JUNE 2025

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.

Accountable Care Collaborative (ACC) Phase III Updates

Accountable Care Collaborative (ACC) Phase III will begin in July 2025, and we want to keep you informed on what you need to know. Please make sure to check this section each month for updates that may affect you. Stay updated about previously shared information from Colorado Access here.

• Recontract with us: With the launch of ACC Phase III on July 1, 2025, we will have one Regional Accountable Entity (RAE) region (the new Region 4), but will still cover Adams, Arapahoe, Denver, and Douglas counties. Elbert County will now be part of Northeast Health Partners’ region. We are communicating with members in Elbert County to ensure they’re supported during the transition.

  • Existing Colorado Access RAE providers do not need new contracts for ACC Phase III unless one of our employees contact you. Elbert County provider contracts will remain in place and Elbert County providers can serve Region 4 members if they present for services.

  • If you are contracted with Colorado Access for Child Health Plan Plus (CHP+) our service area remains the same.

• Last week: We shared important updates for behavioral health providers.

• May 2025: Are you a Health First Colorado (Colorado’s Medicaid program) provider currently contracted with one or more RAEs? If you’d like to continue providing services for Health First Colorado members, the Department of Health Care Policy and Financing (HCPF) has resources to help you:

  • ACC Phase III Program Improvement Advisory Committee (PIAC) webpage
  • ACC stakeholder engagement webpage
  • Contracting reminders for behavioral health providers
  • For primary care medical providers (PCMPs):
    • Contracting reminders for PCMPs
    • ACC Phase III attribution fact sheet
    • ACC Phase III PCMP payment fact sheet

• HCPF’s member communications toolkit: This toolkit will help providers and community organizations support members during this transition to ensure members can navigate changes without disruption to their care. Find the toolkit here.

Physical and Behavioral Health

Billing Tips

• Professional providers: When billing your professional services, please do not list any credentials (i.e. LPC, PhD, LCSW, LMFT, MA, etc.) in the first name or last name fields for the rendering provider, as this will cause a denial and/or a delay in payment.

• Facility providers: When billing NDC codes, please ensure that you are billing complete and valid codes to ensure your claim is not rejected and or denied.

Colorado Medicaid eConsult

You have access to a free and secure statewide electronic consultation platform on coloradomedicaideconsult.com (eConsult), where you can communicate electronically with specialty providers. This frequently eliminates the need for in-person referrals for members.

To learn more about the platform, go to the eConsult platform webpage, or email the eConsult team at hcpf_econsult@state.co.us.  

To enroll in eConsult, fill out the practice enrollment form or register for an upcoming webinar:

• Tuesday, July 1, 2025, from 12:30 to 1:00 p.m. 

• Tuesday, August 5, 2025, from 12:30 to 1:00 p.m. 

If you have any questions, please email coloradosupport@safetynetconnect.com.

New Survey for Community Providers

Colorado Pediatric Psychiatry Consultation and Access Program (CoPPCAP) has a new survey to gain a better understanding of the mental health landscape community providers practice in and what CoPPCAP can do to continue to support you. Take the survey here.

Provider License Status

Practitioner licenses expired with the Department of Regulatory Agencies (DORA) on April 30, 2025. While some licenses were automatically updated, some claims are currently being denied for no license on file with Health First Colorado (Colorado’s Medicaid program).

If an exact match for the provider’s name is not found, you must manually update the license through the Provider Web Portal to avoid claim denials. The grace period for this issue has ended; claims that were previously paid may now be denied. Make sure to check the status of your provider license on file and update as needed. Learn more about how to update licenses here.

Clarification for Substance Use Disorder (SUD) Continuum Providers

On July 1, 2024, new Specialty Types were added under Provider Type (PT) 64 (Substance Use Continuum) to align with Behavioral Health Administration (BHA) Endorsements for each American Society of Addiction Medicine (ASAM) level of care. This allows HCPF and Regional Accountable Entities (RAEs) to accurately track network adequacy for all SUD levels of care.

Make sure that PT 64 enrollments include a Specialty Type for each ASAM level of care endorsement on BHA licenses by June 15, 2025. Add a Specialty Type to the PT 64 enrollment with a maintenance request through the Provider Web Portal. Read more about how to submit a maintenance request here. Please note that you cannot remove a Specialty Type with a maintenance request.

View the list of ASAM level of care Specialty Types here under “SUD Continuum.”

Specialty Type 477 is not associated with an ASAM level of care and is being discontinued. When all SUD continuum providers have added the necessary ASAM level of care Specialty Type(s), the 477 Specialty Type will be end-dated in the system.

If you have any questions, please email hcpf_sudbenefits@state.co.us.

Fiscal Year 2025-2026 Provider Rate Adjustments

Health First Colorado Across-the-Board (ATB) provider rate increases were approved during the 2024-2025 legislative session and are effective for dates of service beginning July 1, 2025. All rate adjustments are subject to Centers for Medicare & Medicaid Services (CMS) approval prior to implementation. Fee schedules will be updated to reflect the approved 1.6% ATB rate increases. Rates will be updated in the Colorado interChange for dates of service beginning July 1, 2025. The 1.6% ATB increase for Home and Community-Based Services (HCBS) waivers do not require CMS approval.

Pediatric Behavioral Therapy Providers Provider Type Transition

Pediatric behavioral therapy providers who are still enrolled in PT 25, please note that the billing codes associated with pediatric behavioral therapies will be closed for PT 25 as of June 30, 2025. If you need help enrolling in an approval provider type to ensure payments continue to be received for services, email Martina Schmidt at martina.schmidt@state.co.us with the subject line “Provider Type Transition” as soon as possible before June 30, 2025 to ensure a smooth transition and minimize disruption to your practice. Learn more in the pediatric behavioral therapies billing manual or email Gina Robinson at gina.robinson@state.co.us.

Eligibility Renewals

Health First Colorado and Child Health Plan Plus (CHP+) both review information annually to make sure a member still qualified. Learn more about the renewal process with these resources:

• Updated toolkit on the new eligibility renewals page

• Partner renewal guide

Share materials from these toolkits to help members through the renewal process:

• Update your address: To help remind members to update their contact information and communication preferences so they can receive important information

• Take action on your renewal: To help remind members to complete their renewal and submit documents by their renewal deadline

• Transitions in coverage: To help people know their health coverage options if they no longer qualify for Health First Colorado or CHP+.

Make sure you are checking the member’s eligibility before providing any services.

90-Day Reconsideration Period/Late Renewals

Members can return their renewal packet and any information to their county for processing within 90 days of losing coverage. Members who are determined eligible during the 90-day reconsideration period can request retroactive coverage if they experienced a gap by contacting their local county or through PEAK once they are approved and their new eligibility date is known.  

Members who disagree with an eligibility decision have the right to appeal. Learn more about the appeals process.  

Provider Services Call Center Virtual Hold

The Provider Services Call Center is currently experiencing higher-than-average wait times. To reduce wait times, select the new "virtual hold" option to hang up the phone while keeping your place in line and get a call back when an agent is available. The system is unable to call back numbers with extensions. With this new self-service option, you can verify payment history, claims status and associated explanation of benefit (EOB) codes, and member eligibility.

News From HCPF

Apply to Join the Medical Care Advisory Committee (MCAC)

In 2024, the Centers for Medicare and Medicaid Services updated federal requirements (42 CFR 431.12) directing states to establish and operate a public Medicaid Advisory Committee that will help improve quality of care, advance health equity, and strengthen Medicaid services across Colorado. HCPF is looking for individuals with relevant experience in health care or advocacy who:

• Serve or represent Health First Colorado members
• Have demonstrated leadership or expertise in their field
• Are open to diverse viewpoints
• Have a desire to improve Medicaid services for all members

Applications are open from May 12, 2025 to July 1, 2025. Learn more about the committee and eligibility requirements.

Explanation of Benefits (EOB) 3110

There have been questions about denials related to EOB code 3110 “The rendering provider is not a group member.” Notations that affiliations are missing do not cause claims to deny and are informational only. HCPF is giving an extended grace period to make all necessary updates to affiliations to avoid future claims denials. If EOB code 3110 appears on a claim, make sure your affiliations are up-to-date and check other EOB codes to see why the claim was denied. Updated affiliations are currently taking five days for final approval. Do not submit duplicate update requests.

Provide Feedback on Member Correspondence Improvements

HCPF is holding quarterly virtual stakeholder meetings about ongoing improvements to member correspondence. Meeting agendas will include:

• Updates on improvements

• Timelines for changes

• Plans for future letter improvements

• An opportunity for attendees to give feedback in smaller workgroups (materials will be sent to registered attendees at least one week before the meeting)

The meetings will be in both English and Spanish, and American Sign Language interpretation will be provided.

Please register or request a recording from hcpf_stakeholders@state.co.us for one or all of the meetings:

• Thursday, July 17, 2025, 12:00 to 1:30 p.m.
• Thursday, October 16, 2025, 12:00 to 1:30 p.m.

ACC Program Improvement Advisory Committee (PIAC) and Subcommittee Meetings

Please update your calendar with the new meeting links:

• PIAC: Wednesday, June 18, 2025, from 9:30 a.m. to 12:00 p.m.

• Performance Measurement and Member Engagement (PMME): The June meeting is canceled. Regular meetings will resume on Thursday, July 24, 2025, 3:00 to 4:30 p.m.

Learn more here.

Community Health Workers (CHW) in Medicaid

Due to the State’s budget shortfall, the Colorado General Assembly passed legislation (SB 25-229) that postpones CHW Health First Colorado reimbursement until January 1, 2026. If you have any questions, please email hcpf_chw_benefit@state.co.us.

Upcoming Trainings

Integrated Care Sustainability Policy Webinar

Join HCPF for a webinar presentation on this new policy on Friday, June 20, 2025, from 9:00 to 10:00 a.m. to learn more about:

• Changes to improve member health by increasing access to integrated care services for Health First Colorado members

• A sustainability reimbursement model for primary care providers who are incorporating behavioral health services into their practices

• Reimbursement codes through fee-for-service (FFS)

• Transitioning the former short-term behavioral health (STBH) benefit from FFS to the behavioral health capitation

HCPF is also offering three office hours sessions after the first webinar to provide an opportunity to ask more questions:

• Friday, June 13, 2025, 9:00 a.m. - 10:00 a.m.
• Monday, June 23, 2025, 9:00 a.m. - 10:00 a.m.
• Thursday, June 26, 2025, 8:30 a.m. - 9:30 a.m.

News from Colorado Access

Online Directory

Is your information correct in our online directory where members search for care? Please go to our online directory, search for yourself, and check that your data is accurate. Use the form at the top of the page to report any discrepancies, or email updates to providerdatamaintenance@coaccess.com.

Colorado System of Care (CO-SOC) Recruitment

The state entered a settlement agreement to develop a system of care for Colorado youth. In ACC Phase III, RAEs are required to build capacity for specific services including Enhanced MST/FFT, Enhanced High-Fidelity Wraparound (HFW) and Enhanced Standardized Assessments (ESA) to support Colorado youth with complex behavioral health needs.

In ACC Phase II, children and youth were able to access a standardized assessment (Independent Assessment) through the Administrative Services Organization (ASO). In ACC Phase III, it will be known as an Enhanced Standardized Assessment (ESA) – a comprehensive clinical assessment completed by a behavioral health provider to assist in determining appropriate treatment/service recommendations for children, youth, and families. It includes a modified template that has been used in the current Independent Assessment process, the use of the Child and Adolescent Needs and Strengths (CANS) and a new tool, the CANS Decision Support Matrix. ESAs will be completed by a provider in the RAE’s network, because it’s moving under the behavioral health capitated benefit for all youth without human service involvement. Learn more here.

If you are interested in joining our assessor network, please email providerrecruitment@coaccess.com.

Credentialing and Recredentialing Process

For our credentialing and recredentialing process, you have the right to:

1. Review information submitted to support your credentialing application.
2. Correct erroneous information.
3. Receive the status of your credentialing or recredentialing application, upon request.

If you have any questions surrounding credentialing or recredentialing, please email credentialing@coaccess.com.

Update to Utilization Management (UM) Process for Therapy Requests for Members Younger than Age 3

Effective immediately, prior authorization is no longer required for physical therapy (PT), occupational therapy (OT), or speech therapy (ST) services for members younger than the age of 3 when delivered in both outpatient and home health settings. This change will reduce unnecessary clinical authorization requests, allowing for more efficient care delivery, improved health outcomes, and enhanced member satisfaction through faster, uninterrupted access to early intervention and preventive care.

Update to UM Process for Maternity Inpatient Admissions

Effective immediately, our UM process will no longer require prior authorization for inpatient maternity admissions with a length of stay of five days or less. This change will reduce unnecessary clinical authorization requests and enable more efficient care delivery. By streamlining this process, we aim to enhance health outcomes and increase member satisfaction through timely, uninterrupted access to maternity care.