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At Colorado Access, caring for you and your success is our top priority as you serve our members. With so much information out there, this monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us.
Claims Issue Trends
We have noticed a claims trend where providers are billing a mismatched NPI/TIN combination when billing their claims and/or missing a rendering provider. Our new claims system is better equipped to catch this billing error. For this circumstance, claims are being denied appropriately per billing standards. These claims can be corrected and resubmitted for payment. If you have questions about this or have other claims issues please contact your provider network services manager. Click here to learn more.
Public Health Emergency (PHE) Update
Health and Human Services will give 60 days advance notice before the PHE will end. Since there was no 60-day notice of the PHE ending by November 12, 2022, it is expected to be extended again on January 11, 2023, most likely for another 90 days (through April 11, 2023). Click here to learn more.
Quality of Care Concern and Critical Incident Reporting Form Update
A Quality of Care Concern (QOC) is “a concern that care provided did not meet a professionally recognized standard of health care. A general quality of care review or a beneficiary complaint review may cover a single or multiple concerns.” (See 42 CFR §476.1.) A QOC is a complaint made about a provider’s competence, conduct, and/or care provided that could adversely affect the health or welfare of a member. A critical incident meets a more severe threshold; it is defined as a patient safety event not primarily related to the natural course of the patient’s illness or condition that results in death, permanent harm, or severe temporary harm. Critical incidents are subject to mandatory reporting under Colorado law as well as your provider agreement. The most common categories of QOCs submitted in 2022 to date include "lack of follow-up/discharge planning," followed by "lack of coordination of care/services."
Any potential QOCs and critical incidents identified during a course of treatment of a member must be reported, in addition to any mandatory reporting you may be responsible for. When a potential QOC or critical incident has occurred, fill out the updated Quality of Care Concern and Critical Incident reporting form in its entirety and email it to qoc@coaccess.com. Please note that the identity of the provider reporting a potential concern or critical incident remains confidential. Additionally, if your facility is contacted with a medical records request pertaining to a QOC investigation, records should be returned to Colorado Access promptly and no later than ten business days of receipt of the medical records request. If you have any questions regarding QOCs, critical incidents, or reporting requirements, please email qoc@coaccess.com.
Connect for Health Colorado Open Enrollment
If your patients do not qualify for Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+), they can enroll in the Connect for Health Colorado marketplace from November 1, 2022 through January 15, 2023. Enrolling by December 15, 2022 ensures that coverage begins January 1, 2023. Connect for Health Colorado is the state’s official health insurance marketplace, and it’s the only place to get financial help when paying for health insurance.
This year during open enrollment, every company selling health insurance in Colorado must offer plans with a specific set of lower, fixed costs, and make them available to everyone, no matter their documentation status. Click to download flyers [English | Spanish].
2023 411 Audit
We are required by the Department of Health Care Policy and Financing (HCPF) to perform the RAE Encounter Data Validation Review (also called the 411 audit) annually to ensure that all providers maintain complete and accurate clinical records for our members. Complete and accurate clinical records are essential for meeting patient needs, complying with federal and state laws, and to support claims billed.
HCPF defines the review to include 411 chart records for each region. Each region is audited across multiple behavioral health services against the coding requirements of the Uniform Services Coding Standards (USCS) Manual. Providers are randomly selected to participate by HCPF.
The 2023 411 audit will review paid behavioral health encounters from inpatient, residential, and outpatient psychotherapy services. The audit will cover dates of service from July 1, 2021 to June 30, 2022 with paid dates between July 1, 2021 and September 30, 2022. If you are chosen for this audit, we will notify you.
Please Share With Your Patients: SimpliFed
SimpliFed is a Health First Colorado telelactation provider for families. They are also contracted with us to serve CHP+ members. With SimpliFed, parents can connect with their network of clinically-trained lactation consultants from their homes through a secure, HIPAA-compliant telehealth platform.
Click here for a secure referral link. You can also download patient referral materials from the resources section of SimpliFed’s website. Parents do not need a referral to schedule an appointment; they can do so either on the SimpliFed website or by texting FEED to 888-458-1364.
New Member Services Page
Twice a year, our quality team sends out a member survey to get real-time feedback to better understand the member experience and to make relevant improvements. After analyzing data from the fall 2021 survey, the quality team noticed that members often ask customer service questions like “who do I call for what?” and “where do I go for help?”
This led to the creation of a new member services webpage that answers these questions, and others like benefit and coverage explanations, where to find community resources (food, housing, clothing, disability and others), transportation services and more. Please direct members to this webpage, and if you have any questions or comments, please email quality_questions2@coaccess.com.
New Vaccine Counseling Visit Codes for Adults and Children
On June 8, 2022, the Centers for Medicare & Medicaid Services (CMS) released vaccine counseling Healthcare Common Procedure Coding System (HCPCS) codes that were available to use starting July 7, 2022. These codes allow you to bill for stand-alone vaccine counseling. This includes COVID-19 vaccine counseling codes for counseling given to Health First Colorado and CHP+ members who are eligible for Early and Periodic Screening, Diagnosis and Treatment (EPSDT) benefits and the COVID-19 vaccination coverage under the American Rescue Plan.
These codes can be used for stand-alone vaccine counseling given in-person or through telehealth. Click here to read more about each new code and billing guidelines.
New Member CAHPS Survey Coming Soon
Every year, DataStat manages the anonymous Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey on behalf of the state of Colorado. The results of this survey give us valuable feedback on how we, along with network providers, can help improve the member experience. Response rates are historically low, which limits our ability to use the results to drive improvement. If a member asks you about this survey, please encourage them to complete it.
Click here to read past Health First Colorado and CHP+ CAHPS reports.
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