Navigator - Provider Newsletter from Colorado Access

Dear Health Community Colleague,

Welcome to the January Navigator. In this issue, you’ll find information on place of service code updates, updates to the Uniform Service Coding Standards Manual, a revalidation update, an enrollment application fee, provider network services here at Colorado Access, the pre-HMO enrollment period, and a member survey.

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

A Quality of Care Concern (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 2021 include “lack of coordination of care/services” and “lack of follow-up/discharge planning.”

You must report any potential QOCs and critical incidents that you identify during a course of treatment of a member, in addition to any mandatory reporting. 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. If you have any questions regarding QOCs, critical incidents, or reporting requirements, please email qoc@coaccess.com.

The Colorado Department of Health Care Policy and Financing (HCPF) and the Health Services Advisory Group (HSAG) work with DataStat each year to administer and collect data for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Member outreach will begin for the 2022 survey this month and will continue until early May 2022. Members are contracted originally by mail and subsequently by computer-assisted phone calls. Survey results are anonymous and provide valuable information on how we can help improve the member experience. Historically, response rates have been low and limit the ability to use the survey results to drive improvement. If members ask you any questions about the survey, please educate them on the importance of completing this survey and reiterate the value of getting their voices heard.

To read past Health First Colorado and CHP+ CAHPS Reports, click here. To learn more about the CAHPS, click here.

Claims are currently not being denied or suspended if revalidation has not been completed, but revalidation applications should still be submitted according to their scheduled due date. The current processing time is an average of five business days. You will be emailed instructions on how to submit a revalidation application approximately six months before the due date. Click here to learn more and verify the next revalidation due date.

Only one update can be processed at a time. If you need to make an additional update while a revalidation application is in process, contact the Provider Services Call Center.

We are here to help you understand what you need to know as a provider in our network. We provide trainings and education to help you through the entire process of being a contracted provider with Colorado Access. This includes navigating the provider portal, claims submissions, and other systems; education on new initiatives and programs; orientations for providers who are new to our network; and more. Our communications platforms, such as this newsletter, help you stay informed.

We will continually support, train, educate, and communicate with you throughout your tenure as a contracted provider in our network. Contact your provider network manager if you have questions about our programs and offerings, or if you have an issue that needs to be resolved. You can also call us at 844-430-6684 or email providernetworkservices@coaccess.com.

Camden Coalition COACH Training
The COACH model is a framework of techniques and tools for the care planning process. A new eight-week virtual course for frontline providers on how to implement the framework to transform patient engagement and reach goals is launching January 18, 2022. The course provides 10 continuing education units (CEUs) for physicians, physician assistants, nurses, nurse practitioners, pharmacists, and social workers. Click here to learn more and to register.

Identifying and Treating Tremor, Parkinson’s and Chorea
As the population ages, the prevalence of neurodegenerative diseases like Parkinson’s grows. A new ECHO Colorado (Extension for Community Health Outcomes) series will teach you how to recognize Parkinson’s disease, Huntington’s disease, and chorea, and will also cover treatments. The five-session course will be held virtually on Tuesdays from 12:00 p.m. to 1:00 p.m. from January 25th to February 22nd. Click here to learn more and to register.

Many Black and Hispanic adults report experiencing discrimination when seeking health care at higher rates than white adults, which raises the question of how might these reported experiences adversely affect health care? A December 2020 study by The Urban Institute found that among the 3.2% of non-elderly adults who reported feeling treated or judged unfairly in a health care setting in the past 12 months, more than 75.9% reported such treatment or judgment disrupted their receipt of health care. Click here to read more.

Data from the 2020 census shows that Colorado, along with the rest of the country, is becoming increasingly diverse. 47.4% of Coloradans under age 18 identify as nonwhite, yet a majority of the staff at many school-based health centers are white. To help support staff so they can provide effective cross-cultural communication and care that not only leads to better outcomes but also promotes understanding and builds trust with students and their families, the journal Pediatrics & Child Health suggests a cross-cultural communication model called LEARN (listen, explain, acknowledge, recommend, negotiate). Click here to read more.

We partnered with Planned Parenthood of the Rocky Mountains (PPRM) to implement behavioral health screenings to reduce related emergency department visits. As of May 17, 2021, 100% of patients at the Littleton location of PPRM are now receiving a behavioral health screening as part of their visit. This change is a major step toward fully integrated patient care, which has the potential to positively impact the long-term health of PPRM patients and the state’s Medicaid population. Click here to read more.

Colorado House Bill 21-1258 established a temporary program to provide access to mental health and substance use disorder services for youth, including addressing needs that may have resulted from the COVID-19 pandemic. Youth and their parents can visit I Matter at imatter.org to take a confidential survey about their mental health and schedule sessions with a licensed behavioral health clinician over telehealth. All Colorado youth ages 18 and younger, or 21 and younger if they are receiving special education services, are eligible to receive these free services.

The Department of Health and Human Services, through its Substance Abuse and Mental Health Services Administration (SAMHSA), announced that it will invest $282 million to help transition the National Suicide Prevention Lifeline from its current 10-digit number to a three-digit dialing code – 988. This is a step toward transforming crisis care in the United States, creating a universal entry point to necessary crisis services in line with access to other emergency medical services. Click here to read more.

The pre-HMO enrollment period is a period of time when members who are determined eligible for CHP+ are not yet enrolled with their chosen HMO. If a CHP+ member’s eligibility start date occurs prior to their enrollment with a CHP+ MCO, any services provided during the retro-eligibility period must be billed for fee-for-service (FFS). FFS claims must be submitted to the Colorado interChange and pharmacy claims must be submitted to Magellan. Any services provided after the start date of a member’s enrollment into an MCO must continue to be submitted to the MCO for reimbursement.

All CHP+ eligible members will be mandatorily enrolled into a participating CHP+ MCO. Members will be enrolled into an MCO based in part on the county in which they live. Enrollment into an MCO will occur on the date the member’s CHP+ eligibility determination is received from the Colorado Benefits Management System (CBMS) by the Colorado interChange, which may result in a member’s date of enrollment into an MCO being different as their CHP+ eligibility start date.

If you got an mRNA vaccine from Pfizer or Moderna, you’re eligible for a booster six months after your second dose. If you got the Johnson & Johnson one-shot vaccine, you’re eligible after just two months. An mRNA booster shot can help protect you from symptomatic and severe illness from COVID-19, but how much protection does it give you? How long will it take to kick in, and how long will that protection last? How much will it protect you from the omicron variant? Click here to learn more.

The Colorado Access Text4Baby program is an SMS (text message) wellness program for pregnant Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus (CHP+) members who are 18 and older. Text4Baby provides educational messages timed to gestational age or birth age, as well as interactive surveys, modules and reminders to improve maternal and child health outcomes, for pregnant and new mothers and their partners with babies up to age 1, as well as providers. Surveys and modules help assess prenatal, postpartum, and well-baby visit attendance, as well as prenatal risk assessments or missed childhood vaccines.

“Starter pack” messages begin on the first Monday after a pregnant member is enrolled. “Pregnancy protocol” messages begin after the completion of the “starter pack” for members who enroll as pregnant and give their baby’s due date. Messages are sent on Mondays, Wednesdays, and Fridays and are timed around the baby’s due date. They encourage members to get more information on a topic by clicking on URLs in the message.

“New baby” messages begin after the member’s due date has passed, or on the first Monday, Wednesday, or Friday after enrollment. These messages will last until the baby turns one year old, and cover topics such as vaccinations, well visits, and appointment reminders for both mother and baby.