Provider Update from Colorado Access

New Claims System

We changed our claims system to HealthRules Payor (HRP) on November 1, 2022. This new system will make claims processing more efficient. As part of this change, we are working with PNC Healthcare to provide new electronic payment methods through their Claim Payments & Remittances (CPR) service, powered by Echo Health, with dates of service starting November 1, 2022. With the CPR service, you’ll be able to log into a website to see a detailed explanation of payment (EOP) for each transaction with any dates of service of November 1, 2022 and after. Transactions with dates of service October 31, 2022 and earlier can be accessed on the Change Healthcare website.

We do not anticipate any disruptions in payments. You will continue to receive payments from Change Healthcare as you currently do for dates of service prior to November 1, 2022.

What You Need to Do Now
You need to select your payment preference. If you have questions about this, please email provider network services at providernetworkservices@coaccess.com.

What You Need to Know

Electronic claims: There will be no changes to how you submit electronic claims today, but we recommend submitting your October and November claims separately.

Paper claims: There is a new P.O. Box where you can submit paper claims.

Colorado Access
P.O. Box 240389
Apple Valley, MN 55124

You will receive two weekly payments.

One payment for claims will be processed by our current system, QNXT, for dates of service before November 1, 2022. We are doing a six-month claims runout in QNXT. Change Healthcare will continue to provide payments during this runout period for dates of service before November 1, 2022.
One payment for claims processed in our new system, HRP, will be delivered by PNC Bank for dates of service on and after November 1, 2022.

We sent you an email, fax, or letter in late September requesting that you choose your preferred payment method (check, direct deposit to a bank account, etc.). If you are already enrolled in “All Payer Access” through Echo, you do not need to do anything, and you will not receive any additional communication

Your provider network services representative will introduce you to a new provider payment portal. If you do not have a provider network services representative, please email providernetworkservices@coaccess.com.

Please use the member’s state ID when submitting claims for services provided to Colorado Access Child Health Plan Plus (CHP+) or Health First Colorado (Colorado’s Medicaid program) members.

- The member’s state ID should include one letter and six numbers. For example, X123456.

We will continue to provide you with updates through the Navigator newsletter, regular monthly Provider Updates, our website, social media channels, and the provider portal. We will also provide training and support through the go-live date.

If you have questions, please contact your provider network services representative directly, or send an email to providernetworkservices@coaccess.com. You can also email Michelle Tomsche, director of claims, operations & research at michelle.tomsche@coaccess.com if you have any questions specific to claims.

Look for more information in upcoming Provider Updates and Navigator newsletters.

HO Modifier
Behavioral health providers who are not eligible to enroll in Medicare (such as licensed professional counselors (LPC), licensed marriage and family therapists (LMFT) and licensed addiction counselors (LAC) and who provide services to members with dual eligibility (Health First Colorado and Medicare), must use the modifier "HO" in the last position on a claim to indicate Health First Colorado is the primary payer for the service. This guidance is published in the July 1, 2022 edition of the Uniform Service Coding Standards (USCS) Manual.

In accordance with Department of Health Care Policy and Financing (HCPF) guidance, when a member is eligible for both Medicare and Health First Colorado (sometimes referred to as "dual eligibles" or "duals"), you should process claims through Medicare before billing the Medicaid Capitated Behavioral Health Benefit. If you are not eligible to bill Medicare (LPC/LMFT/LAC) you can submit claims directly to us. These claims are to include modifier HO in the last position of a claim to indicate a provider is not eligible to be covered by Medicare. In these circumstances, we are only able to pay claims that include this modifier.

Public Health Emergency (PHE) Updates

On October 13, 2022, Health and Human Services Secretary Xavier Becerra formally extended the PHE. This extension will be evaluated by January 15, 2023. The PHE can be extended for up to 90 days at a time, and the Biden administration has indicated there will be a 60-day notice period before any end to the PHE. Click here to learn more.

Flu Vaccines

This year’s flu season is here and it’s expected to be more severe than previous years, so it’s important for everyone 6 months and older to get their annual flu vaccine now. Getting the annual flu vaccine will help prevent spreading the virus to those at a higher risk for complications, including people 65 and older, children under 5, pregnant people, and others with certain chronic medical conditions. It is safe to get both the flu vaccine and the COVID-19 vaccine (including the new omicron booster) at the same time. Anyone 6 months and older can get a COVID-19 vaccine and anyone 12 and older can get a COVID-19 omicron booster at least two months after their initial shots or after getting their most recent booster shot.

Click here to view the Immunizations Fee Schedule for code-specific information from HCPF, and click here for billing guidance. If you have any questions, please email christina.winship@state.co.us.

Patients without health insurance can still get the flu vaccine for free at certain locations. Visit fluvaxcolorado.org to learn more.

Suspended Claims
Claims may be suspended when there is an error on the claim, or when state guidelines require additional manual review by the fiscal agent. The current average processing time for most suspended claims is seven days. If you have a suspended claim that is more than 14 days from the date of receipt, you can contact the Provider Services Call Center to escalate the claim for processing. Common Explanation of Benefits (EOB) reasons claims may be suspended:

EOB 0653: "Claim requires manual pricing. Please attach invoice for medical services."
EOB 5110: "The prior authorization does not match the services billed on your claim. Please correct services or submit a new prior authorization for the services billed."

Click here and go to the Suspended Claims drop-down menu under General Updates to learn more.

HCPF Updates

The “Submitting a Claim with Other Insurance or Medicare Crossover Information” quick guide has been updated.
Updated and newly published billing manuals can be found here.
A new eConsult platform is being implemented across the state, which will enable asynchronous (store and forward) clinical communications between specialists and primary care medical providers (PCMP).

Care Forward Colorado
Senate Bill 22-226 allocates $26 million in state recovery dollars to provide free short-term health care training and education to help Coloradans qualify for health care jobs, including certified nursing assistants, emergency medical technicians, medical assistants, dental assistants, phlebotomy technicians, and pharmacy technicians.

Family Planning Benefits Expansion
Family planning benefits include essential medically necessary services where the intent of the service is to delay, prevent or plan for a pregnancy. These services let members choose if, or when, to become pregnant or to become a parent and include:

All contraceptive methods and services approved by the Food and Drug Administration (FDA), including a 12-month supply of the contraceptive.
Health care and counseling services focused on preventing, delaying or planning a pregnancy.
Follow-up visits to evaluate or manage outcomes associated with contraceptive methods.
Sterilization services.
Basic fertility services.

Health First Colorado has expanded family planning benefit eligibility to include:

Individuals without documentation. This includes individuals who are not pregnant, who would be eligible for Health First Colorado coverage but are not U.S. citizens.
Individuals who have a specific income. This includes individuals who are not pregnant who have a specific income, who would be eligible for Health First Colorado coverage if they had a lower income or are presumptively eligible for the benefit.

Click here to learn more.

Connect for Health Colorado Marketplace Open Enrollment
Connect for Health Colorado is the state’s official health insurance marketplace, and it’s the only place to get financial help to pay for health insurance. If you have members that don’t quality for Health First Colorado, CHP+ or private insurance, please let them know they can enroll in the Connect for Health Colorado Marketplace through January 15, 2023. If they enroll by December 15, 2022, their coverage can begin January 1, 2023.

Click here for an English flyer to share with your patients. Click here for a Spanish flyer.