JUNE  2022

Dear Health Community Colleague,

Welcome to the June Navigator. In this issue, you’ll find information about the end of the public health emergency, how to update your license, fundamentals of addiction medicine training, our expansion into Kit Carson County, and the new Behavioral Health Organizational Provider Endorsement (BHOPE) process, in addition to other important information.

If you want to learn more about anything in this issue of the Navigator or just have a question, please contact us. You can also connect with us on any of our social media channels using the links below.

In good health,
Colorado Access

The Public Health Emergency
Click here for the latest information from the Department of Health Care Policy and Financing (HCPF) about planning for the end of the Public Health Emergency.

Here are three ways you can support this
1. Share with your Health First Colorado (Colorado’s Medicaid program) patients that they need to update their contact information on the PEAK website.
2. Tell your patients to watch for and respond timely to notices from Health First Colorado.
3. Share the Health First Colorado website and social media links so your patients can keep updated and know what to expect.
Colorado Minors Can Now Access Some Vaccines on Their Own
Last year, SB21-016 was passed. This law, Protecting Preventive Health Coverage, allows minors to consent to receive certain vaccines that protect against some common preventable infections. Read more and get fact sheets in both English and Spanish here.
Update License and Revalidate
There have been updates to the License panels of the state’s Provider Enrollment Portal and the Provider Web Portal (Provider Maintenance function). Now, additional information is required when adding a new license or updating/renewing an existing license. This is for enrolled providers only.

Refer to page 2 here for additional information. Or refer to the Quick Guides here for all published HCPF Provider Web Portal Quick Guides. All Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid program) providers must revalidate every five years. Click here for more information.
Submitting Corrected Claims
You may resubmit claims to be reprocessed within 120 days of the date of service or the timeframes that are outlined in your contract or 60 days from the date of the last denial recorded on a voucher.

For more information, please refer to Section 6 of our Provider Manual.
You should routinely review claims and payments to determine if you have received any overpayments. Overpayments requiring recoupment routinely occur in many ways, including, but not limited to:
  • Claims paid in error;
  • Claims allowed/paid greater than billed;
  • Duplicate payments;
  • Payments made for individuals who are not eligible;
  • Payments made for services in excess of applicable benefit limitations; or
  • Payments made in excess of amounts due in instances of third-party liability and/or coordination of benefits. These types of errors are typically discovered through self-disclosure by you or through our claims review and/or audit processes.

These are considered overpayments discovered during the normal course of business, and do not include auditing performed or repayments required specific to fraud, waste, and abuse efforts.

When an overpayment is discovered during the normal course of business, you may be directed to either submit a revised claim on a Non-Clinical Adjustment/Appeal Process Request form available at, or submit a check for the overpayment, at our discretion. Any revised claim adjustments will be reflected as a credit balance and are set off against future claims submitted by you. Repayments for non-participating Providers will be made by check.

For more information, please refer to Section 6 of our Provider Manual.
Health Effectiveness Data and Information Set
Each year we run Health Effectiveness Data and Information Set (HEDIS) rates for a set of core performance measures for our CHP+ HMO health plan. We use HEDIS rates to identify opportunities to eliminate gaps in care and to improve health outcomes for CHP+ HMO members. We benchmark the CHP+ HMO HEDIS rates against regional and national rates each year to prioritize and design internal programs and performance incentive programs across the provider network.

Here are a few key findings from the measurement year 2021 rates:
  • Childhood Immunization Status (CIS): There were 46.81% of eligible members who received all 10 recommended vaccines on or before their second birthday; a nearly 7% decrease from measurement year 2020.
  • Immunizations for Adolescents (IMA): There were 37.74% of eligible members who received one dose of meningococcal vaccine, one Tdap vaccine, and the complete HPV vaccine series on or before their thirteenth birthday; a 4% decrease from measurement year 2020.
Well-Child Visits
    1. 15-30 Months: There were 65.48% of eligible members who received at least two well-child visits with a primary care provider between
    2. 15 and 30 months of life; a nearly 10% decrease from measurement year 2020.
  • Child and Adolescent Well-Care Visits (WCV): There were 48.16% of eligible members 3 to 21 years old who received a well-care visit with a primary care provider or an OB/GYN provider, which is consistent with the measurement 2020 rate.

We want you to know about these rates because you play a critical role in contributing to these HEDIS rates. Stay tuned for more information in upcoming editions of the Navigator. If you have any general questions about HEDIS or measurement year 2021 HEDIS rates, please email our quality team at
The Future of Medicaid After the Public Health Emergency
Medicaid leaders have faced many unique pressures during the public health emergency. In this episode of the "Medicaid Leadership Exchange" podcast, three former Medicaid directors explore what they would prioritize, both now and when the emergency unwinds. Listen to the podcast here.
Vivent Health
Vivent Health, located in Denver, has been at the forefront of the fight against HIV since the earliest days of the epidemic. They are committed to being a respectful, caring partner serving everyone affected by HIV through our comprehensive, integrated prevention, care and treatment programs. Click here to read a timeline of their history. Learn more about Vivent Health here.
Adolescent Reproductive Health and Contraception for Nurses in Primary Care
This series reviews adolescent reproductive health topics, including taking an adolescent sexual health history, minor consent and confidentiality, and STIs in teens. It also provides an overview of available contraceptive methods, patient-centered contraceptive counseling, and strategies for addressing common concerns and side effects of birth control methods. This training begins Thursday, July 28, 2022 and goes through Thursday, August 25, 2022, and meets from 7:00 a.m. to 8:00 a.m. Sign up here.

Not interested in this one? You can find more ECHO trainings here.

COVID-19 Resources

For COVID-19 utilization management information, click here.

For COVID-19 pharmacy information, click here.

For COVID-19 administrative information, click here.

For COVID-19 training information, click here.

For COVID-19 practice support information, click here.

Pride Month
Each year, Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Pride Month is celebrated in the month of June to honor the 1969 Stonewall rebellion in Manhattan and to recognize the impact of these individuals on local, national, and international history. The Stonewall rebellion was a tipping point for the Gay Liberation Movement in the United States. Like many monthly observances, Pride Month has grown from a singular day of acknowledgement to a global effort to honor the diversity, equity and inclusion of all people. There are parades, picnics and parties, but memorials are also held during this month to honor the members of the community who have been lost to hate crimes or HIV/AIDS.

To become more familiar with what the letters L-G-B-T-Q-I-A are referencing, check out this article.

Federal efforts have consistently been aimed at reducing health disparities in the LGBTQIA population. Eliminating health disparities and enhancing efforts to improve LGBTQIA health are necessary to ensure that individuals can lead long, healthy lives. There are many benefits of addressing health concerns and reducing disparities, including:
  • Lower disease transmission and progression
  • Better mental and physical well-being
  • Lower health care costs
  • More longevity
On June 19, 1865, enslaved persons in Galveston, Texas were finally notified of their freedom. While the Emancipation Proclamation had been signed on January 1, 1863, it took over two years for the news to reach enslaved persons, especially those in the most southern region of Texas. This day in 1865 was met with jubilation and was noted as a long-awaited Day of Freedom for thousands of enslaved people as Texas was the last state of the Confederacy with institutional slavery. Today, Juneteenth is a day to celebrate African American culture and features parades, picnics and parties.

As health care professionals, there are lessons to be learned from this important segment of history. This article from Johns Hopkins Medicine provides six important lessons from Juneteenth that will help provide high quality for all people through critical reflective practice and transformative action.
How CMMI is Addressing Social Determinants of Health, Health Equity
The CMMI Accountable Health Communities model helped address social determinants of health and health equity by screening Medicare and Medicaid beneficiaries for health-related social needs. Read more here.  

Fundamentals of Addiction Medicine
Updated Healthy Mom, Healthy Baby Programming
We are proud to announce our partnership with the American Society of Addiction Medicine (ASAM) to bring a free, on-demand training on addiction medicine to providers within our network. This eight-hour, interactive, care-based workshop is designed for providers who are relatively new to the addiction medicine field who see patients with. You will learn more about addiction medicine and how to screen, diagnose, treat, and/or refer patients with addition. The course will cover patient screening tools, motivational interviewing, appropriate treatment options, and much more.

Registration is now open for this training. Click here to register and create an account with ASAM. Enter code COLORADO2022 on the payment screen to waive fees. Space is very limited, so if you are unable to attend, please make sure to cancel your enrollment.

We offer professional development opportunities for our providers in order to promote the highest-quality care for our members. If you have any questions, please email
RAE Encounter Data Validation Review (411) Behavioral Health Audit
Arrow Performance Group (APG) is conducting 20 provider focus groups with independent behavioral health providers, on behalf of HCPF. The main goal is to address recent behavioral health provider complaints, establish a mutual understanding of issues and opportunities, and build collaborative communication and stronger relationships. The focus groups provide an opportunity for behavioral health providers to give feedback to help improve collaboration with the HCPF and Regional Accountable Entities (RAEs). If you are interested in participating and would like to sign up, you may do so here.

These focus groups are limited to 25 attendees. The first 25 attendees to register in each session using the link above will receive a formal invitation with additional event details. After 25 registrations per session have been reached, a waitlist will be started for each session. Those on the waitlist will receive email notification of their waitlist status and will also be notified by email if seats become available.

If you have questions about registering, please contact Allison Faeder.
BHOPE process
We have a new credentialing process for organizational providers (including integrated care clinics) who wish to use unlicensed clinicians to render clinical services. This was developed to respond to the behavioral health workforce shortage. Our greatest priority is to maintain a high clinical standard of care for our members; our updated policies will help ensure that unlicensed providers within mental health organizations and integrated care settings are receiving appropriate supervision and oversight, with the goal of excellent patient care that also supports expanding the workforce pipeline.

If you are an interested provider, please complete a clinical application and appendix form. Once received, we will schedule a site visit with our staff. You will then be credentialed individually to allow the use of unlicensed clinicians. We are no longer requiring providers to have an OBH clinic designation and will not require providers to obtain a BHE designation.

Unlicensed providers (supervised by a licensed clinician) can include the following:
  • Bachelor’s level staff functioning as case managers, community outreach staff, and/or peers
  • Master’s level interns
  • Master’s pre-licensed clinicians
  • Licensed clinicians not yet validated with Medicaid and/or credentialed with us

If you have any questions, please contact our provider network services team at
Last month we updated the Healthy Mom, Healthy Baby digital engagement programming to include an increased frequency of messages, additional resources, and appointment reminders. This program includes both Regional Accountable Entity (RAE) and CHP+ members and lasts from pregnancy until the baby’s first year. The digital engagement program is a SMS-based (text message based) wellness program for pregnant people age 18 and older. It provides educational messages timed to gestational age or birth age, as well as interactive surveys and reminders to improve maternal and child health outcomes. Text (SMS) messages are intended for pregnant people and new parents with babies up to age 1, and providers. Additional surveys and interactive modules help assess prenatal, postpartum, and well-baby visit attendance, as well as risk factors such as prenatal risk assessment or missed childhood vaccinations. Messages are offered in both English and Spanish.
Tobacco Cessation
If you have patients that need support to quit tobacco products, we have a webpage that offers information that can help. The initial page provides different options that are available to help educate people on the best option for them. It covers different types of tobacco products, including vapes, and includes a diversity, equity and inclusion focus, as it includes specific information on race and ethnicity. Check it out here.
Colorado Access Expands into Kit Carson County
Next month, we are expanding our CHP+ HMO plan into Kit Carson County. Read more here.
11100 E. Bethany Dr.
Aurora, CO 80014

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