MARCH 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 begins 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 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, March 26: Learn more about Innovaccer, a new technology platform that will power our provider reporting and support data-driven decision-making, care coordination, and value-based care. Register here.

Thursday, April 17:Learn more about the upcoming Medical Home Payment Model that launches July 1 and get a breakdown of our payment structure. Register here.

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

Stay updated about previously shared information regarding ACC Phase III 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.

Provider Services Call Center Vendor Transition

The Health First Colorado (Colorado’s Medicaid program) Provider Services Call Center will transition from Gainwell to OptumInsight (Optum) on May 1, 2025. Learn more here.

New Criteria for Pediatric Behavioral Therapies

New criteria were posted after working with the pediatric behavioral therapy provider community that aims to ensure evidence-based, high-quality care for children and youth who require behavioral interventions. Learn more here.

Colorado Medicaid eConsult Update

Did you know that Health First Colorado providers have access to a free, secure statewide eConsult platform that allows primary care medical providers (PCMPs) to communicate electronically with specialty providers and can often eliminate the need for in-person member referrals? 20 adult specialties and 16 pediatric specialties are available:

• Adult: Addiction medicine, allergy and immunology, cardiology, dermatology, endocrinology, gastroenterology, geriatric medicine, obstetrics and gynecology, hematology/oncology, hepatology, infectious disease, nephrology, neurology, orthopedics, otolaryngology (ENT), pain medicine, physical medicine/rehabilitation, psychiatry, pulmonology/sleep medicine, rheumatology, and urology.

• Pediatric: Allergy and immunology, cardiology, dermatology, developmental pediatrics, endocrinology, gastroenterology, hematology/oncology, infectious disease, nephrology, neurology, orthopedics, otolaryngology (ENT), psychiatry, pulmonology, rheumatology, urology.

• Adult obstetrics and gynecology specialists are available to respond to eConsults for adult and adolescent patients 14 and older.

Complete the practice enrollment form or register for a monthly webinar to begin the enrollment process, and if you have any questions, send an email to coloradosupport@safetynetconnect.com.

Money Follows the Person (MFP) Services and Provider Training

This training on Wednesday, March 19, from 1:00 p.m. to 3:00 p.m., is for providers and organizations directly involved in the State’s MFP and Transition Services programs. The State’s MFP Demonstration is set to implement in May 2025, and the training will cover provider enrollment and requirements, as well as service requirements. Register here.  

Third-Party Liability

Providers cannot bill members for copays or deductibles assessed by third-party resources or bill members for the difference between commercial health insurance payments and their billed charges when Health First Colorado does not make an additional payment. The member’s commercial health insurance must be billed first, and lower-of pricing is used to calculate Health First Colorado reimbursement. Learn more on the third-party liability and recoveries webpage and in the general provider information manual.

News From HCPF

Child Health Plan Plus (CHP+) Transplant Benefit Update

CHP+ is low-cost health insurance for children and pregnant people whose households earn too much to quality for Health First Colorado, but not enough to pay for private health insurance. As of July 1, 2025, the maximum lifetime benefit for major organ transplants for $1,000 per member is being removed per a federal final rule. Learn more on the CHP+ webpage, and if you have any questions, please email hcpf_chpplus@state.co.us.

How to Help Members with MedRide Contract Termination

As of February 7, 2025, HCPF terminated its contract with MedRide, LLC (a NEMT provider), which means MedRide is no longer allowed to provide NEMT services for Health First Colorado. MedRide failed to comply with the corrective action plan the company agreed to in November 2024, which required credentialing and revalidation, including driver background checks and vehicle inspections (which are required for all NEMT providers), no later than February 1, 2025.

More than 130 other NEMT providers who have completed revalidation and credentialing are now available to help members:

• Members in the Denver area can call Transdev Health Solutions at 303-398-2155 or 720-279-3830 to schedule a ride

• Members outside of the Denver area can contact a provider from the NEMT service area list of more than 100 providers. Providers who are authorized to be on this list must follow state and federal rules, including not requesting or accepting payment from members for NEMT rides.

• Members can call the Member Contact Center at 800-221-3943 or go to hcpf.colorado.gov/nemtlist to find a new provider or other transportation services. Callers with speech or hearing disabilities should use State Relay 711.

Upcoming Trainings

Colorado Prior Authorization Request Program (ColoradoPAR) Training

Acentra Health is offering benefit-specific PAR submission training on how to submit a PAR using their provider portal, Atrezzo®. Learn more and register for a session here. If you have any questions, please email coproviderissue@acentra.com.

Neurology, Endocrinology, and Pediatric Psychology Trainings 

Extension for Community Health Outcomes (ECHO) Colorado is hosting multiple training sessions on various topics:

• Access to Neurology: Collaboration in Neurologic Care
  
  

  • Thursdays from 12:00 p.m. to 1:00 p.m. for 10 weeks from April 17 through June 19

  • Learn more and register here.

• Endocrine Explained
  
  

  • Tuesdays from 12:00 p.m. to 1:00 p.m. for 11 weeks from April 1 through June 10

  • Learn more and register here.

• Pediatric Psychiatry in Primary Care: Core Essentials
  
  

  • Thursday from 7:30 to 8:30 a.m. for seven weeks from March 20 through May 1

  • Learn more and register here.

Colorado Pediatric Psychiatry Consultation & Access Program (CoPPCAP) Survey

CoPPCAP has a survey to help them better understand the mental health landscape community providers practice in and what they can do to continue to support you. Survey answers will be used by their team to help develop future programming. Take the survey here.

Signatures on Paper Claims

Claims must be signed or stamped by the enrolled billing provider or by an authorized agent or representative designated by the enrolled billing provider. Types-in names are not acceptable. The red-ink forms must be used for paper claims and cannot be photocopies. Please use black ink to complete the forms. For Professional (CMS-1500) claim forms, ensure box 31 is signed. For Institutional (UB-04) claim forms, complete and sign the Instituational Provider Certification and mail it with the paper claim. Paper claims mailed without the proper signatures will be denied.

Only authorized providers who submit five or less claims per month may submit paper claims; all other providers must submit claims electronically, even if an attachment is required. Mail any exemption requests to Gainwell Technologies, PO Box 30, Denver, CO 80201-0030.

Learn more in the “Authorized Signatures” section of the “General Provider Billing Manual” and the “General Claim Completion Instructions.”

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Program Training

EPSDT training is important to ensure you are updated with the latest guidelines and best practices for providing comprehensive care to children with Health First Colorado. The program focuses on preventive health care, including regular screenings, vaccinations, and diagnostic services essential for the early detection and treatment of health conditions. Trainings are released in January and July.