JANUARY 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:

Accountable Care Collaborative Phase III Education Sessions for Primary Care Medical Providers

With Accountable Care Collaborative (ACC) Phase III, many changes are coming to improve care access for members, the member and provider service experience, and cost management to protect member coverage, benefits, and provider reimbursements.

You’re invited to three sessions on Wednesdays from 12:00 p.m. to 1:00 p.m. to help prepare you for these upcoming changes. At each session, you will receive key updates and have an opportunity to ask questions. Topics may change as more information from the Department of Health Care Policy and Financing (HCPF) is available.

Wednesday, January 29: Learn more about changes to attribution methodology, medical home payments (per-member per-month (PMPM) payments), and access stabilization payments. Register here.

Wednesday, February 12: Learn more about changes to payments based on integrated behavioral health (IBH) and member acuity. Register here.

Wednesday, February 26 (For enhanced clinical partners (ECPs) only): Learn more about the differences between care coordination expectations and services we offer to members. Register here.

If you have any questions or need more information, please email practice_support@coaccess.com.

Stay updated about previously shared information from Colorado Access here.

Physical and Behavioral Health

End Date for Allowing First Position Modifiers on Claims

HCPF had issued guidance on removing all required first position modifiers to indicate State Plan or "B3" services in the State Behavioral Health Services (SBHS) Billing Manual, as of January 1, 2024. HCPF, RAEs, and Denver Health Medicaid Choice (DHMC) have allowed these modifiers on claims while providers updated electronic health records (EHRs), billing systems, and other workflows, but claims for services provided on or after January 1, 2025, that include State Plan or “B3” modifiers shall be denied by RAEs. EHRs and billing systems should reflect correct coding as detailed in the SBHS Billing Manual.

If you have any questions, please email your program specialist and copy hcpf_bhcoding@state.co.us.

HCPF Provider Escalation Form

The Health First Colorado (Colorado’s Medicaid program) Managed Care Organization (MCO) and Child Health Plan Plus (CHP+) Provider Escalation Form is intended for use by providers contracted (or attempting to contract) with RAEs and/or CHP+ MCOs as an additional level of communication to support providers when needed. Learn more on the HCPF provider help page.

Coordination of Benefits

Some Health First Colorado members may also have Medicare, private insurance, or other insurance. When a member has more than one type of coverage:

• Be sure you are in both networks before you provide services. You cannot bill Health First Colorado without first billing the primary payer.

• Verify both Medicaid and other coverage in the Medicaid Provider Portal.

• If you get paid by Health First Colorado or CHP+ before learning of the primary coverage, immediately bill the primary payer. When you receive payment from the primary payer, return the Health First Colorado payment and resubmit the bill as a secondary payment.

• You cannot bill a Health First Colorado member for any service covered by Health First Colorado, even if the member agrees to pay. You can bill Health First Colorado members only if a service is not covered by Health First Colorado.

Learn more in HCPF’s guidance on coordination of benefits.

News From HCPF

Cover All Coloradans – Expanding Health Coverage for Children and Pregnant People

Beginning January 1, 2025, under Cover All Coloradans, Health First Colorado and CHP+ will offer health coverage to children under 18 and pregnant people, regardless of their immigration status. This new initiative aims to improve health access and equity by providing free health insurance for eligible individuals who may have previously lacked coverage. These members will have access to full Health First Colorado and CHP+ benefits and may seek services from providers with no action required from you.

Cover All Coloradans was established through House Bill HB22-1289 and recognizes the importance of accessible health care for all Coloradans, supporting healthier communities by offering affordable coverage to those who might otherwise be excluded. These members will have access to full Health First Colorado and CHP+ benefits and may seek services from providers without additional action needed by those providers.

Program Details

• Groups who may qualify and should apply, no matter their immigration status:
  
  

  • Children age 18 and younger

  • Pregnant people

  • People whose pregnancy ends on or after January 1, 2025

• Coverage begins January 1, 2025

• Enrollment is open year-round with no cap on enrollment

• Income requirements are based on family size, standard eligibility criteria apply

Frequently Asked Questions

What does this mean for providers?

There will be no change to processes for eligibility checks or submitting claims, but there may be a potential increase in patients seeking services who do not speak English well or at all. Section 1557 of the Affordable Care Act (ACA) requires health care providers who receive federal funding to provide limited English proficiency (LEP) patients with a qualified interpreter.

Is billing for members with Cover All Coloradans eligibility different than billing for other members?

No, you do not need to do anything different when seeing these members.

Do providers have to see members eligible under Cover All Coloradans?

Yes, the Provider Participation Agreement, nondiscrimination section 3.4, represents this newly eligible population.

How will this expansion of eligibility affect providers?

You may see an increase in members seeking services and an increase in members who speak English as a second language or do not speak English at all.

We can assist with interpretation services. Please call us at 800-511-5010.

How can I help?

As a trusted provider, you play a critical role in informing eligible patients about this coverage expansion. By raising awareness and helping patients navigate enrollment, you contribute to improving health outcomes and reducing barriers to care within your community.

Learn more here.

New From Colorado Access

Language Interpretation Services

We offer language interpretation services, including American Sign Language (ASL), for our members’ appointments. To request an interpreter, please go to coaccess.com/interpreterrequest or call us at 800-511-5010. TTY users can call 888-803-4494. We require four business days advance notice to schedule an interpreter, and two business days advance notice to cancel a scheduled interpreter.