AUGUST 2023

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.

Clarification on the Early Periodic Screening Diagnostic and Treatment (EPSDT) Benefit

In last week’s edition of our quarterly provider newsletter, “Navigator,” we highlighted the federally-mandated EPSDT benefit that is for all children and youth ages 20 and under, as well as adults who are pregnant and are enrolled in Medicaid. The article listed specific conditions that are part of our own definition of children with complex needs but did not go into detail about how much broader the benefit is. Under federal law, the EPSDT benefit covers much more than just the conditions noted in the article. The federal Medicaid website goes into more detail about the EPSDT benefit: 

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Public Health Emergency (PHE) Update 

The requirement to have a U modifier on depression screens delivered to members that was outlined in the January 2023 Department of Health Care Policy and Financing (HCPF) Provider Bulletin (B2300488) will not be enforced, to avoid additional barriers to accessing depression screens for members, birthing parents, and non-birthing caregivers. You can give depression screens to any caregiver of a child enrolled in Health First Colorado, as required by Senate Bill (SB) 21-137. Depression screening claims without the U modifiers will not be denied due to lack of a modifier.

2023 HCPF Health Equity Plan Public Meetings

Provider-Carrier Dispute Process Updates

We have made updates to the provider-carrier dispute process to streamline protocols and ensure compliance with Division of Insurance and Colorado Medicaid requirements. We have ensured that the processes for provider-carrier disputes and member appeals are separate. These changes will be reflected in letters that you may get from the claims appeals team for provider-carrier disputes, letters from utilization management for member appeals, information at the top of explanation of payments (EOPs), and in an updated provider manual.

Member Copay Reductions 

As of July 1, 2023, most of the current Health First Colorado member copays are being lowered to $0, to comply with Senate Bill (SB) 23-222 and SB 23-214. This applies to members eligible for Title XIX, the Alternative Benefits Plan (ABP) and the Old Age Pension (OAP) Health and Medical Care Program. Other special programs administered by HCPF, such as Child Health Plan Plus (CHP+), will continue to have normal copays.  

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Revised Obstetrical Global Billing Requirements  

There is a new billing methodology to comply with CMS to capture information about care rendered through the maternity service time frame. The new methodology will give information needed to support high-quality maternity care and help providers report provision of these critical services. Learn more here. 

Coding Committee 

The quarterly coding committee meeting facilitated by HCPF is an opportunity to discuss coding questions, policy considerations, and requested edits to the billing manual with sister agencies, managed care entities (MCEs), and providers. These meetings are advisory opportunities for HCPF to engage state policy subject matter experts, MCE representatives, and providers to review and discuss issues that impact content in the billing manual. These meetings are not intended to be forums for general billing questions from providers. Learn more about the meetings here.

New Vision Tool for Coloradans in Need 

The state of Colorado has launched a new service, Aira, for Coloradans who are blind and have low vision. Aira is an app that provides live, on-demand visual interpreting. Users can get free access for up to 30 minutes per session to help them navigate state locations, websites, and applications. Learn more about Aira here. 

Billing Information for CHP+ Providers 

As of July 1, 2023, if a CHP+ member’s eligibility start date occurs prior to their enrollment with a Managed Care Organization (MCO), claims must be billed directly to the fiscal agent. After the member is assigned to an MCO, the claims must be billed to that MCO. Learn more here. 

New Portal for the Family and Medical Leave Insurance Program 

Proposition 118, passed in 2020, paved the way for Colorado’s Paid Family and Medical Leave Insurance (FAMLI) program. A system is being built for Coloradans to use to apply for paid leave benefits when they become available in 2024. It’s anticipated that health care providers will be able to register in the portal around the middle of this month to review claims submitted by patients under their care. 

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Your Contact Information 

Keeping your contact information updated in the provider web portal will help make sure that you get emails specific to your organization’s claims, such as newsletters. The email address you have in the portal associated with your mailing address will be used to communicate with you. Click here to learn how to access and update your email address that’s on file in the portal.