MARCH 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.

Peer Services Documentation Standards Education Training

We are excited to announce a new training focused on documentation standards for peer services. This training must be completed by a licensed provider and/or peer supervisor within your organization. It can be downloaded and shared with other peer staff at routine trainings. Only one person from your organization should enroll in the course on our Learning Management System. Click here to complete the enrollment form.

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 credentialing questions, please email credentialing@coaccess.com. 

Provider-Carrier Disputes

Reminder: Please read your resolution letter carefully when submitting a provider/carrier dispute. This letter contains important information about whether we upheld or overturned the dispute. 

You can submit a provider-carrier dispute on our provider portal. Please view section eight of our provider manual to learn more about provider-carrier disputes.

Medicare Allowing More Enrollment

The Centers for Medicare & Medicaid Services (CMS) announced a rule change that allows Licensed Marriage and Family Therapists (LMFTs), Licensed Professional Counselors (LPCs), and Licensed Addiction Counselors (LACs) who meet qualification requirements to enroll for the first time in Medicare. Newly eligible providers were able to enroll starting November 1, 2023, and were able to start billing Medicare as of January 1, 2024.

These providers currently must use HO modifier on claims submitted directly to Medicaid without a Medicare denial, but the policy will be changing as of April 1, 2024, to only allow the HO modifier in situations where enrolled Medicare providers are supervising unlicensed behavioral health providers and submitting claims as the rendering provider.

Get Higher Reimbursements for Providing Behavioral Health Services in Languages Other Than English

We are excited to introduce a new program that allows you to earn enhanced reimbursements for providing behavioral health services in languages other than English. Eligible outpatient providers can now bill a 10% increased rate on direct outpatient behavioral health services offered in a member's identified language. Federally qualified health centers, community mental health centers, and inpatient hospitals do not qualify for this incentive.  

This incentive is the first of its kind, and it recognizes the additional effort, training, and expertise needed to deliver culturally and linguistically appropriate care.

This program is exclusive to us, Colorado Access, and does not apply to any other Regional Accountable Entity (RAE) services that use an interpreter.

Talk to your assigned provider network manager or find out who to contact here to learn more. 

Public Health Emergency (PHE) Unwind Support

Please share HCPF’s partner toolkits (Update Your Address and Take Action on Your Renewal) to help Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members prepare for renewals. HCPF also has a new joint webpage with partner resources and information for those needing to transition to other coverage, keepcocovered.com.

HCPF also has member-facing materials in English and Spanish, and the top 11 languages members speak: Amharic, Arabic, Burmese, Chinese, Dari, Pashto, Russian, Somali, Swahili, Ukrainian, and Vietnamese.

Other ways you can help:

• Post flyers in public areas
• Include renewal messaging in your emails and newsletters
• Share social media posts
• Educate yourself on the basics of the renewal process

Learn more:

• Frequently asked questions
• PHE planning resource center
• Health First Colorado renewal webpage – English, Spanish
• Attend the next HCPF quarterly PHE unwind webinar on Wednesday, April 24th, from 1:00 to 2:00 p.m.

Upcoming ECHO Colorado Sessions

• Colorado Updates in Public Health: COVID and Beyond
  • Topic: Syphilis and sexually transmitted infections (STIs)
  • Friday, March 22nd, 12:00 to 1:00 p.m.

• Autism: Core Concepts for Primary Care Part 2
  • Wednesday, March 20th, 12:00 to 1:00 p.m.

• Pediatric Psychiatry in Primary Care: Core Essentials
  • Sessions each Thursday from March 7th through April 18th, 7:30 to 8:30 a.m.

• Adolescent Reproductive Health for Nurses and Health Professionals
  • Sessions each Thursday from April 4th through April 25th, 8:00 to 9:15 a.m.

• Benefits of Screening for Early Type 1 Diabetes
  • Sessions each Thursday from April 11th through May 2nd, 12:00 to 1:00 p.m.

• Pediatric Suicide Prevention: A Practical Care Pathway for Primary Care
  •     Sessions each Tuesday from April 16th through May 21st, 12:00 to 1:00 p.m.

Click here to view all current ECHO Colorado offerings.

Polis-Primavera Administration Submits Updated Canadian Drug Importation Plan to the Food and Drug Administration (FDA)

On February 27, 2024, Governor Polis and the Colorado Department of Health Care Policy & Financing (HCPF) announced the submission of Colorado’s amended application to the FDA and the Biden Administration to import lower-cost prescription drugs from Canada. The submission is an amendment to the initial application submitted on December 5, 2022. This brings Colorado closer to federal approval to operate Colorado’s Colorado’s Canadian Drug Importation Program. If the FDA approves, Colorado can start bringing lower-cost prescription drugs into the state so more Coloradans can afford the medication they need to thrive. Click here to learn more.

Verifying Medicaid Coverage Types

You may see a “Coverage” type for Behavioral Health Administration Benefits (BHAB), shown as “BHA Benefit Plan” and “BHAB” in the provider web portal. BHAB is a new program overseen by the Behavioral Health Administration (BHA) and uses the Colorado InterChange system. The BHA is a separate entity that addresses the behavioral health crisis needs of individuals not covered by other medical assistance programs. The BHAB program is not part of Health First Colorado or CHP+. Individuals who only have “BHA Benefit Plan” listed are not eligible for any service under Medicaid or CHP+.

Timely Filing Information

For fee-to-service claims billed to the state: You always have 365 days from the date of service (DOS) to submit a claim. A claim is considered filed when the fiscal agent documents receipt of the claim. Correspondence with the fiscal agent is not proof of timely filing. The claim must be submitted and received within 365 days, even if the result is a denial. Provider staffing changes or issues between the provider and the software vendor, billing agent, or clearinghouse are unacceptable reasons to be outside the timely filing period. Click here to learn more.

Escalating a Concern About a Managed Care Entity (MCE) or Managed Care Organization (MCO)

Contact the contracted MCE first to resolve any concerns. If this does not work, complete the complaint submission form to escalate the complaint for further review. You must fill out the entire form and click the “submit” button to move on to further review. Do not include Protected Individual Information (PII) or Protected Health Information (PHI), such as a member's birth date, member ID, social security number, or personal medical information.

This process allows HCPF to track the complaint, monitor its resolution, and identify issues affecting multiple providers.

Review of Fee-for-Service (FFS) Behavioral Health Substance Use Disorder (SUD) Services

FFS behavioral health SUD services H0001, H0004, H0005, H0006, H0010, S9445, and H0020 are scheduled to be reviewed under the Medicaid Provider Rate Review Advisory Committee (MPRRAC) process in 2024. MPRRAC is a committee of community professionals that oversees the process for reviewing rates of Medicaid services and works with HCPF to review the sufficiency of FFS provider reimbursement rates and ensure compliance with regulatory guidelines. Each service is reviewed every three years. Click here to learn more.

There will be an HCPF meeting on Friday, March 29th, from 9:00 a.m. to 2:00 p.m. Click here to learn more.