 |
|
|
|
NOVEMBER 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. |
Accountable Care Collaborative (ACC) Phase III Updates
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:
Stay updated about previously shared information from Colorado Access here. |
|
Mental Health/Substance Use Disorder (SUD) |
|
|
988 Colorado Mental Health Line
The Colorado Behavioral Health Administration (BHA) and 988 Crisis Hotline Enterprise have launched a campaign to promote the 988 Colorado Mental Health Line. The crisis line connects callers to trained crisis specialists who offer mental health, emotional, and substance use support through calls, texts, and chats.
Although the state is transitioning from Colorado Crisis Services to 988, the same contact center manages both services, and the walk-in centers will not be impacted. Colorado Crisis Services will continue to be available.
Learn more on the new 988 website. If you have questions, read the 988 frequently asked questions or email the BHA and 988 board team at 988colorado@state.co.us. |
End Date for Allowing First Position Modifiers on Claims
The Department of Health Care Policy and Financing (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 include hcpf_bhcoding@state.co.us on that email. |
Increasing Access to Supportive Housing Services
HCPF has a distinct billable pathway to supportive housing providers to support expanding these services. The coding pages in the SBHS Billing Manual for H0043 (supportive housing, per diem) and H0044 (supportive housing per month) have been revised to reflect the scope of the benefit. To qualify for full reimbursement of these codes, you must get a letter from the Colorado Department of Local Affairs Division of Housing (DOLA/DOH), which identifies your agency as a supportive housing provider overseeing an allocation of supportive housing resources/vouchers. You should also enroll as a supportive housing provider (provider type 89 – community support services provider with specialty 208 – supportive housing provider). Learn more here. |
Implementation Support for Medication Use Disorder (ISM)
Implementation Support for MOUD (ISM), run by the University of Colorado Anschutz, can help your practice increase patient access to MOUD and become more confident in treating substance use. ISM includes nine months of practice facilitation support, a toolkit with editable documents, access to an addiction-trained subject matter expert, and $9000 compensation for time to develop a substance use program. They are looking for practices who have prescribed MOUD to four or fewer patients in the last three months. Learn more here. |
Perinatal Substance Use Disorder (SUD) Community Conversation
Join HCPF and other guest speakers on Friday, November 22, from 8:00 a.m. to 12:00 p.m. for a free Zoom conference. Health First Colorado (Colorado’s Medicaid program) providers, advocates, and those who provide integrated care for pregnant and postpartum people with SUD are encouraged to attend. Learn more and register here. |
Physical Health
|
|
|
Free COVID-19 Tests
Households across the U.S. can order up to four more free COVID-19 tests from the federal government. Read more here and request tests now from covidtests.org. |
Updated COVID-19 Vaccines
The Centers for Disease Control and Prevention (CDC) recommends that everyone six months old and older get an updated COVID-19 vaccine. This year, multiple options from Moderna and Pfizer target the KP.2 variant, which has been dominant in the U.S. since May. A Novavax vaccine is also available, but it targets JN.1, which has been circulating at lesser rates than a few months ago. |
COVID-19 Reimbursement Rates
The COVID-19 vaccine administration rate changed for dates of service on or after October 1, 2024. The vaccine will be reimbursed at the same rate as all other vaccines. The Current Procedural Terminology (CPT) code 90480 reimbursement rate will change to $21.17.
All vaccine reimbursement rates were updated on July 1, 2024. Click here to read the immunization fee schedule.
Coverage and rates are the same for Child Health Plan Plus (CHP+) members.
If you have any questions about vaccine policy, email Christina Winship at christina.winship@state.co.us. For help with claims and billing, contact the Provider Services Call Center. |
For Clinic Practitioners – Provider Type 16 – Claims with Certain Procedure Codes Paying Incorrect Rates
Claims billed with procedure codes 51725, 51736, 51741, 51785, 51792, 54240, 54250, 59020, and 62252 have modifier-specific rates on the fee schedule for modifiers TC and 26. These claims are paying incorrect global rates even when these modifiers for the professional or technical component are present. Affected claims will be reprocessed. |
News From HCPF |
|
|
Colorado Medicaid eConsult Update
All Health First Colorado providers can access a free and secure statewide electronic consultation (eConsult) platform through coloradomedicaideconsult.com. eConsults frequently eliminate the need for in-person member referrals by allowing primary care medical providers (PCMPs) to communicate electronically with specialty providers. A policy update from HCPF is coming to allow for specialty-to-specialty eConsults.
More Information
|
Doing Business As (DBA) Name Field in the Provider Web Portal
The provider web portal will display the DBA name field for Atypical, Billing Individual (BI), Facility, and Group enrollment types. During revalidation and maintenance requests, you will be able to view and update the DBA name for a service location. If you want to update a DBA name, please use the DBA Name Change Form. DBA names are not required. |
For Clinic Practitioners and SUD Clinics – Non-Emergent Medical Transport (NEMT) Information
NEMT is a Health First Colorado benefit for members who don’t have transportation to Medicaid-covered medical appointments. Health First Colorado covers rides for eligible individuals to and from their nearest doctor’s office, hospital, or other medical office for approved care. NEMT drivers can give members, or their eligible family members, a ride under the following conditions:
-
Only take members to the appointment and then home
-
Always take the most direct route to the appointment and back home
-
Never offer members money or other incentives
As a Health First Colorado provider, you can help protect members by reporting suspicious activity by NEMT drivers, including:
-
Rides of more than 25 miles
-
Multiple members being transported in the same vehicle
-
Members being offered money or other incentives
-
NEMT providers, drivers, or companies contacting health care providers for member names, IDs, or patient referrals to use their transportation service
If a driver does something they should not, please contact Health First Colorado or the Attorney General’s Office:
Names and personal information will be kept confidential when reporting suspected provider fraud. |
Billing Health First Colorado Members for Services
Colorado law (C.R.S. § 25.5-4-301) states that no Health First Colorado member shall be liable to the cost of a covered service except for the Health First Colorado copay (if applicable). This requirement applies regardless of whether Health First Colorado has reimbursed the provider, claims are denied by Health First Colorado due to provider error, or the provider is enrolled with Health First Colorado. This requirement also applies even if a member agrees to pay for part or all of a covered service.
You may only collect payment from a Health First Colorado member if the service or medication is not covered by Health First Colorado. In this case, before charging a member for uncovered services, you must enter into a documented and written agreement with the member under which they agree to pay for services that are not covered. Members cannot lose Health First Colorado coverage if they choose to pay out-of-pocket for services, whether or not they are covered.
Learn more here. If you have any questions, email Korri Conilogue at korri.conilogue@state.co.us. |
Cover All Coloradans – Expanding Health Coverage for Children and Pregnant People
Beginning January 1, 2025, under Cover All Coloradans, Health First Colorado and CHP+ will offer 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.
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 will 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:
-
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
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 help 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 increasing awareness and helping patients navigate enrollment, you contribute to improving health outcomes and reducing barriers to care within your community.
Learn more here. |
Training Opportunities |
|
|
Resources for Behavioral Health Providers
The new HCPF training library page has recordings of live training, links to pre-recorded training, and slides from each training. HCPF also has monthly office hours during which you can ask experts your questions. Learn more here. |
New From Colorado Access |
|
|
New Care Management Digital Referral Form
The Colorado Access care management team has a new digital referral form that will allow you to submit a referral for care management services online and help us serve our members faster. You can find the new form at caremanagementreferral.coaccess.com. Learn more about the form here. |
New Renewal Digital Engagement Program
On October 1, 2024, we launched a new digital engagement program to help eligible members keep their Health First Colorado or Child Health Plan Plus (CHP+) coverage and prevent them from losing their benefits or having a gap in services. The program includes a one-time automated phone call reminding members that their renewal deadline is approaching and gives directions on submitting their renewal packet. Members who cannot be properly integrated into the automated call program are sent a direct mailer with the same information.
If Colorado Access members have questions about their renewal, please direct them to healthfirstcolorado.com/renewals and co.gov/peak. |
Upcoming Flu/Respiratory Digital Engagement Program
This program, which runs from October to February, informs Health First Colorado and CHP+ members about the flu, including tips on flu prevention and reminders that flu, respiratory syncytial virus (RSV), and COVID-19 all have the same peak season. |
Checking Credentialing Status
You can now check the status of those approved for credentialing at your clinic. Log into the provider portal and click “Reports” to get a list of credentialed providers under the clinic tax ID number and the approval/effective date. If you have any questions about credentialing, please email credentialing@coaccess.com. |
Health Care News Highlights |
|
|
|
|
