AUGUST 2024

At Colorado Access, we are committed to caring for you and your success as you serve our members. Our monthly Provider Update highlights essential information and resources to support you as a contracted provider with us.

Checking Credentialing Status

You can now check the status of those approved for credentialing at your clinic. When you log into the provider portal, click "Reports." You will find a report at the bottom of the page with a list of credentialed providers under the clinic tax ID number and the approval/effective date. If you have any questions about credentials, please email credentialing@coaccess.com. 

Change to PNC/ECHO Healthcare Remittance Advice

To facilitate provider reconciliation with fee-for-service payments, we have modified our procedure to offer paper EPPs (explanation of provider payments) and electronic 835s broken down by Regional Accountable Entity (RAE) region, rather than combined under Colorado Access. For example, if you have claims for members in Regions 3 and 5, you will get one reimbursement for Region 3 and another for Region 5. This also means you may receive multiple payments instead of one consolidated payment. This will not affect your current payment method with ECHO/PNC Healthcare or the process by which you get your remittance.

This change will be in effect with the payment run on August 20.

Primary Care Medical Provider (PCMP) Network Feedback

We have several upcoming opportunities for the primary care medical provider (PCMP) network to share feedback on the administrative payment models under ACC Phase III. We will review priority areas identified by the Department of Health Care Policy and Financing (HCPF), provide comprehensive overviews of potential metrics, discuss complex member populations and care coordination objectives, and encourage you to share your insights and suggestions.

All sessions will be held from 12:00 p.m. to 1:30 p.m. online:

• Pediatric focus: Thursday, August 15, and Thursday, August 29

• Adult focus: Wednesday, September 11 and Thursday, September 26

• Reproductive health focus: Tuesday, October 15 and Wednesday, October 30

We recommend that family medicine providers attend both the pediatric and adult sessions.

Your feedback and insights help us refine these models to ensure alignment with our regional goals. Click here to register. If you have any questions, please contact our payment reform team.

Coverage Enrollment Window Extended

The Colorado Division of Insurance (DOI) has extended the enrollment window for people who are no longer eligible for Health First Colorado coverage after the end of the COVID-19 public health emergency (PHE) to November 30.

PHE Unwind Updates

April 2024 was the last month of Colorado's 12-month Medicaid continuous coverage unwind program. HCPF has published renewal reports, and a summary is here.

HCPF has temporarily paused terminations for all reasons for Long-Term Services and Supports (LTSS) members for two months past the member's original termination date unless the termination is for a member who has moved out of Colorado or has passed away. This change will remain in effect until at least December 2024. It replaces the 60-day extension for the renewal period for Long-Term Care (LTC), individuals with Home and Community-Based Services (HCBS), and Buy-In recipients who have yet to return their renewal packet on time.

Ensuring that LTSS members maintain their coverage is a top priority for HCPF, and they are urging the Centers for Medicare and Medicaid Services (CMS) to make temporary waivers that impact LTSS members permanent.

Provider Services Call Center Interactive Voice Response (IVR) System

To reach a live agent, you can say key terms or phrases, such as "EDI," "prior authorization," "I'm not enrolled," "application," or "password," to be transferred to the appropriate provider services call center queue.

You can also say “details,” “detailed information,” or “more details” to reach a live call center agent any time after Health First Colorado ID verification.

Other paths:

• Claims information other than claim status: Say a phrase such as “pricing,” “revenue code,” “electronic visit verification,” or “remittance advice.”

• Provider web portal: Say a phrase such as “portal,” “web portal,” or “add a delegate.”

• Prior authorization: Say a phrase such as “prior authorization,” “PA,” or “PAR.”

• Password inquiries: Say a phrase that contains the word “password.”

More tips:

• The call tracking number (CTN) will be stated at the end, even when you get transferred to a live agent. You can reference the CTN if you make additional calls to the provider services call center.

• When you check a claim status by member ID and date span, use the format “month-day-year.” For example, say "June one, 2024," for June 1, 2024.

• When asked for ID verification, please enter your Health First Colorado ID, not your National Provider Identifier (NPI).

• Key in your provider ID and internal control number (ICN). This is often faster and more accurate than saying the numbers aloud.

Recently Updated Billing Manuals and Fee Schedules

Billing Manuals

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

• Durable Medical Equipment HCPCS Codes
  

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

• Gender-Affirming Care 

• General Provider Information Manual

• Laboratory Services

• Non-Emergent Medical Transportation (NEMT) 

• Physical and Occupational Therapy (PT/OT)

• School Health Services

• State Behavioral Health Services (SBHS) Fee-For-Service Behavioral Health Benefit
  

Fee Schedules

• Child Health Plan Plus (CHP+) Fee-for-Service (FFS) Rates

Accountable Care Collaborative (ACC) Phase II Updates

Learn more from the Department of Health Care Policy & Financing (HCPF) here.

New Auditing Resource for Outpatient Behavioral Health Services

Audits are intended to inform, promote, and evaluate your adherence to documentation standards, support the provision of services that enrich the quality of member care, and continually improve members' lives. They also provide oversight of network providers and ensure adherence to contracts.

There is a new auditing resource that supports documentation for requirements for outpatient behavioral health services provided to Health First Colorado (Colorado's Medicaid program) members. It is not intended to replace or supersede coding-specific guidance in the State Behavioral Health Services (SBHS) billing manual, Current Procedural Terminology (CPT) coding guidelines, or any state or federal regulations, including Centers for Medicare and Medicaid Services (CMS) requirements. It is not comprehensive of regulatory expectations for documentation of services for providers holding specific licenses under the Behavioral Health Administration or expectations for other specific professional licensures or regulatory agencies.

You are also encouraged to develop your own internal audit system.

You can find the tool under “Tools and Resources” here.

Upcoming Extension for Community Health Outcomes (ECHO) Trainings

• For primary care providers: Managing Rheumatic Conditions in Primary Care: Using eConsult Data to Answer Your FAQs
  
  

  • Six weekly virtual sessions, Tuesdays from 12:00 p.m. to 1:00 p.m.

  • September 10 through October 15

  • Registration is optional. You can attend any session.

• For prescribing providers (MD, DO, APP) in Colorado and surrounding areas: Autism: Core Concepts for Primary Care Part 2
  
  

  • Five weekly virtual sessions, Wednesdays from 12:00 p.m. to 1:00 p.m.

  • September 4 through October 9

  • Register here.
    

Kaiser Family Foundation (KFF) Health News Highlights

• Getting A Shingles Vaccine Might Lower Your Dementia Risk 
  

• Florida’s RSV Season Has Started, and It’s Coming Soon to the Rest of US. Here's a Primer

• CNN: Most Young People Who Die By Suicide In The US Do Not Have Previous Mental Health Diagnoses, Study Suggests 

• CBS News: Nearly A Third Of Adolescents Getting Mental Health Treatment, Federal Survey Finds 

• Stat: 48 Million Americans Estimated To Have Substance Use Problem 

• Roll Call: SAMHSA Finds Increase In Nicotine Vaping, Treatment Uptake 

• CIDRAP: CDC Urges Livestock Workers Get Seasonal Flu Vaccine To Cut Pandemic Risk 
  

• Stat: Medical Schools Need To Teach Cost Counseling And Stewardship 
  

Important Communications from HCPF

• Third-party liability and coordination of benefits

• August 2024 bulletin
  

HCPF Decision on Transforming Mental Health (TMaH) Model

HCPF is not reapplying for the CMS TMaH model. The decision to not reapply is based on three main factors:

• TMaH competes with the organization’s stakeholder and maternity Alternative Payment Model (APM) work. TMaH contains a few core design elements, including developing a maternity APM designed by CMS that awardee states must implement in 2029. CMS has an explicit cost-savings goal for this APM.
  
  

  • Colorado is working with stakeholders to develop a maternity APM that will go live in 2026.

  • After working with internal and external stakeholders, HCPF has deliberately excluded a cost-savings goal from their APM. They acknowledge that improved and more equitable outcomes and member experience should be the driving force behind the maternity payment reform.

  • Implementing a CMS-designed APM could “undo the years of stakeholder relationship-building” that HCPF has been working on.

• HCPF wouldn’t be able to spend TMaH funds on its financial priorities. TMaH funding is restricted to a small set of activities that do not include increasing provider rates. HCPF has heard from stakeholders that increasing provider rates is a financial priority, and TMaH wouldn't allow it to do that.
  
  

  • The funding isn't guaranteed, and the measures used to determine progress won't be set until a few years into the model.

  • Historically, when HCPF priorities are out of alignment with strict spending parameters, they underspend grant funds and struggle to sustain models when funding ends.

• Colorado has already made significant progress on many of TMaH’s required and optional model elements. The model parameters would commit HCPF to a 10-year strategic plan for implementing those elements, with little flexibility for change and adjustment. HCPF commented, “Given our vision for maternal health equity in the next 10 years, committing to TMaH might direct our energy toward fulfilling model requirements and working within CMS’ parameters, as opposed to doing the work that we know needs to be done in Colorado.”

Measurement-Based Care (MBC)

We are excited to invite you to a webinar to learn more about MBC, a health care approach focusing on high-quality, patient-centered outcomes. Join us in implementing MBC and be part of this transformative health care movement. Your participation will contribute to evidence-based practice, ultimately leading to better health care for the community. If you want to get involved with MBC, click here to be invited to a webinar.