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APRIL 2024
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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.
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Peer Services Documentation Standards Education Training
We are excited to announce a new training focused on documentation standards for peer services. This training must be completed by a licensed provider and/or peer supervisor within your organization. It can be downloaded and shared with other peer staff at routine trainings. Only one person from your organization should enroll in the course on our Learning Management System. Click here to complete the enrollment form.
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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.
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Provider-Carrier DisputesReminder: Please read your resolution letter carefully when submitting a provider/carrier dispute. This letter contains important information about whether we upheld or overturned the dispute.
You can submit a provider-carrier dispute on our provider portal. Please view section eight of our provider manual to learn more about provider-carrier disputes.
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Medicare Opt-Out
Newly-eligible Licensed Marriage and Family Therapists (LMFTs), Licensed Professional Counselors (LPCs), and Licensed Addiction Counselors (LACs) were able to enroll in Medicare as of November 1, 2023, and could start billing Medicare as of January 1, 2024. Behavioral health services provided to Medicare members by these practitioners will no longer be allowed to use the HO modifier on claims submitted to the Regional Accountable Entities (RAEs) as of April 1, 2024, and will be required to file claims with Medicare first when Medicare covers the service.
Practitioners eligible for Medicare cannot opt out of Medicare if you choose to serve members who are enrolled in both Medicare and Health First Colorado. The HO modifier can be used only on claims submitted directly to a RAE without a Medicare denial in situations where an enrolled Medicare provider is supervising an unlicensed behavioral health practitioner.
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Upcoming ECHO Colorado Sessions
Click here to view all current ECHO Colorado offerings.
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Arapahoe County Affordable Housing and Community Needs Survey
Arapahoe County receives federal funds to help increase and preserve affordable housing options that benefit low- and moderate-income households. The county is looking for input from residents to help identify priority needs for the Arapahoe County Urban Consortium to spend funds on from 2025 through 2030. Identified priority needs will guide funding from the Community Development Block Grant and HOME Partnerships.
Provide feedback online through May 1 or at an in-person meeting in April. Learn more here.
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Prior Authorization Requests (PARs) With Health First Colorado (Colorado’s Medicaid program)
Primary insurance can also be called a Third-Party Liability (TPL) payer. Primary insurance can be Medicare, commercial, or private, such as United Healthcare, Cigna, or Blue Cross Blue Shield. Health First Colorado is the payer of last resort (42 CFR Part 433 Subpart D). The other insurance is the primary insurance or payer when a Health First Colorado member has other insurance.
Here is a guide for PAR submissions to Acentra when primary insurance is involved.
| When is a PAR required? |
When is a PAR not required?* |
| The primary insurance did not pay on the claim. |
TPL or Medicare paid on the claim for the services billed. |
| The TPL PAR is partially denied by the primary payer. |
TPL covers all of the services provided. |
| The member does not have Medicare or TPL. |
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*Note: This policy does not apply to Physician-Administered Drugs (PADs), which require a PAR if the member has TPL other than Medicare.
Learn more here. If you have any questions about PAR submissions, email coproviderissue@kepro.com or the ColoradoPAR program utilization management team at hcpf_um@state.co.us.
If you have questions about claim submissions, contact the Provider Services Call Center.
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Revalidation
Some of the information on the revalidation application will be auto-populated, so it can’t be changed. To update this information, you must submit a provider maintenance request on the Provider Web Portal. Learn more here.
You cannot submit a revalidation application while an active change application is in process. To reduce delays, please make sure to prioritize your revalidation application process ahead of any other change applications. If you need to request cancellation of an active change application, contact the Provider Services Call Center. After the cancellation is complete, you can submit the revalidation application.
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Helpful Articles
Data suggest that people are more often the origin of infectious diseases in animals than the other way around. Learn more here.
Common household chemicals can be damaging brains. Learn more here.
Amgen sues the state of Colorado over a “price-setting prescription board.” Learn more here.
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COVID-19 Treatment Updates
On March 22, the Food and Drug Administration (FDA) granted emergency use authorization (EUA) for Inviyyd’s monoclonal antibody to prevent COVID-19 in immunocompromised patients. Learn more here.
New data shows that Paxlovid outperforms Molnupiravir against severe COVID-19 outcomes Learn more here.
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Opinion Pieces
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PCMPs, Please Join Us!You're invited to a primary care medical provider (PCMP) forum on Wednesday, May 15, 2024, at 11:30 a.m. that will cover updates to our Administrative Payment Model (APM) that goes live July 1, 2024. This forum will cover:
Programmatic changes
Review of metrics included in the administrative payment models
Review updated performance standards and (spell out acronym) PMPM changes
Discuss enhanced care provider investment opportunity and APM 2 early adoption incentive
Data reporting enhancements
There will be additional time for your questions at the end.
We will send out a registration link later this month and another reminder in the beginning of May.
PCMP contracts will be distributed to the network in May 2024. To avoid any disruption in PMPM payments, please sign and return your contract by June 30, 2024.
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Reinstatement of Long-Term Services and Supports (LTSS) Members Who Lost Eligibility
The Department of Health Care Policy and Financing (HCPF) is working to temporarily pause terminations for LTSS members, but some members got a termination notice effective March 31, 2024. Those members have been reinstated as of April 1, 2024.
Impacted members who got a termination notice for March 31, 2024, will get, or have already gotten, a new notice of action letter with an approval effective April 1, 2024. Electronic messages were sent between Saturday, March 23 and Friday, March 29. Mailed notices were sent between Monday, March 25 and Monday, April 1. If an LTSS member contacts you about a termination notice, please share this information with them. You can also use HCPF’s escalations form when needed to help members stay connected to services.
Learn more here in English and here in Spanish.
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