Provider Update from Colorado Access

New Claims System

We are changing our claims system to HealthRules Payor (HRP) on November 1, 2022. This new system will make claims processing more efficient. As part of this change, we are working with PNC Healthcare to provide new electronic payment methods through their Claim Payments & Remittances (CPR) service, powered by Echo Health, with dates of service starting November 1, 2022. With the CPR service, you’ll be able to log into a website to see a detailed explanation of payment (EOP) for each transaction with any dates of service of November 1, 2022 and after. Transactions with dates of service October 31, 2022 and earlier can be accessed on the Change Healthcare website.

We do not anticipate any disruptions in payments. You will continue to receive payments from Change Healthcare as you currently do for dates of service prior to November 1, 2022.

What You Need to Do Now
You need to select your payment preference. If you have questions about this, please email provider network services at providernetworkservices@coaccess.com.

What You Need to Know

Electronic claims: There will be no changes to how you submit electronic claims today, but we recommend submitting your October and November claims separately.

Paper claims: There will be a new P.O. Box where you can submit paper claims. Starting with claims with a date of service of November 1, 2022 or later, please send these paper claims to:

Before November 1, 2022:
Colorado Access
PO Box 17470
Denver, CO 80217-0470
Starting November 1, 2022:
Colorado Access
P.O. Box 240389
Apple Valley, MN 551247

You will receive two weekly payments.

One payment for claims will be processed by our current system, QNXT, for dates of service before November 1, 2022. We are doing a six-month claims runout in QNXT. Change Healthcare will continue to provide payments during this runout period for dates of service before November 1, 2022.
One payment for claims processed in our new system, HRC, will be delivered by PNC Bank for dates of service on and after November 1, 2022. Claims payment processing for dates of service after November 1, 2022 will take additional time.

We will send you an email, fax, or letter later this month requesting that you choose your preferred payment method (check, direct deposit to a bank account, etc.). If you are already enrolled in “All Payer Access” through Echo, you do not need to do anything and you will not receive any additional communication.

Before the go-live date of November 1, 2022, your provider network services representative will introduce you to a new provider payment portal. If you do not have a provider network services representative, please email providernetworkservices@coaccess.com.

Please use the member’s state ID when submitting claims for services provided to Colorado Access Child Health Plan Plus (CHP+) or Health First Colorado (Colorado’s Medicaid program) members.

- The member’s state ID should include one letter and six numbers. For example, X123456.

We will continue to provide you with updates through the Navigator newsletter, regular monthly Provider Updates, our website, social media channels, and the provider portal. We will also provide training and support through the go-live date.

If you have questions, please contact your provider network services representative directly, or send an email to providernetworkservices@coaccess.com. You can also email Michelle Tomsche, director of claims, operations & research at michelle.tomsche@coaccess.com if you have any questions specific to claims.

Look for more information in upcoming Provider Updates and Navigator newsletters.

HO Modifier
Behavioral health providers who are not eligible to enroll in Medicare (such as licensed professional counselors (LPC), licensed marriage and family therapists (LMFT) and licensed addiction counselors (LAC) and who provide services to members with dual eligibility (Health First Colorado and Medicare), must use the modifier "HO" in the last position on a claim to indicate Health First Colorado is the primary payer for the service. This guidance is published in the July 1, 2022 edition of the Uniform Service Coding Standards (USCS) Manual.

In accordance with (HCPF) guidance, when a member is eligible for both Medicare and Health First Colorado (sometimes referred to as "dual eligibles" or "duals"), you should process claims through Medicare before billing the Medicaid Capitated Behavioral Health Benefit. If you are not eligible to bill Medicare (LPC/LMFT/LAC) you can submit claims directly to us. These claims are to include modifier HO in the last position of a claim to indicate a provider is not eligible to be covered by Medicare. In these circumstances, we are only able to pay claims that include this modifier.

Public Health Emergency (PHE) Updates

On July 15, 2022, Health and Human Services Secretary Xavier Becerra formally extended the PHE, which, if extended a full 90 days, will run through today, October 13, 2022. As there will be a 60-day notice period before any end to the PHE and Colorado has not yet received this notice, it’s expected that the PHE will be extended again.

The PHE designation allows the Colorado Department of Health Care Policy & Financing (HCPF) to extend continuous coverage, maintenance of effort (MOE), get additional enhanced federal funding, and other federally-approved policies and waivers. During the PHE, state agencies must continue health care coverage for all medical assistance programs, even if an individual’s eligibility changes. This means we will be keeping Health First Colorado and CHP+ members covered during the PHE. They won’t have to worry about their health and wellbeing during this challenging time.

No one knows how long the PHE will last, so it’s important to prepare now. As soon as we get notice of an end date, we will notify our members and partners. Visit healthfirstcolorado.com to learn more.

Care Forward Colorado

Senate Bill 22-226 allocates $26 million in state recovery dollars to provide free short-term health care training and education to help Coloradans qualify for health care jobs, including certified nursing assistants, emergency medical technicians, medical assistants, dental assistants, phlebotomy technicians, and pharmacy technicians.

National Disability Employment Awareness Month
The Americans with Disabilities Act (ADA) was signed into law 32 years ago by President George H.W. Bush, bringing a new era of civil rights by guaranteeing that people with disabilities have the same rights as everyone else, including access to quality education, housing, and employment. Inspired by the Civil Rights Act of 1964, the ADA further solidified the idea that separate is not equal. Employment equity is part of the ADA.

October is National Disability Employment Awareness Month, which celebrates the contributions people with disabilities make to the economy and workplaces. The Supported Employment Program provides resources to help Coloradans with disabilities find jobs, get reimbursed for professional development, and more.

We know access can be an issue. If you have thoughts or concerns about how to accommodate differently-abled members, please email provider network services at providernetworkservices@coaccess.com or call us at 844-430-6684 or 720-744-5667.

Family Planning Benefits Expansion
As of July 1, 2022, Health First Colorado has expanded family planning benefits to include:

Guaranteed postpartum service coverage for pregnant members for up to 12 months after their pregnancy ends.
Covered family planning and family planning-related services for individuals with incomes higher than the standard Health First Colorado limit. This includes presumptive eligibility for all individuals.
A covered 12-month supply of contraceptives for all members, regardless of their immigration or citizenship status.
Expanded preventive services and a redefinition of family planning-related services to mean services eligible outside of managed care organizations, without copays.

Flu Vaccines
This year’s flu season is here and it’s expected to be more severe than previous years, so it’s important for everyone 6 months and older to get their annual flu vaccine before the end of October. Getting the annual flu vaccine will help prevent spreading the virus to those at a higher risk for complications, including people 65 and older, children under 5, pregnant people, and others with certain chronic medical conditions. It is safe to get both the flu vaccine and the COVID-19 vaccine (including the new omicron booster) at the same time. Anyone 6 months and older can get a COVID-19 vaccine and anyone 12 and older can get a COVID-19 omicron booster at least two months after their initial shots or after getting their most recent booster shot.

Health First Colorado, Medicare, (CHP+), and most private health insurers cover the full cost of the flu vaccine. Patients without health insurance can still get the flu vaccine for free at certain locations. Visit fluvaxcolorado.org to learn more.