Effective July 1, 2021, we have removed the authorization requirement for additional visits beyond the first six that were billed to fee-for-service (FFS) Medicaid! Please continue to bill the first six visits to FFS Medicaid. If the member requires additional visits, those can be billed to Colorado Access without requesting authorization. Remember, these codes include: 90791, 90832, 90834, 90837, 90846, and 90847.

We will monitor the claims to ensure that we only receive and pay for the additional visits and not the first six visits. Failure to adhere to this process will result in recoupment of claims billed incorrectly to Colorado Access.

Please contact the Provider Relations team at providerrelations@coaccess.com if you have any questions.

During recent audits, we have found many documentation errors when billing for outpatient therapy services. All documentation must be legibly signed, dated, and include the providers’ credentials/license as part of the signature. The credentialed signature is what validates the claim for payment and must be completed before you submit a claim for payment. 

Audited records that reveal signatures added after the payment date or with inadequate provider signatures will fail an audit and lead to recoupment of the overpayment. It is critical that those who bill for outpatient therapy are familiar with the technical documentation requirements listed in the Uniform Service Coding Standards Manual maintained by HCPF. You can find the latest version of this manual here.

We recently reviewed 90791 and H0001 assessment claims and noticed billing patterns that may be outside of billing compliance standards. Please note the following billing standards for 90791 and H0001 codes:

1. Only ONE 90791 or H0001 can be billed per assessment, even if it takes two sessions to complete an assessment
   
2. Assessments should be reviewed and updated when there is a change in the patient's level of care or functioning, and should not be billed more frequently

It is important to ensure billing compliance. If you have any questions, please email our quality improvement team at qualityimprovement@coaccess.com.

We regularly monitor provider documentation to ensure all participating providers who deliver substance use services meet quality documentation standards. Quality audit criteria is based on regulations, billing manuals, industry best practices, and other sources that support quality documentation. We developed a comprehensive training on the most up-to-date SUD documentation standards that includes:

• General documentation
  
• Assessment
  
• Treatment planning
  
• Psychotherapy progress notes
  
• Case management

This training is titled “Quality Improvement Substance Use Disorder Documentation Training” and can be found in our Learning Management System. Please contact your provider relations representative or send an email to providerrelations@coaccess.com if you have not yet signed up for access to the Learning Management System. If you have questions about the training, please send an email to our quality improvement team at qualityimprovement@coaccess.com.

As of July 1, 2021, there is no longer cost sharing for outpatient behavioral health services for Child Health Plan Plus (CHP+) offered by Colorado Access. Members at all income levels will pay $0 copay for these services. If you have any questions, please contact your provider relations representative or send an email to providerrelations@coaccess.com if you have questions.

1. 25.8% for Outpatient Visits**
2. 39.3% for ED Visits**
   **These decreases were likely due to reduced utilization of discretionary and emergency medical services during the height of the COVID-19 pandemic.

1. 19.8% for Blood Glucose Monitoring*
2. 14.5% for Cholesterol Monitoring*
3. 11.6% for Blood Glucose and Cholesterol Monitoring*
   *These decreases were likely a result of the COVID-19 pandemic due to increased telehealth visits and challenges with getting CHP+ HMO members scheduled for in-person blood draws.

How can you help move the needle on HEDIS metrics in measurement year 2021? Providers who see CHP+ members play a critical role in contributing to these HEDIS rates. Stay tuned for more information in the next edition of the Navigator. If you have any general questions about HEDIS or measurement year 2020 HEDIS rates, please email
qualityimprovement@coaccess.com.

Join us on Thursday, July 22nd from 12:30 p.m. to 2:00 p.m. for a provider learning collaborative focused on emergency department utilization by members with uncontrolled chronic conditions. This event will support primary care medical providers (PCMPs), who are participating in our Controlled Chronic Conditions: ED Reduction Program (C3EDR) in their intervention design. Attendance will count toward the two required learning opportunities of the C3EDR program. Register here.