AUGUST 2025

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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 Phase III Updates

Accountable Care Collaborative (ACC) Phase III began this month, 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.

• Primary care medical providers (PCMPs): HCPF has released a new fact sheet to help you plan for your primary care practice in ACC Phase III. Learn more about changes for Phase III in the Attribution fact sheet and the PCMP Payment Structure fact sheet.

  • If you experience issues due to the transition or you have questions around contracting, payment, attribution or member care coordination and support, contact your RAE first.

• Members and organizations supporting members: Resources are available on the Member Messaging Resource Center.

  With program changes for ACC Phase III, including new RAE regions, some members may have a new PCMP or RAE or may be newly enrolled in one of the two managed care organizations (MCOs).

  • Members that want to update or select a new PCMP can contact Health First Colorado Enrollment.

  • Members enrolled in an MCO that want to opt out will receive instructions in a letter from Health First Colorado. Contact Health First Colorado Enrollment if you have any questions.

  • Members with questions or concerns about this transition can contact Health First Colorado Enrollment or their RAE.

  • Members who are on Home and Community-Based Services (HCBS) waivers and were newly enrolled into Elevate (Denver Health) Medicaid Choice as of July 1 can get more information in the System-Wide Issues and Resolutions Log.

• For all ACC Phase III: Complete this form if you have been notified of or are experiencing a critical issue due to the transition that could not be resolved through the above steps. Identified issues that may impact a larger number of stakeholders will be documented on this System-Wide Issues and Resolutions Log.

Physical and Behavioral Health

Discontinuation of Provider Specialty Type 64/477

On July 1, 2025, new specialty types (ST) were added under provider type (PT) 64 (substance use continuum) to align with BHA endorsements. Providers should no longer be enrolled with ST 477. All substance use disorder (SUD) providers who currently have an ST 477 enrollment must submit a maintenance request through Gainwell to modify your ST to align with your BHA endorsement for level of care. Claims with dates of service after December 31, 2025, will be denied when billed by provider specialty type 64/477. If you have any questions about this, please email hcpf_sudbenefits@state.co.us.

Notification of Colorado Medically Unlikely Edits (CO MUEs)

Starting October 1, 2025, HCPF will apply CO MUEs and Procedure-to-Procedure (CO PTP) edits for services that do not have National Correct Coding Initiative (NCCI) edits. Learn more here, and email hcpf_sudbenefits@state.co.us if you have any questions.

HCPF Wants Input on Supervision Policy

To allow for time to gather input and provide clarity on policy changes, HCPF is delaying implementation of updates to the Supervision Policy for Medicaid Billable Behavioral Health Services and reverting the updated policy to a draft. Between now and August 30, you can submit your written feedback using this Google Form, or attend a meeting to provide verbal feedback. Please register for the next Zoom meeting on Monday, August 18 from 5:00 to 6:00 p.m. here.

After feedback is collected, HCPF will share a revised policy. Attestations will not be required until the final policy is posted and takes effect, which is expected on January 1, 2026. Learn more here.

New Integrated Care Policy Published

This new policy is now available here. There are also new rates for the Collaborative Care Model (CoCM) and Health Behavior Assessment and Intervention (HBAI) here. Additional updates were made to the guidelines for billing the HBAI and CoCM codes compared to the HCPF billing system on July 18, 2025. If you have any questions, please email hcpf_integratedcare@state.co.us.

Behavioral Health Secure Transport (BHST) Billing

As of July 1, 2025, BHST is included in the capitation and paid by the Regional Accountable Entities (RAEs). This change will require providers to contract with the RAEs to bill for payment.

BHST is a benefit for all Health First Colorado members who are experiencing a behavioral health crisis and require urgent transportation for behavioral health stabilization and treatment.

The required codes/modifiers to be billed for these services are:

* When submitting a claim, providers must use modifier ET to get reimbursed.

Colorado Health Foundation Public Briefings

There is one more upcoming public briefing to go over the Colorado Health Foundation’s recent survey. Register for any or all sessions and learn more here: Insights from Hispanic and Latino Coloradans: Wednesday, September 10, 5:30 p.m. (Presented in Spanish and English with simultaneous interpretation)

Health-Related Social Needs (HRSN) – Nutrition Benefit Stakeholder Webinars

The Department of Health Care Policy and Financing (HCPF) is hosting webinars to share feedback and ask questions about the development and implementation of the nutrition benefits under the HRSN initiative.

• Medically-tailored meals: Wednesday, September 10, 12:00 p.m. to 1:30 p.m.

• Other benefit details: Wednesday, October 15, 12:00 p.m. to 1:30 p.m.

Register for the meetings and learn more here.

NCCI Notification of Quarterly Updates

Monitor the Centers for Medicare & Medicaid Services (CMS) website for updates to NCCI rules and guidelines. Updates to the procedure-to-procedure (PTP) and medically unlikely edit (MUE) files are completed quarterly. Learn more here.

Resources for Behavioral Health Providers

The Behavioral Health Initiatives and Coverage (BHIC) office at HCPF offers regular forums, meetings, and office hours for behavioral health providers. Learn more on their calendar or sign up for their newsletter to stay informed. If you have any questions, please email hcpf_bhbenefits@state.co.us.

Breast Pump Equipment Bundle

As of July 1, 2025, you may supply a bundle of breast pump equipment that includes: one manual pump, one single-user electric pump, and one set of replacement shields/flanges (when all three items are provided on the same day of service). This bundle is billed using Healthcare Common Procedure Coding System (HCPCS) E0603 and modifier U1. All components of this bundle must be supplied when submitting a claim. If you have any questions, please email alaina.kelley@state.co.us.

Colorado Medicaid eConsult Update

The eConsult free, secure, statewide platform allows primary care medical providers (PCMPs) to consult electronically with experts, often reducing the need for in-person referrals for members. As of July 1, 2025, eConsult has expanded to support specialty-to-specialty consultations. The existing PCMP user role is now a general “submitter” role, which allows specialists, including medical doctors (MDs), doctors of osteopathic medicine (DOs), nurse practitioners (NPs), and physician assistants (PAs) to initiate eConsults as treating practitioners.

The billing manual will be updated to reflect these changes, enabling third-party platforms to implement and submit claims for specialty-to-specialty reimbursement. Learn more here, and if you have any questions, please email:

• hcpf_econsult@state.co.us for more information about this feature

• coloradosupport@safetynetconnect.com for help with platform access and more technical support

News From HCPF

Health First Colorado Behavioral Health Updates

Read more here.

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, October 16, 2025, 12:00 to 1:30 p.m.

Behavioral Health Crisis Services Updates

The 988 Colorado Mental Health Line is now the primary way to connect to free emotional, mental health, or substance use support 24 hours a day, seven days a week, as a result of Senate Bill (SB) 25-236. As of July 1, 2025, if someone tries to call or text Colorado Crisis Services, they will be connected to 988 Colorado. Learn more here, or email 988colorado@state.co.us if you have any questions.

Prevent Inactivation of Provider Web Portal Accounts

If you are a delegate or trading partner, please make sure to log into the provider web portal regularly to prevent inactivation. This does not apply to administrators.

For new accounts, if the delegate or trading partner account has no login activity for a period of 60 days, the status automatically changes from “active” to “inactive.” For existing accounts, if the delegate or trading partner account has no login activity for a period of 90 days, the status automatically changes from “active” to “inactive.”

Learn more in the Delegates Quick Guide and the Link the Trading Partner Identification (TPID) Quick Guide on the Quick Guide webpage.

Refer to the Disenrollment Quick Guide webpage and the Provider Enrollment Manual if a TIN change is required. Refer to the Updating Legal Name and Tax Identification Number Quick Guide for more information.

Updating Legal Name and Tax Identification Number (TIN)

During enrollment, you’re asked to enter your TIN and legal name on the “request information” panel in the provider web portal. That information is compared against the Internal Revenue Service (IRS) record. If it doesn’t match, all subsequent claims submitted for processing are placed on a payment hold. If you need to update your legal name, you can submit a legal name change form in the provider web portal.

The TIN cannot be changed after enrollment. If the TIN is incorrect, you must disenroll and submit a new enrollment with the correct TIN. Compare the TIN on your profile in the provider web portal to the TIN on IRS form 147c to determine if disenrollment and reenrollment is required.

Resources

• For a TIN update:

  • Disenrollment Quick Guide webpage

  • Provider Enrollment Manual

• Updating Legal Name and Tax Identification Number Quick Guide

Recently Updated Billing Manuals and Fee Schedules

Billing Manuals

• Appendix Q - Revenue Code Table

• Appendix R – Remittance Advice (RA) Messages

• Appendix X - HCPCS/NDC Crosswalk for Billing Physician-Administered Drugs

• Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

• Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC)

• Wheelchair Benefit Coverage Standard

Go to the Billing Manuals webpage for all published manuals.

Fee Schedules

• Home & Community-Based Services - Elderly Blind and Disabled (EDB), Community Mental Health Supports (CMHS), Brain Injury (BI), and Complementary and Integrative Health (CIH) 

• Home & Community-Based Services - Developmental Disabilities (DD), Supported Living Services (SLS), Children's Extensive Supports (CES)

• Integrated Care Fee Schedule FY25-26

• July 2025 Health First Colorado Fee Schedule

• Physician-Administered Drug Fee Schedule for Q1/Q2/Q3 2025

Go to the Provider Rates and Fee Schedule webpage for all published fee schedules.

Certified Community Behavioral Health Clinic (CCBHC) 

Monthly Stakeholder Forum

HCPF and the Behavioral Health Administration (BHA) are hosting a monthly public meeting for members, providers, individuals with lived experience and their families, advocates, state agencies, managed care entities, and anyone interested in learning more about the CCBHC model in Colorado. Register for one or more upcoming sessions here:

• Wednesday, August 27, at 1:00 p.m.

• Wednesday, September 24, at 1:00 p.m.

• Wednesday, October 29, at 1:00 p.m.

Learn more here.

Electronic Data Integration (EDI) Vendor Transition

EDI functionality, including batch processing and trading partner enrollment, will transition from Medicaid Management Information System (MMIS) operated by Gainwell Technologies to a new module operated by Cotiviti (formerly Edifecs). This will only affect trading partners who submit batch transactions for providers. Please ensure that the clearinghouse or billing agent is aware of these changes and in compliance before implementation.

What is staying the same?

• You may still use the provider web portal submit individual claims, maintain enrollment, verify individual eligibility and more.

• You may also still contact the provider services call center with any questions about claims, the provider web portal or EDI.

• Optum agents will still have access to the EDI systems and can answer your questions about EDI.

• Trading partners will retain the same trading partner IDs.

What is changing?

• Existing trading partners will need to test and sign a new agreement.

• New Secure File Transfer Protocol (SFTP) credentials will be issued.

The new EDI transition is scheduled to be implemented in the late summer of 2026, with phased implementation starting in 2025. Learn more on the Electronic Data Interchange (EDI) Support webpage and Colorado Medicaid Enterprise Solutions (CMES) Transition webpage. You can also sign up for targeted communications here.

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 2.0, 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.

Claims Auditing Vendor – EXL

EXL is our external claims auditing vendor. EXL also reviews medical records for correct coding on our behalf. If you receive a request for information from EXL about a claim filed with us, please respond accordingly.

Smart Data Stream (SDS) Clearinghouse Service

We recently partnered with SDS to access their provider portal for direct claim entry, which eliminates the need to complete and mail a paper claim. This will result in faster turnaround time for claim processing and faster receipt of payment from the payor. This service is free for you to use. Read the user guide here and be sure to select the Colorado Access payer ID to establish the connection. If you have any questions, please email providernetworkservices@coaccess.com.

Please note: This is not intended to replace your current clearinghouse for electronic submissions; it is a more efficient avenue to submit paper claims.

Provider Self-Service From Now Available Online

The provider self-service form is now live on our website! This form is designed to streamline your communication with our provider teams. your questions will be routed directly to the appropriate department, saving you time and ensuring quicker responses. You can access the form anytime at coaccess.com/providers in the “Provider Self-Service Form” section at the top of the page.

Business Associate Agreement (BAA) Required for Third-Party Billing Communications

As a reminder, we cannot release protected health information (PHI) – such as claims data, vouchers, or copies of contracts – to third-party billers or consultants without a valid BAA on file. This agreement must be established between the provider and their third-party representative, and grants permission for payers like Colorado Access to communicate with them. Additionally, providers should be included in all communications involving third-party billers or consultants when PHI is involved.

Our contracting and compliance teams are working together to ensure these agreements are requested, filed, and honored. If your practice works with a third-party biller or consultant, please make sure a BAA is in place and send a copy to our contracting team for our records.

We will share more detailed guidance in the provider manual and other future communications.

Upcoming Trainings

On-Demand Caring for Gender-Diverse Patients: Essentials for Primary Care

The Extension for Community Health Outcomes (ECHO) Colorado is hosting an online, on-demand, multi-part course targeted to primary care providers (PCPs) that aims to improve provider skills in delivering culturally-competent, gender-affirming care. Modules focus on the fundamentals of transgender and gender-diverse (TGD) care including creating gender-affirming spaces for patients, mental health, feminizing and masculinizing hormone therapies, preventive care, sexual health and surgeries for adult TGD patients. All health care professionals are welcome to register. Register here.

Provider Enrollment Training and Billing Training

Provider Enrollment Training
This is designed for providers at various stages of the initial enrollment process with Health First Colorado (Colorado’s Medicaid program). It provides an overview of the program and guidance on the provider application process, enrollment types and common errors. It also provides information on next steps after enrollment. Register here for the session on Tuesday, August 19, from 1:00 p.m. to 3:30 p.m.

Billing Training - Medicare and Third-Party Liability
This addresses billing Medicare and third-party liability (TPL) (e.g., commercial and private insurance) as primary payers, including detailed information on Medicare lower-of pricing logic and timely filing guidelines. This training is not relevant to Home and Community-Based Services (HCBS) and Non-Emergent Medical Transportation (NEMT) providers. Register here for the session on Thursday, August 21, from 1:00 p.m. to 2:30 pm.

Expand Your Impact in Youth Behavioral Health

If you currently deliver NWIC High-Fidelity Wraparound (HWF), Multisystemic Therapy (MST), or Functional Family Therapy (FFT) services, you may want to participate in an upcoming session related to the Colorado System of Care (CO-SOC). Learn more here.

PCMP Learning Community

The practice innovation program at University of Colorado (CU-PIP) is running learning community sessions for PCMPs to support success through the new ACC Phase III payment program. The sessions are planning for the second Thursday of the month at 12:00 p.m. Register here, and learn more here.

Other Resources

Gun Violence Prevention Resources

The Office of Gun Violence at the Colorado Department of Public Health and Environment (CDPHE) has a bilingual statewide “Let’s Talk Guns, Colorado” campaign designed to reduce firearm injuries and deaths through education and open dialogue. The campaign websites, letstalkgunscolorado.com in English and coloradohablemosdearmas.com in Spanish, offer valuable tools, including safe firearm storage best practices, guidance on reporting lost or stolen firearms, information about Extreme Risk Protection Orders (ERPOs) and access to mental health and substance use treatment resources. For Health First Colorado providers and Regional Accountable Entities (RAEs), these resources can support conversations with clients about firearm safety, particularly when addressing mental health concerns or substance use issues.

Colorado’s Extreme Risk Protection Hotline is available 24 hours a day, seven days a week at 855-999-3776 to provide information abot ERPOs when there are concerns about someone’s access to firearms. Email molly.siegel@state.co.us if you have questions or need more information.