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At Colorado Access, caring for you and your success is our top priority as you serve our members. With so much information out there, this monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with Colorado Access.
In the past, we have sent out monthly Navigator newsletters in addition to our weekly COVID-19 update. We are excited to introduce a new format
where we can share relevant information about not only COVID-19, but important Colorado Access information monthly, as a Provider Update.
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Virtual Care Collaboration and Integration (VCCI) Program: Our VCCI program is now accepting new practices. The program is designed to support primary care practices in our network with addressing and managing behavioral health within the primary care
medical home. It offers rapid response to the VCCI team of clinicians and psychiatrists, with consultation services, direct patient care over telehealth, short-term counseling, medication management, eConsults, online scheduling, and more, all to increase access to behavioral health care for our eligible member population.
The VCCI program is a short-term treatment and brief intervention program that emphasizes collaborative, team-based care and care coordination. We work with primary care providers in the program to determine the best course of treatment for patients. Since its inception in July 2017, the VCCI program has provided more than 5,000 total service encounters. Our experienced staff have designed workflows and protocols to make the VCCI program work within almost any primary care practice. If you are interested in learning more about the program, please email acs@acccesscare.com to set up an introductory meeting.
- HO Modifier: Behavioral health providers who are not eligible to enroll in Medicare (such as licensed professional counselors (LPC), licensed marriage and family therapists (LMFT) and licensed addiction counselors (LAC) and who provide services to members with dual eligibility (Health First Colorado (Colorado's Medicaid program) and Medicare), must use the modifier "HO" in the last position on a claim to indicate Health First Colorado is the primary payer for the service. This guidance is published in the July 1, 2022 edition of
the Uniform Service Coding Standards (USCS) Manual.
In accordance with Department of Health Care Policy and Financing (HCPF) guidance, when a member is eligible for both Medicare and Health First Colorado (sometimes referred to as “dual eligibles” or “duals”), you should process claims through Medicare before billing the Medicaid Capitated Behavioral Health Benefit. If you are not eligible to bill Medicare (LPC/LMFT/LAC) you can submit claims directly to us. These claims are to include modifier HO in the last position of a claim to indicate a provider is not eligible to be covered by Medicare. In these circumstances, Colorado
Access is only able to pay claims that include this modifier.
- Access to Care Standards: We uphold and monitor Access to Care Standards for physical and behavioral health services to assure timely, appropriate routine and urgent services are available to members. If you are unable to provide an appointment within the required timeframes, please refer the member to our customer service team at 800-511-5010 to find services within the required timeframes. If you have any questions about Access to Care Standards, please email us at qualitymanagement@coaccess.com.
- Clinical Practice Guideline Update: We adopt clinical practice guidelines that are known to be effective in improving health outcomes to ensure adequate informational support for network providers and members. These guidelines include topics that relate to well child care; perinatal, prenatal, and postpartum care for pregnant people; and conditions related to people with a disability or special health care needs. We revised and updated these clinical practice guidelines during a recent review by a cohort of our
medical directors. We also updated resources on generalized anxiety disorder, bipolar disorder, gastroesophageal reflux disease, health equity, immunizations, COPD, appropriate antibiotic use, and other resources that are applicable to our members.
You can find these clinical practice guidelines and additional resources on our website. We make these guidelines available to providers, members, and other
interested parties at no cost. If you have any questions or have a suggestion for a clinical practice guideline or resource, please email us at qualitymanagement@coaccess.com.
- Claims Payments:
All in-network providers can submit paper and electronic claims by fax, clearinghouses, and through our provider portal. If you have questions about submitting claims, please read section 6 of our provider manual.
You must have enrollment and validation requirements completed to continue receiving claim payments when the PHE ends. Some enrollment requirements, including application fees, fingerprinting, and site visits may have been waived for the PHE, but may be required once it ends. Check your enrollment status and requirements with the provider services call center.
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