorder. The series runs from February 26 to April 16, 2025, and will place a strong emphasis on helping families implement these strategies in their daily lives. To register, click here.

Colorado Prior Authorization Request Program (ColoradoPAR) Training

Acentra Health is offering benefit-specific PAR submission training on how to submit a PAR using their provider portal, Atrezzo®. Learn more and register for a session here. If you have any questions, please email coproviderissue@acentra.com.