JULY  2021

Dear Health Community Colleague,

Welcome to the first issue of the Navigator for July. In this issue, you’ll find important information about an opportunity to help transform the maternal health of our community, an update to Section 2 of the Provider Manual, information about the new telemedicine bill Governor Polis signed into law, and information about the Child Health Plan Plus (CHP+) State Managed Care Network.

Be on the lookout later this month for the second issue of the July Navigator, where we’ll provide more COVID-19 resources and highlight another provider partnership in the community.

If you want to learn more about anything in this issue of the Navigator or just have a question, please contact us. You can also connect with us on any of our social media channels using the links below.

In good health,
Colorado Access

Maternal Health for the Black Community
Do you want to help make pregnancy, childbirth, and new motherhood better for Black women in our community? Or do you have patients who fit the criteria? We want to hear from you! Help transform the maternal health of our community! Sign up for an informative meeting here or share this flyer with others who may be interested and fit the criteria.
Member Grievances and Appeals: Information in the Provider Manual
We provide information directly to members about their rights regarding grievances and appeals. We also make this information available to providers in Section 2 of the Provider Manual and on our website. The Provider Manual contains important information about member grievances and appeals. This includes who can file a grievance or appeal, assistance Colorado Access can provide, and the relevant timeframes for filing grievances and appeals.

If you have a patient who has questions or needs assistance to file a grievance or appeal, please have them call us at 800-511-5010. For more information, please see the Provider Manual and associated policies here and here. Your patients, our members, can learn more here. If you have any questions, please contact your provider relations representative.

Telemedicine Bill Signed into Law
Governor Polis signed HB21-1256 into law, which directs the Department of Health Care Policy and Financing (HCPF) to create rules that regulate providers who offer health care services in Colorado predominantly through telemedicine. Click here for more information.

State Managed Care Network Ends
As of July 1, 2021, all members who are eligible for Child Health Plan Plus (CHP+) have been automatically enrolled into a CHP+ Managed Care Organization (MCO). As a result, if you do not have an active contract with a CHP+ MCO, you are not eligible for reimbursement for services delivered to CHP+ members after June 30, 2021.

The CHP+ State Managed Care Network (SMCN) is not available to pay for health care services for CHP+ members delivered after June 30, 2021. Contract with CHP+ MCO(s) as soon as possible to ensure continuity of care for members and timely reimbursement.

We continue to participate in the CHP+ program as an MCO. If you were an SMCN provider, contract with CHP+ provided by Colorado Access for continued participation in our CHP+ program. If you are not currently contracted with an MCO, you should contact other participating CHP+ MCOs to begin the contracting process to be eligible for reimbursement for providing health care services to CHP+ members beginning July 1, 2021.
For additional information on the State Managed Care Network Transition click here SMCN Transition CHP+ Provider Resources Webpage. If you have any additional questions, please contact our provider relations team at

Patient Roster is Now Available in the Provider Portal
You can now find your patient roster in our provider portal. Found in the Eligibility tab, the Patient Roster grid automatically displays patients associated with the provider selected (through the drop-down selection).
This roster will be updated each month.

Protect Me, You, Us - Provider Brief
COVID-19 vaccine hesitancy is highest among the very populations most disproportionally affected by the pandemic. This includes communities of color as well as groups who are economically and socially disadvantaged. Perceptions and concerns regarding patients’ responses to getting the vaccine may discourage engagement in conversations that are essential to increasing vaccination rates. Read more here.
Past the Pandemic: Mental Well-being for You and Your Patients
This ECHO series offers strategies to navigate, normalize and hold space for worries and experiences during this pandemic. Each session provides helpful, tangible tools in a psychoeducational, didactic format. By understanding stress along a continuum, you will learn how to manage stress and loss, increase capacity to prevent burnout, elevate connectedness and mindfulness, and promote quality patient care. There will be six weekly sessions, held virtually from 12:00 p.m. to 1:00 p.m., starting Tuesday, June 29th and continuing through Tuesday, August 3rd. Learn more and register here.

Trauma Informed Care
Register now for upcoming free webinars offered in July and August on Trauma Informed Care: The Basics of the Brain. These are offered by Denver Children’s Advocacy Center (DCAC). A donation is welcome but not required. Learn more and register here.
Community Events

Park Hill Area Free Food Resources

Please see the flyer here for more information about food resources in the Park Hill area.

Invitation to Apply for Funding Summer/Fall 2021: Youth Engagement Pop-Up Event Series

The Youth Violence Prevention Program is a newly funded initiative to implement a public health approach and intervention level efforts that are based on national models and best practices to prevent and address the youth violence crisis occurring in the City of Aurora. Both intervention and prevention level strategies will be implemented through a multi-disciplinary approach to include community-based efforts such as youth engagement pop-up events to increase neighborhood protective factors. The grant period is from June 20,2021 to October 31, 2021. Learn more here.

The City of Aurora has created a new economic development program to connect people in the community who are experiencing food insecurity with free meals at local restaurants. If you work with people or groups that could benefit from this program, please contact Frank for more information at 303-739-7272 or email

If you have an upcoming community event that you'd like us to share, please email us.
COVID-19 Resources

For COVID-19 utilization management information, click here.

For COVID-19 pharmacy information, click here.

For COVID-19 administrative information, click here.

For COVID-19 training information, click here.

For COVID-19 practice support information, click here.

Diabetes Empowerment Virtual Education Program
Free virtual and in-person monthly classes will help patients develop the tools needed to better control diabetes. This program is being offered by Tri-County Health Department, in partnership with The Center for African American Health. Click here for more information and to register.

Short-Term Behavioral Services in Primary Care- “six visit rule”
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 if you have any questions.
Behavioral Health RAE: Audit Observations and Important Claims Reminders
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.
Billing Pattern Problems
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

Substance Use Disorder Documentation (SUD) Training
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 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

Behavioral Health Copays
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 if you have questions.
Health Effectiveness Data and Information Set
Each year, we run Health Effectiveness Data and Information Set (HEDIS) rates for a set of core performance measures for our CHP+ HMO health plan. We use HEDIS rates to find ways to eliminate gaps in care and to improve health outcomes for CHP+ HMO members. We benchmark the CHP+ HMO HEDIS rates against regional and national rates to prioritize and design internal programs and performance incentive programs across the provider network.

Here are a few key findings from the measurement year 2020 rates:
  • Of eligible CHP+ HMO members, 66.7% received an Influenza immunization in 2020,
    up nearly 4% from 2019
  • Childhood Immunization Status measures increased on average 2.8% in 2020 compared
    to 2019
  • ED Visit and Outpatient Visit utilization measures saw the largest decreases in 2020, decreasing by:
    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

Well Visit Key Performance Indicator
Please join us on Wednesday, July 14th from 12:15 p.m. to 1:00 p.m. to review changes to the well visit key performance indicator (KPI) and discuss how your practice might adapt to these changes. We’ll hear from Colorado Access staff about the details of these changes, along with future updates to our provider performance data. Learn how your practice can implement successful adaptations in the upcoming fiscal year. Register here.
Provider Forum - Provider and Member Emergency Department (ED) Experiences
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.
11100 E. Bethany Dr.
Aurora, CO 80014

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