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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 highlights important information and resources to help you as a contracted provider with us.
Public Health Emergency (PHE) Update
The PHE ends May 11, 2023. Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) members will return to normal eligibility renewal processes. Noticing began in March 2023 and renewals will start to be due in May 2023. The redetermination process for all Health First Colorado members across the state will take place over 12 months, so not all members will renew at the same time. Members will be due for renewal in the calendar month they enrolled.
Understanding the renewal process will help you to best support your Health First Colorado eligible patients through this transition. Click here to learn more about what they must do for their renewal, including determining eligibility and how to re-enroll.
Learn more about our plan for the end of continuous coverage here. As more updates become available, we will continue to share what this means for you and for our members.
Text Messages Being Sent about Medicaid & CHP+ Renewals
Health First Colorado and CHP+ members are now receiving text messages from HCPF. These text messages are reminders to those members who need to complete renewal paperwork to see if they still qualify for health coverage. These text messages coincide with the resumption of HCPF’s regular renewal processes which were paused the past three years due to the COVID-19 pandemic.
The following messages are being sent in English and Spanish at the beginning of a member’s renewal period. HCPF text messages will originate from 6659 and read:
- Health First Colorado: Complete your Medicaid or CHP+ renewal. Go to CO.gov/PEAK or the Health First CO app. More info at: hfcgo.com/4. Reply STOP to opt out.
Text messages from health plan partners will be sent in April for members whose renewals are due in May and may originate from different numbers depending on where a person lives.
They will read:
- [Health Plan]: Don't wait: Complete your Medicaid or CHP+ renewal now on CO.gov/PEAK or the Health First CO app. Learn more: hfcgo.com/4. Reply STOP to opt out.
- [Health Plan]: Renew your health coverage now! Complete and sign your renewal packet at CO.gov/PEAK. Questions? Learn more: hfcgo.com/4. Reply STOP to opt out.
Telehealth Coverage of Well Child Checks Discontinued
During the PHE, telemedicine coverage for well child checks was added, but to align with the end of the PHE, this coverage will be discontinued as of May 12, 2023. You will still be reimbursed for in-person well child checks. Affected procedure codes include 99382, 99383, 99384, 99392, 99393 and 99394. Learn more here. If you have any questions, please email Morgan Anderson at morgan.anderson@state.co.us and Naomi Mendoza at naomi.mendoza@state.co.us.
QNXT Shutdown
On November 1, 2022, we moved to a new claims processing system. This has not changed, and will not change, the process you use to submit and appeal claims. Our six-month runout period for claims with a date of service of October 31, 2022 or earlier with our former claims processing system will end on April 30, 2023.
The timely filing requirement for claims submission remains 120 days from the date of service. Provider-carrier disputes must be submitted within 60 calendar days from the date of the incident on which the dispute is based or the explanation of payment (EOP) on which the disputed claim appears. Active credit balances in the legacy claims system as of April 30, 2023 will be moved to the new claims system.
We will no longer use Change Healthcare for payments issued after April 30, 2023. We will now be using PNC/Echo for all claims with a date of service November 1, 2022 and later. You can continue to access EOPs and other historical claims payment information through the Change Healthcare portal for claims with a date of service October 31, 2022 and before. If you use a third-party billing service, please share this information with them.
If you have any questions, please email us at providernetworkservices@coaccess.com.
2023 Health Equity Plan Public Meetings
HCPF has multiple health equity plan public meetings coming up. These meetings are for providers, members, and community stakeholders to learn more about the plan and give input and feedback.
- Wednesday, April 19, 2023 from 3:00 p.m. to 4:00 p.m.
- Focus: Asian-American Pacific Islander (AAPI) community
- Register here.
- Tuesday, May 9, 2023 from 12:00 p.m. to 1:00 p.m.
- Focus: LGBTQ+ community
- Register here.
- Tuesday, May 23, 2023 from 3:00 p.m. to 4:00 p.m
- Focus: American Indian/Alaska Native community
- Register here.
- Wednesday, June 21, 2023 from 1:00 p.m. to 2:00 p.m.
- Focus: African American community
- Register here.
- Tuesday, August 22, 2023 from 12:00 p.m. to 1:00 p.m.
- Focus: Disability community
- Register here.
- Tuesday, September 26, 2023 from 3:00 p.m. to 4:00 p.m.
- Focus: Latino community
- Register here.
Substance Use Disorder (SUD) Provider Forum
HCPF is partnering with the Behavioral Health Administration (BHA) on quarterly joint forums for SUD providers. The next 2023 forums will be on the first Wednesday of July and October from 2:00 p.m. to 3:00 p.m. Click here to register for any or all meetings.
Learn more about the SUD benefit here and here. You can also sign up for the monthly newsletter here.
Provider Services Call Center Virtual Agent
The HCPF provider services call center has a virtual agent, “GABBY™,” that’s designed to listen and respond to callers. The virtual agent is available 24 hours a day, seven days a week. You can use keywords like “prior authorization” or “password” to get transferred to the correct queue. Learn more here.
Aira Partnership
The state of Colorado is partnering with Aira to connect people who are blind or have low vision to interpreters. This will help remove barriers around navigating state locations and digital services. Learn more here or watch this video.
COVID-19 Booster Shot for Children
In March 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech bivalent COVID-19 vaccine to allow it to be used as a booster shot for children 6 months through 4 years old. Learn more here.
Statewide Utilization Management Standards for Behavioral Health Providers
HCPF has been working with the Regional Accountable Entities (RAEs) to create statewide standardized utilization management (SSUM) guidelines to assess the most appropriate level of care for children referred for residential treatment. These guidelines complement national UM standards RAEs use to authorize behavioral health services. They have information about Qualified Residential Treatment Programs (QRTP) and Psychiatric Residential Treatment Facilities (PRTF).
Starting July 1, 2023, RAEs will be required to use these guidelines in their UM processes.
Learn more here. If you have any questions about the SSUM guidelines, please email John Laukkanen at john.laukkanen@state.co.us.
Updated Rule Definition
The definition of a supervised encounter at federally qualified health centers (FQHCs) was updated as of September 30, 2022. The update adds a “candidate permit as a clinical social worker candidate (SWC) to the supervised provider types that can generate a billable encounter.” This means that supervised visits with SWCs will be paid as FQHC encounters with the prospective payment system. Learn more by searching for 8.700.1.B.1 here. If you have any questions, please email Morgan Anderson at morgan.anderson@state.co.us.
For Obstetrics and Maternity Providers: Revised Obstetrical Global Billing Requirements
View updates to obstetrical billing requirements here. The Obstetrical Care Billing Manual will be updated as well. If you have any questions, please email Melanie Reece at melanie.reece@state.co.us or call the provider services call center at 844-235-2387 from 7:00 a.m. to 5:00 p.m. Monday through Friday.
2022-2023 Respiratory Syncytial Virus (RSV) Season and Vaccine Update
Health First Colorado has been monitoring the RSV season in Colorado and reassessed member needs based on virology reporting from the Centers for Disease Control and Prevention (CDC) and guidance from the American Academy of Pediatrics (AAP). An approved maximum of five doses of Synagis will be maintained through the Colorado RSV season end date of April 28, 2023. Learn more here.
Doc2Doc Well-Being Consulting
The Colorado Medical Society has three free, confidential peer well-being consultation sessions available for any Colorado physician or medical student. Call their hotline 24 hours a day, seven days a week at 720-810-9131 to talk to a masters-level licensed clinician. Learn more here.
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