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Bulletins

Provider Bulletin Index

Provider Bulletin Index (6/2024) - The Provider Bulletin Index contains a list of topics and sub-topics in current and prior year bulletins. To use the Index, simply find your topic and go to the bulletin for the date listed in the far-right column. This is the bulletin in which the topic was published. If you have questions about Provider Bulletins, contact the Provider Services Call Center.

The Provider Bulletin is published monthly and posted to this web page. The bulletin covers topics of interest to providers and billing professionals.

2024: B2400503 - Current

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400509 - 06/24) - Did You Know? Revalidation; Reconsiderations and Appeals; Community Providers in a School Setting; FY 2024-2025 Provider Rate Adjustments; NCCI Notification of Quarterly Updates; Gifts and Inducements to Beneficiaries; ColoradoPAR: General Updates; Ordering, Prescribing and Referring and Attending Provider Claim Requirement; Behavioral Health: General Updates; HCBS: Ensure Account Information is Up-To-Date; HCBS Denver County, Transportation Codes; Hospital: General Updates; Medications List Update; Authorization of Extencilline®; Nursing Facility: Ensure Account Information is Up-To-Date; Attending Providers Claims Requirement; PDL Announcement of Preferred Products; Colorado Medicaid eConsult Update; Free SBIRT Training for Providers; Residential Provider Survey; Movement as a Treatment Tool; Policy Clarification; NEMT Provider Credentialing Program; New Coverage of Corneal Crosslinking; June 2024 Provider Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400508 - 05/24) - Did You Know? Referring NPIs; ECHO Colorado – Online Distance Learning; New Additional Search Options Available; ColoradoPAR: General Updates; myAIRVO™ Accessories; Program Aid Code Changes for Member Eligibility; HCBS: Ensure Account Information is Up To Date; Removal of EVV From Hospice; Hospital: General Updates; Medications List Update; Code 90611 Now a Covered Benefit; STI Testing is Covered Benefit; NF/ACF: Ensure Account Information is Up To Date; Colorado Medicaid eConsult Update; Free SBIRT Training for Providers; Billing Guidance: Avastin® Used for Ophthalmology Treatment of AMD; Telehealth Access Expansion; Equine Movement as a Treatment Tool; OPR Claim Identifier Mandate; Claim Editing for NEMT Providers; Newly Covered Provider Type; May 2024 Provider Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400507 - 04/24) - Did You Know? Claim Submissions; Billing and Eligibility Information for CHP+ Members; Recovery Audit Contractor Information; ColoradoPAR Program Provider Training; Payment Methodology – Virtual Meetings; Changes to HO Modifier Policy; Comprehensive Safety Net Providers Can Now Enroll with Health First Colorado; Finalized Coverage for SB 23-174; DME: Updates for OPR Providers; Updates to the DMEPOS Billing Manual; Hospital: General Updates; Updates to Billing Guidance for Outpatient Claims with a Behavioral Health-Covered Primary Diagnosis Code; Hospital: Updates for OPR Providers; PENBRAYA™ is a Covered Benefit; PT/OT: Reminder: Satisfaction Survey; PAD: Quarter 2 Rate Update 2024; Asthma SMART Therapy Covered; Prescriber Tool APM; Colorado Medicaid eConsult Update; Free SBIRT Training for Providers; Update to SHS Billing Manual; OPR Claim Identifier Mandate; April 2024 Provider Beginner Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400506 - 03/24) - Did You Know? Enrollment Processing Time; Attending Physician NPI Requirement; Expanding HRSN Services in Colorado Stakeholder Kickoff; License Update Reminder; NCCI Notification of Quarterly Updates; New EMS Billing Manual Published; OPR Providers Enrollment Requirement; Timely Filing Information; Verifying Medicaid Coverage Types; Escalating a Concern About an MCE or MCO; FFS Behavioral Health SUD Services Review; DME: Updates for OPR Providers; Hospital: General Updates; Hospital Specialty Drugs Policy: Medications List Update; Hospital: Updates for OPR Providers; Newly Covered Benefits; Reminder: Scheduling Trips with IntelliRide; corrected version 2/28/2024 -Supplemental Rate Increases; PDL Announcement of Preferred Products; Record Keeping and Retention; Colorado Medicaid eConsult Update; eConsults Reimbursement; February and March 2024 Provider Beginner Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400505 - 02/24) - Did You Know? 2024 HCPCS Updates; Revalidation Requirements for Billing Providers; OPR Providers Enrollment Requirement; ColoradoPAR Program: General Updates; DME: General Updates; Pharmacist-Administered COVID-19 Vaccinations; Extension of Temporary Suspension of PA Requirements for PLTHH; Hospital: General Updates; Hospital Specialty Drugs Policy: Medications List Update; Immunization Rate Update; Immunization Updates and Reminders; Novavax COVID-19 Vaccines; OTC Nicotine Replacement Therapy; Pharmacist-Administered Vaccines; Prescriber Tool Alternative Payment Model; Updates to Preferred Drug List; Colorado Medicaid eConsult Update; Reimbursement for eConsults; Free SBIRT Training; Change of Provider for PARs; Changes to Billing Under Early Intervention; Requirements for Eyewear; February 2024 Provider Beginner Billing Training Sessions

Special Provider Bulletin - Healthcare Common Procedure Coding System (HCPCS) Updates for 2024 (B2400504 - 01/24) - This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2024; Discontinued Codes; New Procedure Codes; Procedure Codes with Description Changes

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2400503 - 01/24) - Did You Know? 2024 Application Fee; Claims for HCPCS 2024 Procedure Codes Suspending for EOB 0000; New EOB Reasons for Revalidation; New Language Proficiency Field Available; New System Error for Attachments in the Provider Web Portal; Verifying Medicaid Coverage - New Coverage Types; Information About ColoradoPAR Program; CGM Submission Tips; New Coverage of Unilateral Cochlear Implants for Members Aged 20 and Under; ASAM Criteria 4th Edition; Upcoming Changes in SUD Provider Types; Carfentanil Resurfaces in the United States; APM for Comprehensive Behavioral Health Safety Net Providers; Updated Residential Provider Billing Guidance: QRTP and PRTF; Durable Medical Equipment: General Announcements; Calculation Error, Retroactive Adjustment Upwards; Licensure or Certification Required from CDPHE; Hospital: General Updates; Nursing Facility Swing Bed Rate Effective January 1, 2024; OTC Nicotine Replacement Therapy; Coverage Change for Generic Fluticasone HFA Inhaler; PDL Announcement of Preferred Products; Pharmacist Services Billing Code and Policy Update; Participate in Colorado Medicaid eConsult; Physician-Administered Drugs (PAD): Quarter 1 Rate Update 2024; Claim Editing for NEMT Providers; January and February 2024 Provider Billing Training Sessions

2023: B2300488 - B2300502

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300502 - 12/23) - Did You Know? Third Party Liability (TPL); NCCI Notification of Quarterly Updates; RAC Provider Training; Acentra Provider Training; Annual Supervision Attestation; Medicare Allowing LMFTs, LPCs and LACs 
to Enroll; Neuro/Psychological Testing Policy Change; New Specialty Types for SUD; ASD as Covered Diagnosis Under RAEs for Psychotherapy Services; Removing First Position Modifiers; New Code for Drop-In Centers; Safety Net Provider Training and Technical Assistance; IMD Campus Policy; Hospice: Rate Update Effective October 1, 2023, (FFY 2023-2024); Hospital: General Updates; Updates to Billing Guidance for Specialty Drugs; Nursing Facility: Fiscal Year 2023-2024 Rate Updates; Outpatient Hospital Specialty Drugs: Medications List Update; OTC Nicotine Replacement Therapy; Pharmacist Billing Code and Policy Update; Long-Acting Injectable Medication Quantity Limits; Naloxone is Covered With Zero Co-Pay; Outer Package National Drug Codes (NDCs); Co-Surgery Prior Authorization; Colorado Medicaid eConsult Update; University of Colorado School of Medicine Physician and Professional Services Supplemental Payment; CHW Services Stakeholder Resource; Free SBIRT Training for Providers; Speech Therapy PAR Information and Daily Limit Removal; Vaccine Information for CHP+ Members; December 2023 and January 2024 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300501 - 11/23) - Did You Know - Provider Enrollment Revalidation; Colorado Recovery Audit Contract (RAC) Provider Stakeholder Webinar; DRA of 2005 Due November 1, 2023; Electronic Funds Transfer (EFT) Changes or Updates; Provider Services Call Center; Reminder: Update Address for Internal Revenue Service (IRS) Form 1099 in Provider Web Portal; Acentra (Formerly Kepro®) Provider Training; Access to Certain Behavioral Health Services; HCBS for Persons with IDD Waiver Programs Billing Manual Update; Hospital General Updates; Updates to Hospital Policy; Vaccine Code Updates; Rabies Vaccine Rates; Outpatient Hospital Specialty Drugs: Medications List Update; Underpayment of Rate Increase; Pharmacist Prescriptions; eConsult Platform Update; Screening, Brief Intervention and Referral to Treatment (SBIRT); Update to School Health Services (SHS) Billing Manual; Speech Therapy Before a PAR is Required; Claim Editing for Non-Emergent Medical Transportation (NEMT) Providers; November and December 2023 Provider Billing Training Sessions

Special Provider Bulletin - Synagis® Vaccine Benefit (B2300500 - 10/23) - This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit; Prior Authorization Requests (PARs) Submission Methods; Prior Authorization Requests (PARs) Criteria and Guidelines; Billing Instructions; Synagis® and Home Health Agencies

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300499 - 10/23) - Did You Know - Member Eligibility; Claim Processing for New Procedure Codes; Colorado RAC Invitation; DRA of 2005 due November 1, 2023; OPR Providers Enrollment Requirement; Provider Enrollment Revalidation; Extension for Member Eligibility Renewal; Timely Filing Resubmission Instructions; Acentra Provider Training; Prescriber Tool Alternative Payment Model; Behavioral Assessment Code Reduction Reversal; Face-to-Face Requirements; Certificate of Medical Necessity Changes; Hospice Rate Update Effective October 1, 2023; Hospital: General Updates; Emergency Medicaid Services (EMS) Billing; Suspended Claims for New Procedure Codes; Presumptive and Definitive Tests; PAD Quarter 4 Rate Update 2023; Specialty Drugs: Policy Clarification; Free SBIRT Training for Health First Colorado Providers; New Resource for Providers Managing Chronic Pain Treatment; Information Regarding Speech Therapy Before PAR is Required; Third Annual SUD Stakeholder Forum; October and November 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300498 - 09/23) - Did You Know - Third-Party Liability; Billing and Eligibility Information for CHP+ Members; DRA of 2005 Due November 1, 2023; NCCI Notification of Quarterly Updates; Inpatient Hospital Review Program (IHRP); Secondary Medical Necessity SUD Reviews; Request a Peer-To-Peer Review; DME Provider Satisfaction Survey; License Portal Panel Field Changes; Facility-Based Dialysis Rate Correction for July 1, 2023; HCBS-CIH Waiver Acupuncture Service Procedure Code Change; Hospital General Updates; PAR Requirement for CPT Code 81220; Presumptive and Definitive Tests; Rate Increase Delay; Prescription of Statin Therapies; Preferred Products; eConsult Platform Informational Update; Updates to Gender-Affirming Care Policy; EPSDT Services; September and October 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300497 - 08/23) - Did You Know - New Virtual Agent Option for Case Managers; Provider Enrollment Revalidation; Upcoming License Portal Panel Field Changes and License Reminder; Inpatient Hospital Review Program (IHRP); Secondary Medical Necessity Substance Use Disorder (SUD) Reviews; myAirvoTM 2 Device Information; Hospital: General Updates; Newly Covered Benefit CPT 0047U; Changes in Buprenorphine/Naloxone Policy; Prevention of Duplicate Injectables Within Seven Days of Billing; eConsult Platform Informational Update; MED-178 Sterilization Form; Free SBIRT Training for Health First Colorado Providers; Incorrect Rate Reduction; August 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300496 - 07/23) - Did You Know - Keeping a Claim in Timely Filing; Correct Member ID Required on Submitted Claims; Member Co-Pay Reductions; ColoradoPAR Program Updates; Secondary Medical Necessity Substance Use Disorder (SUD) Reviews; Inpatient Hospital Review Program (IHRP); Increase to DME Manual Pricing Percentages; Hospital General Updates; Urinalysis Test Information for Xylazine and Fentanyl; 2023 Quarter 3 Rate Update; Prior Authorization (PA) Update; Depression Screen Billing Changes; Free SBIRT Training; New COVID-19 Vaccine Common Procedural Terminology (CPT) Codes; PDN Service Unit Limits; Outpatient Speech Therapy PAR Update; Mifepristone Available as Pharmacy Benefit; Obstetrics (OB) Global Billing Changes and Expanded Billing Options; July 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300495 - 06/23) - Did You Know - Provider Enrollment Requirements; Correct Member ID Required on Submitted Claims; FY2023-2024 Rate Adjustments; Free SBIRT Training for Providers; Important Billing Information for CHP+ Providers; NCCI Notification of Quarterly Updates; PHE Unwind Resources; Multi-Payer Portal Values; NPI Updates in the Provider Web Portal; New PAR Process for Members Currently Enrolled in a Clinical Trial; Senate Bill 21-137 Implementation; Name Change for USCS Manual; Health First Colorado Directed Payment Fee Schedule; Two New Behavioral Health Crisis Services Provider Types; Family Planning Updates; Updates to HCBS Children's Habilitation Residential Program (CHRP) Services; Hospital General Updates; EAPG System Specialty Drug Carveout; Coverage of Laboratory Codes after PHE; Pharmacy & Therapeutics Committee Applications; Uninsured Individuals with Emergency Coverage for COVID-19; Preferred Drug List (PDL) Announcement of Preferred Products; Take-Home Buprenorphine; Prescriber Tool Alternative Payment Methodology Timeline Change; Changes to Telemedicine Post-Public Health Emergency; Optometrist Codes; June and July 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300494 - 05/23) - Did You Know - Verifying Member Eligibility; Electronic Fund Transfers (EFT); NPI Updates in Provider Web Portal; PHE Expiration and Member Eligibility; PHE Unwind Resources; RAC Program Stakeholder Engagement Meeting; Inpatient Hospital Review Program (IHRP); Provider Satisfaction Survey Now Closed; DMEPOS: General Updates; ARPA Base Wage Attestations; Temporary Billing Practices for 5615 Forms; Hospital: General Updates; CHASE Supplemental Payments; Coverage of Laboratory Codes for PHE; Breast Implant Policy Update; FAQ Document Now Available; EVV in Pediatric Behavioral Therapies; Critical Incident Reporting for Residential; Buprenorphine/Naloxone Sublingual Tablet Update; Opioid Treatment Providers: Take-Home Buprenorphine; Gender-Affirming Care Stakeholder Engagement Questions and Answers; Well Child Check-ups Via Telemedicine; COVID-19 Pediatric Bivalent Boosters; May and June 2023 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300493 - 04/23) - Did You Know - Provider Web Portal URL; NCCI Notification of Quarterly Updates; All Providers Who Utilize the ColoradoPAR Program: General Updates; Statewide Standardized Utilization Management (SSUM) Guidelines; Dental Rate Updates for New HCPCS; DME: General Updates; Updated Rule Definition of a Supervised Encounter at FQHCs; HCBS-IDD Additional Enrollment Information; HCBS Specialties Requiring CDPHE Licensure for Revalidation; HCBS Provider Enrollment Training Reminder; Home Delivered Meals Expanded Benefit Billing; Hospital: General Updates; Inpatient Hospital Review Program (IHRP); RAC Program—Upcoming Changes; Revised Obstetrical Global Billing Requirements; Pharmacy: General Updates; Drug Utilization Review Board Position; Physician-Administered Drugs (PAD): Quarter 2 Rate Update 2023; 2022-2023 RSV Season and Synagis® Vaccine Benefit; eConsult Platform Informational Update; Well Child Check-ups Via Telemedicine Update; Private Duty Nursing (PDN): Prior Authorization Requests (PAR) Update; April and May 2023 Training Sessions

Special Provider Bulletin - Obstetrics and Maternity Healthcare (B2300492 - 03/23) - This bulletin contains information on the revised Obstetrical Global Billing Requirements; Detailed Examples: New Billing Requirements: Global, Partial, Labor and Delivery (L&D) Only and Billing Antepartum or Postpartum Only Codes

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300491 - 03/23) - Did You Know - Timely Filing Guidelines; Electronic Funds Transfer (EFT) Update; ColoradoPAR General Updates; Grant Program for Integrated Health; Rate and Modifier Change to Procedure Code E0445; Home Delivered Meals Expanded Benefit; Co-Pay Change; Hospital General Updates; Inpatient Hospital Review Program (IHRP) 2.0; PDL Announcement of Preferred Products; Update: COVID-19 Monoclonal Antibody Injection Evusheld; Ketamine Medically Accepted Indications; New PAD HCPCS Updates; Extension to Temporary Administrative Approval Process; EVV Implementation for Outpatient Therapy Provided via Telehealth; March and April 2023 Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300490 - 02/23) - Did You Know - Known Issues and Provider Resources; Authenticating When Contacting the Provider Services Call Center; Reminder: Health First Colorado Payer of Last Resort; General Updates; Basic Fertility Services Coverage; General Updates; Emergent Add-A-Baby Request Process; February and March 2023 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Healthcare Common Procedure Coding System (HCPCS) Updates for 2023 (B2300489 - 01/23) - This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2023; Discontinued Codes; New Procedure Code; Procedure Code with Description Changes

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300488 - 01/23) - Did You Know - Provider ID Requirement; Claims for HCPCS 2023 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000; Public Health Emergency End Preparations; Provider Enrollment Application Fee 2023; Provider Enrollment Update Limit; Member Rights to Timely Access to Services; Multi-User Breast Pump Loaner Benefit; Temporary Change to Face-to-Face Encounter Requirements; Temporary Changes to PAR Requirements; ARPA Base Wage Attestations; General Updates; Emergent Add-A-Baby Request Process; Lab Billing for Family Planning Services; Prior Authorization Update - PAD; Quarter 1 Rate Update 2023; Private Duty Nursing (Home Health); Extension – Temporary Administration Approval; Glucagon Emergency Kit discontinuation; P&T Committee Meeting; Preferred Drug List (PDL) Products; Prior Authorization (PA) on First-Line Preferred Medications for Initial Treatment of Hepatitis C; Diagnostic COVID-19 Pharmacist Testing; COVID-19 Monoclonal Antibodies; Depression Screen Billing Changes: POSTPONED until July 1, 2023; Increased Rates of Syphilis & Congenital Syphilis Diagnoses; Modified Barium Swallow Study Speech Therapy Prior Authorization Request (PAR) Override Update; Reminder: Billing IntelliRide for Denver Metro Area NEMT Services; January and February 2023 Provider Billing Webinar-Only Training Sessions

2022: B2200472 - B2200487

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200487 - 12/22) - Did You Know - Electronic Claims Requirement; Authenticating When Contacting the Provider Services Call Center; Member Benefit Plan Codes Displaying on Remittance Advice (RA); New Medicare-Only Provider Enrollment Type; Updating Previously Waived Provider Enrollment Requirements; General Updates; Healthcare Common Procedure Coding System (HCPCS) Code L8614 for Cochlear Device; American Rescue Plan Act (ARPA) Base Wage Attestations; Children’s Habilitation Residential Program (CHRP) Update; Reminder: HCBS Enrollment Specialties; Rate Update Effective October 1, 2022 (FFY 22-23); General Updates; Healthcare Common Procedure Coding System (HCPCS) Code 31599 for Gender-Affirming Surgeries; Electronic Visit Verification (EVV) Implementation Update; Prior Authorization (PA) Notification; Prior Authorization Update; eConsult Platform Informational Update; Reminder – Well Care Visits; Updates on Dual Eligible Members Receiving an Alternative Payment Model 2 (APM 2) Per-Member Per-Month (PMPM) Payment; Pharmacy and Therapeutics (P&T) Committee Meeting; Preferred Drug List (PDL) Announcement of Preferred Products; Using Dispense As Written (DAW); Behavioral Health Billing Guidance for Gender-Affirming Care; COVID-19 Monoclonal Antibodies and Other Therapeutics; Discontinuation of Current Procedural Terminology (CPT) Consultation Codes; Prescribers of Breast Pumps; Physician-Administered Drugs (PAD) Claims Selected for Potential Recovery Audit Contractor (RAC) Review; Screening, Brief Intervention and Referral to Treatment (SBIRT); Synagis® Prior Authorization Form Updated; December 2022 and January 2023 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Synagis® Vaccine Benefit (B2200486 - 11/22) - This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit; Prior Authorization Requests (PARs) Submission Methods; Prior Authorization Requests (PARs) Criteria and Guidelines; Billing Instructions; Synagis® and Home Health Agencies; Gainwell Technologies Contacts; Magellan Rx Management Contacts; Keystone Peer Review Organization (Kepro)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200485 - 11/22) - Did You Know - Synagis Special Bulletin; Deficit Reduction Act of 2005 (DRA) due November 1, 2022; Enrollment License Requirement and License Panel Updates; Member Benefit Plan Codes Displaying on Remittance Advice (RA); Payment Error Rate Management (PERM) Audit; Provider Services Call Center Change; General Updates; General Updates; HCPCS Code L8614 for Cochlear Device; Family Planning Expansion Benefits; Children’s Habilitation Residential Program (CHRP) Updates; Rate Update Effective October 1, 2022; General Updates; Healthcare Common Procedure Coding System (HCPCS) Code 31599 for Gender-Affirming Surgeries; Continuum of Services; Pharmacy and Therapeutics (P&T) Committee Member Openings; Antihypertensive Products on the Preferred Drug List; Family Planning for Expanded Income or Fee-for-Service Population and Pharmacy Claims; Telemedicine Electronic Health (eHealth); November and December 2022 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Synagis® Vaccine Benefit (B2200484 - 10/22) - This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit; Prior Authorization Requests (PARs) Submission Methods; Prior Authorization Requests (PARs) Criteria and Guidelines; Billing Instructions; Synagis® and Home Health Agencies

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200483 - 10/22) - Did You Know - Provider Type Manual Spreadsheet; Deficit Reduction Act of 2005 (DRA) due November 1, 2022; Member Billing; New Provider Participation Agreement (PPA) Will Go into Effect on December 1, 2022; Updates to the Addresses Panel during Revalidation; General Updates; Peer Provider Forum; Bed Rail Policy Update; Family Planning Expansion Benefits; HCBS-IDD Providers Requiring Program Approval: Additional Enrollment Information Required; Co-Pay Rate Update; General Updates; Substance Use Disorder - Opiate Antagonist; The Emergent Add-A-Baby Request Process; Electronic Visit Verification (EVV) Update; Brand Name Medication Favored Over Equivalent Generic; Family Planning for Expanded Eligibility Population and Pharmacy Claims; Preferred Drug List (PDL) Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Use of Emergency Supply to Allow for Prior Authorization; Total Annual Prescription Volume (TAPV) Reminder; Prior Authorization Update; Quarter 4 Rate Update 2022; COVID-19 Bivalent Booster Vaccines; Global Surgery Modifier Update; October and November 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200482 - 09/22) - Did You Know - Maintain Delegate Access to Provider Web Portal; Administrative Password Reset Process Change; Electronic Funds Transfer (EFT) Process Change; License Portal Panel Field Changes and License Reminder; Load Letters; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Provider Services Call Center Change; Co-Pay Regarding COVID-19; Prior Authorization Requirement for Private Duty Nursing (PDN); Utilization Management Prior Authorization Requests (PAR) Program Updates; Health Screenings for Refugee Newcomers; August 2022 Rates Update; General Updates; Electronic Visit Verification (EVV) Update; Prior Authorization Request (PAR) Training; Guidance for the Prescription of Paxlovid; Family Planning for Expanded Eligibility Population and Pharmacy Claims; Preferred Drug List (PDL) Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Total Annual Prescription Volume (TAPV) Reminder; Physician-Administered Drugs (PAD); Family Planning Expansion Benefit; New Vaccine Counseling Visits for Adults and Children; 2022 Telehealth Survey; Statewide & National Reports of Increasing Rates of Syphilis Diagnoses (for Women of Reproductive Age) & Increased Congenital Syphilis Diagnoses; September and October 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200481 - 08/22) - Did You Know - Retroactive Provider Enrollment Applications; Child Health Plan Plus Update; Expanded Family Planning Benefit Now Live; Electronic Visit Verification (EVV) Update; Non-Invasive Prenatal Testing (NIPT); General Updates; Additions to Preferred Drug List (PDL); Bright Futures Recommendations; Monkeypox Vaccine Reimbursement; Shingles Age Update; Physician-Administered Drug (PAD) Prior Authorization (PA) and Billed Units; Radiology Claims Selected for Potential Recovery Audit Contractor (RAC) Review; Residential Child Care Policy Summary; August 2022 and September 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200480 - 07/22) - Did You Know - Switch to Mailchimp; Claims Editing Bypass for Gender Restrictions; Fiscal Year 2022-2023 Provider Rate Adjustments; New Procedure Codes; Billing Under a Licensed Behavioral Health Clinician; Update to Uniform Services Coding Standards (USCS) Manual; Breast Pumps; General Updates; House Bill (HB) 22-1290 Implementation; Targeted Rate Increase for Fiscal Year 2022-2023; Family Planning Expansion; Postpartum Coverage Expansion; Spinal Cord Injury (SCI) Waiver Name Change; Targeted Case Management Provided to Certain Home and Community-Based Services Members by Community-Centered Boards; General Updates; Healthcare Affordability & Sustainability Supplemental Payment Adjustment Factors & Groups; Age Increase Limit for Members; Expansion of Rocky Mountain Health Plans Prime Service Area; Fiscal Year 2022-2023 Rate Updates; Family Planning-Related Services and Pharmacy Claims; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Preferred Drug List (PDL) Announcement of Preferred Products; Quarter 3 Rate Update 2022; Wound Care/Skin Substitutes Delayed Benefit Implementation; New COVID-19 Vaccine Counseling Visits for Adults and Children; General Updates; Outpatient Speech Therapy for Gender-Affirming Care; Outpatient Speech Therapy Prior Authorizations Requests (PARs); Place of Service (POS) 10 Added to Telehealth; Targeted Rate Increase for Fiscal Year 2022-2023; Post-Partum Coverage Extended to 12 Months for Child Health Plan Plus (CHP+) and Health First Colorado Members; July 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200479 - 06/22) - Did You Know - Enrollment Requirements; Fiscal Year 2022-2023 Provider Rate Adjustments; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Ordering, Prescribing, Referring (OPR) Claim Identifier Project - Update; Update to ACC Member Disenrollment Rules; Update of Billing Modifiers; Omnipod® Coding Update; Family Planning Expansion; Increased Broadband Access Grant; Respite Rate Updates Effective April 1, 2022; General Updates; Brand Name Medication Favored Over Equivalent Generic; Carved-out Procedure Codes - Reminder; Emergency Use Authorization (EUA) COVID-19 Antivirals Claim Requirements; Family Planning-Related Services and Pharmacy Claims; Pharmacy Administered Adult Vaccines; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Preferred Drug List (PDL) Announcement of Preferred Products; Prescribing Opioid Antagonists When Used For Drug Overdose; Depression Screen Billing Changes: Adding Modifiers and Allowing other Caregivers under Child’s ID; Retroactive Rate Update for COVID-19 Booster Vaccines, Effective March 1, 2022; eConsult Platform Informational Update; Residential Child Care Facility Reimbursement Policy; Changes to PARs for Extended Part C - Early Intervention Providers; Individual Family Services Plan or Plan of Care Needed; Postoperative Care for Eye Surgery Updates, Effective June 1, 2022; June 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200478 - 05/22) - Did You Know - Provider Revalidation Dates Spreadsheet; Providers Help to Keep Member Contact Information Up to Date; Reminder: Enrollment License Requirement and License Panel Updates; Updated Provider Enrollment and Claims Submission Policy; Contracting Alert Ahead of Friday Health Plans Transition; Update to the Enclosed/Safety Bed PAR Process; Rates for Modifier FP; General Updates; COVID-19 Monoclonal Antibodies and Other Therapeutics; Expanded Coverage under the Emergency Medical Service (EMS) COVID-19 Only Benefit Plan; Upcoming Expansion of Rocky Mountain Health Plans Prime Service Area; Carved-Out Procedure Codes; Behavioral Health for Gender-Affirming Care; Appendix Y; Telemedicine: Public Health Emergency (PHE) and Beyond; Ventilator Tubing PARs; “No PAR Required” Codes entered into Kepro’s Provider PAR portal, Atrezzo; Retroactive PARs; Reminder for Home Health if Providing Private Duty Nursing (PDN); Kepro is Here for Colorado Providers!; Changes to Family Planning Services: Undocumented and Expanded Income Group; Post-Partum Coverage Extended to 12 Months for Child Health Plan Plus (CHP+) and Health First Colorado Members; May and June 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200477 - 04/22) - Did You Know - Submitted Claims with Medicare Advantage Primary; Delayed Member Notification of Health First Colorado (Colorado’s Medicaid program) Eligibility; License Panel Update for the Provider Enrollment Portal and the Provider Web Portal; Ordering, Prescribing, Referring (OPR) Guidance Update; Payment Error Rate Measurement (PERM) Audit; Colorado interChange Update for Geographic Rates for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL); Remote Supports Providers; Rate Increase for Some Waiver Services Paid to Targeted Case Management (TCM), Community Centered Boards (CCBs); Temporary Rate Increase Extension; Extension on Pause for Prior Authorization Requests (PARs); General Updates; Rates for House Bill 21-1198 Health Care Billing Requirements for Indigent Patients Now Available; Brand Name Medication Favored over Equivalent Generic; Health First Colorado Preferred Drug List Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Billing Manual Update; Pharmaceutical Rate Methodology; Prior Authorization Request (PAR) Policy; Quarter 2 Rate Update 2022; Newborn Metabolic Screen (NMS) Test; Longer Pend Times for Keystone Peer Review Organization (Kepro) Prior Authorization Requests (PARs); April and May 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200476 - 03/22) - Did You Know? Insurance and Provider Enrollment Dates; Provider Maintenance Enrollment Profile Updates; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Audiology Billing Manual Update; Ordering, Prescribing, and Referring (OPR) Providers; Billing Changes for Gender Identity Disorders; DMEPOS General Updates; Upcoming Colorado interChange Update for Geographic Rates for DME Codes Subject to Medicare Upper Payment Limit (UPL); Centers for Disease Control (CDC) Lowers Blood Lead Reference Value for Children to 3.5 μg/dL; Provider Enrollment for Remote Supports Benefit Paused; Ambulatory Surgical Center (ASC), Home Health & Home and Community-Based Services (HCBS) Claims Selected for Potential Recovery Audit Contractor (RAC) Review; Ordering, Prescribing, and Referring (OPR) Information; Rate Update Effective October 1, 2021 (FFY 21-22); COVID-19 Monoclonal Antibody Infusions; Hospital - General Updates; Ordering, Prescribing & Referring Providers – Laboratory and Radiology Services; Temporary Suspension of Prior Authorization Requirements for Pediatric Long-Term Home Health; Health First Colorado Preferred Drug List (PDL) Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Pharmaceutical Rate Methodology; Co-treatment Policy for Pediatric Behavioral Therapists, Physical Therapists, Occupational Therapists, and Speech Therapists; Ordering, Prescribing, Referring Providers Outpatient Therapies; Luxturna® Rate Update; Billing Medication Assisted Treatment Codes for Medicare Enrollees; COVID-19 Vaccine Counseling Visits for Adults and Children; Hospital Surge Continues, Physician Services for In-Home Care; New Billing Manual -Targeted Case Management – Transition Coordination (TCM-TC) Services; March and April 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/22) This bulletin contains information on Did You Know - Verify Member Eligibility for Other Insurance and Medicare Coverage; Provider Maintenance Enrollment Profile Updates; Update to Provider Participation Rule Section 8.130; 2022 Healthcare Common Procedure Coding (HCPCS) & Current Procedural Terminology (CPT) Procedure Code Release; Fee-For-Service Behavioral Health Benefits; At-Home Over-The-Counter COVID-19 Test Coverage; General Updates; Ordering, Prescribing, Referring (OPR) Requirements for Durable Medical Equipment; Encounter Rate “Carve-Out” – Remdesivir, an Antiviral Medication for COVID-19; Geriatric Loan Repayment Program Implemented; Electronic Visit Verification (EVV) Denials; General Updates; Sign Up for the Hospital Discounted Care Newsletter; COVID-19 Monoclonal Antibodies and Other Therapeutics; Pediatric Personal Care Rate Increase; Pharmacy Billing Manual Update; Upcoming Changes; Prior Authorization (PA) Implementation; Synagis® (Palivizumab) Vaccine Benefit UPDATE; COVID-19 Vaccine and Immunization Inventory Management Strategies for Healthcare Practices and Providers; New/Modifications to the Place of Service (POS) Code for Telemedicine; February and March 2022 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Healthcare Common Procedure Coding System (HCPCS) Updates for 2022 (B2200474 - 01/22) This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2022; Discontinued Codes (The Discontinued Codes Table has been updated since it was originally published. Procedure code D8090 was updated to D8690. 2/8/22); New Procedure Code (The New Procedure Code table was updated since it was originally published. 1/28/22); Procedure Code with Description Changes

Special Provider Bulletin - Synagis® Vaccine Benefit (B2200473 - 01/22) This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit UPDATE; Coverage and Reimbursement; Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro); Prior Authorization Requests (PARs) Submitted to Magellan Rx Management

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200472 - 01/22) This bulletin contains information on Did You Know - Verify Member Eligibility for Other Insurance and Medicare Coverage; Health First Colorado and Child Health Plan Plus (CHP+) COVID-19 Vaccine Administration Rate Increase; 2022 Healthcare Common Procedure Coding (HCPCS) & Current Procedural Terminology (CPT) Procedure Code Release; New Recovery Audit Contract (RAC) Vendor; Reconsiderations and Appeals; Reclassification of ASC Grouper Rate for Procedure Code 36561; January 2022 Updates to Allowed Ambulatory Surgery Center (ASC) Procedures; Home Dialysis for Recipients of Emergency Medicaid Services with End-Stage Renal Disease; Remote Supports Provider Enrollment and Billing; Respite Providers: Temporary Enhanced Rate for Respite Benefits; General Updates; The Emergent Add-A-Baby Request Process; Rate Increase for COVID-19 Vaccinations; COVID-19 Vaccine Counseling Visits for Children and Youth; Nursing Facility Swing Bed Rate Effective January 1, 2022; Health First Colorado (Colorado Medicaid) PDL Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Upcoming Changes for Pharmacist Services Benefits and Billing; Quarter 1 Rate Update 2022; Prior Authorization (PA) Implementation Date; Abortion Services Coverage and Billing Guidance; Screening Children and Youth; January and February 2022 Provider Billing Webinar-Only Training Sessions

2021: B2100457- B2100471

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100471 - 12/21) This bulletin contains information on Did You Know - Provider Web Portal Password Reset; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Provider Enrollment Requirement; Update to Provider Participation Rule Section 8.130; Coverage of Electrolysis (Permanent Hair Removal); Home Dialysis for Recipients of Emergency Medicaid Services with End-Stage Renal Disease (ESRD); American Rescue Plan Act (ARPA) Billing for Home and Community-Based (HCBS) Services; Hospice Claims Selected for Potential Recovery Audit Contractor (RAC) Review; General Updates; COVID-19 Monoclonal Antibody Infusions; Reminder to Update Fax Numbers; Health First Colorado Preferred Drug List (PDL) Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Prior Authorization (PA) Update; Upcoming Diabetes Webinar Opportunity; Temporary Removal of Prior Authorization Requests for Specific Diagnostic Imaging Codes; December 2021 and January 2022 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100470 - 11/21) This bulletin contains information on Did You Know - Backdating a New Enrollment Application; Clarification of Hospice Rules Regarding DMEPOS; Philips Respironics Sleep and Respiratory Care Device Recall Update; Prior Authorization Request (PAR) Requirement Re-start Delay; General Updates; 2021 Flu Vaccine Code Update; License Prefix Change for Licensed Addition Counselors; House Bill (HB) 21-1275 Implementation; Prior Authorization Update; New Non-Emergent Medical Transportation (NEMT) Out-of-State Request Form; November and December 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100469 - 10/21) This bulletin contains information on Did You Know - Delegates and the Provider Web Portal; Deficit Reduction Act of 2005 due November 1, 2021; Member Testimonial; Procedure Code S1040 Cranial Remolding Orthosis; Billing Manual Updates; Senate Bill (SB) 19-238 Reporting Timelines for Fiscal Year (FY) 2020-2021: Provider Web Portal Ready for Reporting; New Procedure Codes for Regional Center Billing for Members with the Developmental Disabilities (DD) Waiver; Group Rate Billing for Private Duty Nursing (PDN); Billing Manual Updates; Rate Update Effective October 1, 2021; General Updates; The Emergent Add-A-Baby Request Process; 2021 Flu Vaccine Code Update; Account Deactivation; Drug Utilization Review; Health First Colorado Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy & Therapeutics (P&T) Committee Open Positions; COVID-19 Vaccine; Total Annual Prescription Volume (TAPV) Reminder COVID-19 Vaccines; Prior Authorization Update; Quarter 4 Rate Update 2021; Prior Authorization Request (PAR) Requirement Re-start Delay; Enrollment for New Program; Bed Count Updates; October and November 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100468 - 09/21) This bulletin contains information on Did You Know - Verifying Eligibility Without the Member ID; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Prescription Drug Monitoring Program and Controlled Substances; Updates to Colorectal Cancer Screening Policy; Fee-for-Service Prosthetic, Orthotic and Supplies Rate Rebalance Effective July 1, 2021; Upcoming Changes to Telehealth in Waivers Postponed; Opportunity to Provide Input on HCBS Case Management Redesign; Updates to Billing Procedure for Home Modification Second Unit; General Updates; Inpatient and Outpatient Supplemental Payment Adjustment Factors; The Emergent Add-A-Baby Request Process; COVID-19 Monoclonal Antibody Infusions; Updated Training for the Personal Care Assessment Tool; Health First Colorado Announcement of Preferred Products; Dispense as Written (DAW) Codes Usage for Billing Brand Products due to Generic Drug Shortages and Brand Favored Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy & Therapeutics (P&T) Committee Open Positions; Total Annual Prescription Volume (TAPV) Reminder and COVID-19 Vaccines; Prior Authorization (PA) Update; Modification for Contraceptive Pill Billing (S4993); No Rate Adjustments for Program Year 2020; Initial Per Diem Rate; September and October 2021 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Synagis® Vaccine Benefit (B2100467 - 08/21) This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit, Coverage and Reimbursement, Prior Authorization Requests (PARs) Submission Methods, Prior Authorization Requests (PARs) Criteria and Guidelines, Billing Instructions, Synagis® and Home Health Agencies

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100466 - 08/21) This bulletin contains information on Did You Know - Delayed Notification of Health First Colorado Eligibility; Upcoming Provider Enrollment Portal Update for Change of Ownership Applications and Provider Web Portal Update for Disenrollment Requests; New Prescriber Tool for Health First Colorado; Prescription Drug Monitoring Program and Controlled Substances; Fee-for-Service (FFS) Behavioral Health Rate Rebalance Effective April 1, 2021; Peristeen System Coding Update; General Updates; Replacement of Current Procedural Terminology (CPT) Codes with Healthcare Common Procedure Coding System (HCPCS) Codes; Increased Rate for Pediatric Personal Care; Brand Name Medication Favored Over Equivalent Generic; Pharmacy and Therapeutics (P&T) Committee Member Openings; Total Annual Prescription Volume (TAPV) and COVID-19 Vaccines; PADs Prior Authorization (PA) Update; Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person; Substance Use Disorder (SUD) Benefit Expansion Update; August and September 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100465 - 07/21) This bulletin contains information on Did You Know - Member Programs Web Page; Child Health Plan Plus CHP+ State Managed Care Network (SMCN) Transition: How to Bill for CHP+ Services after July 1, 2021; Fiscal Year 2021-2022 Provider Rate Adjustments; Prior Authorization Required for Code L8687; First Notice: Claims Reprocessing Retroactive to July 1, 2020; Cholesterol Supplement Products; Early and Periodic Screening Diagnostic and Treatment (EPSDT) Requests for Wipes; Upcoming Changes to Telehealth in HCBS Waivers; General Updates; Hospital Transformation Program (HTP) Update; Replacement of Current Procedural Terminology (CPT) Codes with Healthcare Common Procedure Coding System (HCPCS) Codes; Fiscal Year 2021-2022 Rate Updates; New Pharmaceutical Benefit Help Guide; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Preferred Drug List (PDL) Announcement of Preferred Products; Total Annual Prescription Volume (TAPV) and COVID-19 Vaccines; PADs – Prior Authorization (PA) Update; Quarter 3 Rate Update 2021; Prior Authorization Requirement (PAR) for L3000; Targeted Rate Increase Effective July 1, 2021; Updated Rule Definition of a Payable Encounter RHCs; July and August 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100464 - 06/21) This bulletin contains information on Did You Know - Reminder to Verify Member Eligibility; Child Health Plan Plus (CHP+) State Managed Care Network (SMCN) Transition: Provider Contracting; Expanded Age Range for Flu Vaccine Code 90688; Health Management Systems (HMS) Launches New Integrative Provider Portal for Third-Party Liability (TPL) and Recovery Audit Contract (RAC) Contracts for Health First Colorado Providers; Name Fields on the Disclosure Panels Updated in the Provider Web Portal; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; General Updates; Hospital Transformation Program (HTP) Update; Drug Utilization Review; New Pharmaceutical Benefit Help Guide; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Preferred Drug List (PDL) Announcement of Preferred Products; Reminder to Update Fax Numbers; PADs Prior Authorization (PA) Update; Policy and Procedures for Physician-Administered Drugs; June and July 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100463 - 05/21) This bulletin contains information on Did You Know - Reconsiderations & Appeals; The Written Appeals Process; The Top Five Reasons Enrollment Applications are Returned to Providers; Provider Participation Rule Change; General Updates; Billing Changes for Twin or Other Multiple Births; Prior Authorization Update; Drug Utilization Review (DUR) Update - Pharmacy Claims Edit for Concomitant Opioid and Oral Buprenorphine-Containing MAT Therapy; Lead Poisoning Survey; May and June 2021 Provider Billing Webinar-Only Training Sessions

Special Provider Bulletin - Utilization Management (UM) Vendor Transition (B2100462 - 04/21) This bulletin contains information on the Transition Overview; ColoradoPAR Program: Utilization Management (UM) for Health First Colorado; Prior Authorization Request (PAR) Requirement for Home Health and In-state Inpatient Hospitals; Prior Authorization Requests (PARs) for Select Physician Administered Drugs; Utilization Management (UM) Vendor Transition Plan and Key Dates; Modification of Prior Authorization Requests (PARs) Completed by eQHealth Solutions; Key Changes Between eQHealth Solutions and Kepro; Kepro’s Provider Training Information; Kepro’s Provider Portal Registration Information; ColoradoPAR Program Web Page

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100461 - 04/21) This bulletin contains information on Did You Know - Website Redesign; Span Billing for Certain Supplies; Encounter Rate “Carve-Out” – COVID-19 Vaccine and Monoclonal Antibody Therapy Treatments; COVID-19 Monoclonal Antibody Infusions; New Utilization Management (UM) Vendor Update; General Updates; Hospital Transformation Program (HTP) Update; Increases in Medicaid Reimbursement for All COVID-19 Vaccine Administration; Johnson & Johnson Single-dose Vaccine Administration; Brand Name Medication Favored Over Equivalent Generic; Bydureon Discontinuation and Trulicity Preferred; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee Member Openings; Preferred Drug List (PDL) Announcement of Preferred Products; Reminder to Update Fax Numbers; Value Based Contracting; Quarter 2 Rate Updates 2021; Telemedicine Report Available; April and May 2021 Provider Billing Webinar-Only Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100460 - 03/21) This bulletin contains information on Did You Know - Medicare Advantage Plans Billed as Medicare, Co-Pay and COVID-19, Health First Colorado Recovery Audit Contractor (RAC), Incorrect Member Billing, Member Video Toolkit, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Hospital Services Rendered Via Telemedicine, Inpatient Hospital Review Program (IHRP): Suspension Continues, Updated Supervision Rules, Continued Suspension of the Prior Authorization Requirement, Preferred Drug List (PDL) Announcement of Preferred Products, Pharmacy and Therapeutics (P&T) Committee Meeting, Pharmacy and Therapeutics (P&T) Committee Member Openings, New Utilization Management (UM) Vendor Update, March and April 2021 Provider Billing Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100459 - 02/21) This bulletin contains information on Did You Know -Keeping Claims Within Timely Filing, Provider Guidance for COVID-19 Vaccine Administration Delegation and Billing, Prescriber Tool Project, Geographic Rate Update, Correction to January Guidance, Update for E0118, New Utilization Management (UM) Vendor, Electronic Visit Verification (EVV) Update, Denver Minimum Wage Increase Effective January 1, 2021, General Updates, Hospital Transformation Program (HTP) Update, Prior Authorization for Specialty Drugs, Pharmacist Administration of COVID-19 Vaccines, Pharmacy & Therapeutics (P&T) Committee Member Openings, Prior Authorization Request (PAR) Suspension Information, February and March 2021 Provider Billing Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100458 - 01/21) This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2021, Discontinued Codes, New Procedure Codes, Procedure Codes with Description Changes.


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100457 - 01/21) This bulletin contains information on Did You Know - Provider Enrollment Application Fee, Direct Care Collaborative Starts in January, Member Billing, Member Video Toolkit, Social Security Verification for Revalidation Applications, Prescriber Tool Project, COVID-19 Vaccines, Sign Up to Receive Updates on the Upcoming Care and Case Management System Implementation, Physician Administered Drugs (PADs) - Healthcare Common Procedure Coding System (HCPCS)/ National Drug Code (NDC) Crosswalk Update, Multiple Line Items, Children's Habilitation Residential Program (CHRP) - Service Changes, General Updates, Hospital Transformation Program (HTP) Update, Reminder to Bill through IntelliRide, Preferred Drug List (PDL) Announcement of Preferred Products, Pharmacy and Therapeutics (P&T) Committee Meeting, Pharmacy and Therapeutics (P&T) Committee New Member Openings, Reminder to Update Fax Numbers, Quarter 1 Rate Updates 2021, COVID-19 Monoclonal Antibody Infusions, Benefit Expansion Go-Live, Residential and Inpatient SUD Provider Manual and Updates to Other Billing Manuals, Telemedicine Well-Child Check-Ups, January and February 2021 Provider Billing Webinar-Only Training Sessions

2020: B2000441 - B2000456

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000456 - 12/20) - This bulletin contains information on Did You Know - Procedure Code Updates and Coverage, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, National Provider Identification (NPI) Law, Prescriber Tool Project, Physician Administered Drugs (PADs) - Healthcare Common Procedure Coding System (HCPCS)/National Drug Code (NDC) Crosswalk Update, Changes to Room and Board (R&B) and Personal Needs Amounts (PNA), Children's Habilitation Residential Program (CHRP) Changes, Rendering Services, Home Modification Evaluation Billing, General Updates, Hospital Transformation Program (HTP) Update, Preferred Drug List (PDL) Announcement of Preferred Products, Pharmacy and Therapeutics (P&T) Committee Meeting, Pharmacy and Therapeutics (P&T) Committee New Member Openings, Medication Prior Authorization Request (PAR) Form Requirements, December 2020 and January 2021 Provider Billing and ClaimsXten™ Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000455 - 11/20) - This bulletin contains information on Did You Know - Updating Delegate Status of Previous Employees in Provider Web Portal, Maintaining Current Licenses, Updating 1099 Address in Provider Web Portal, Upcoming Update to Increase Third-Party Liability (TPL) Records for Enhanced Cost Avoidance, Drug Acquisition Cost Survey - Physician-Administered Drugs (PADs) & Hospital Outpatient Services Drugs, Telemedicine Policy for FQHCs and RHCs Extended Beyond COVID-19 State of Emergency for Appropriate Procedure Codes, Senate Bill (SB) 19-238 Reporting Timelines for Fiscal Year (FY) 2019-2020: Provider Web Portal Ready for Reporting, Hospice Rate Updates- Fiscal Year 2020-2021, General Updates, Outpatient Hospital Therapy Services Billable Via Telemedicine, Capitation Recoupments for Deceased Members, Final Reminder to Bill through IntelliRide, Maternity Bundled Payment Program Goes Live, Pharmaceutical Rate Methodology, Pharmacist-Administered Adult Vaccines, Total Annual Prescription Volume (TAPV) Survey, Changes to Coding Guidelines for Evaluation and Management (E/M) Services, Upcoming Provider Enrollment for SUD Benefit Expansion, November and December 2020 Provider Billing and ClaimsXten™ Webinar-Only Training Sessions


Special Provider Bulletin - Synagis® and Seasonal Influenza Vaccines (B2000454 - 10/20) - This bulletin contains information on Synagis® (Palivizumab) Vaccine Benefit, Coverage and Reimbursement, Prior Authorization Requests (PARs) Submission Methods, Prior Authorization Requests (PARs) Criteria and Guidelines, Billing Instructions, Synagis® and Home Health Agencies, Seasonal Influenza Vaccine is a Benefit for Children and Adults, Children/Adolescents and Adults, Billing Information for Seasonal Influenza Vaccine


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000453 - 10/20) - This bulletin contains information on Did You Know - New Holiday to Replace Columbus Day, Colorado interChange Update for the State of Colorado Intercept Process, Colorado interChange Update - ClaimsXten™ Claims Editing Solution, COVID-19-Related Services for Recipients of Emergency Medicaid Services (EMS), Deficit Reduction Act (DRA) Documentation Due November 2, 2020, Healthy Communities Program for Members Shifted to Regional Accountable Entities (RAEs), New Mobile App for Health First Colorado and Child Health Plan Plus (CHP+) Members, We're Here for YOU, Colorado! Member Enrollment Campaign, Prior Authorization Request Supporting Documentation Reminder, Peristeen System Coverage Update, Attention DME-CRT and Assistive Technology Assessment Therapy Codes PA Update, Policy Change for Travel Time Billing, HCBS Rate Increases for Denver Minimum Wage, SB 19-238 Reporting Timelines for FY 2019-2020, Group Rate Billing, General Updates, Reminder to Bill through IntelliRide, COVID-19 Early Refill Override Removal, October Preferred Drug List (PDL) Announcement, Pharmacy and Therapeutics (P&T) Committee Meeting, Pharmacy and Therapeutics (P&T) Committee Open Positions, New FDA-Approved Medication for Spinal Muscular Atrophy, Pharmaceutical Rate Methodology, Pharmacy System Updates for Oral Buprenorphine Drugs for Medication-Assisted Treatment (MAT), Prescription Drug Average Acquisition Cost (AAC) Survey, Reminder to Update Fax Numbers, Total Annual Prescription Volume (TAPV) Survey, Quarter 4 Rate Updates 2020, Medicinal Treatment for Non-Viable Pregnancy Circumstances, Outpatient Speech Therapy Prior Authorizations Requests (PARs), ICD-10 Updates for Substance Use Disorder Conditions, October and November 2020 Provider Billing and ClaimsXten™ Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000452 - 09/20) - This bulletin contains information on Did You Know - Provider Rates & Fee Schedule Web Page, Deficit Reduction Act (DRA) Documentation Due November 2, 2020, End of 2020 Payment Error Rate Measurement (PERM) Audit, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Provider Enrollment Type Changes, Upcoming Colorado interChange Update - ClaimsXten™ Claims Editing Solution, Attention DME-CRT and Assistive Technology Assessment Therapy Codes PA Update, DME Oxygen for Members Enrolled in Denver Health Medicaid Choice or Rocky Mountain Health Plans Prime Managed Care Organizations (MCOs), Electronic Visit Verification (EVV) Compliance Timeline, General Updates, Age Range Update for Human Papilloma Virus (HPV) Vaccine, Replacement of CPT Codes with HCPCS Codes, October Preferred Drug List (PDL) Announcement, Brand / Generic Change for Albuterol HFA Inhalers, P&T Committee Meeting, P&T Committee Open Positions, Total Annual Prescription Volume (TAPV) Survey, Pharmaceutical Rate Methodology, Reminder to Update Fax Numbers, Well Care Visits Reminder, SUD Benefit Expansion, September and October 2020 Provider Billing and ClaimsXten™ Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000451 - 08/20) - This bulletin contains information on Did You Know - Provider Web Portal Claim Attachment File Size Limit, Reminder to Update Contact Information for Member Search, Upcoming Colorado interChange Update - ClaimsXten™ Claims Editing Solution, Children's Habilitation Residential Program (CHRP) Training, General Updates, Replacement of Current Procedural Terminology (CPT) Codes with Healthcare Common Procedure Coding System (HCPCS) Codes, Nursing Facility Fiscal Year 2020-2021 Rate Updates, 48-Unit Benefit Limit in Provider Web Portal, Pharmacist-Administered Flu Vaccine for the 2020-2021 Flu Season, Regulatory Review of OAP Health and Medical Program Rules, August and September 2020 Provider Billing Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/20) - This bulletin contains information on Did You Know - ConnectToCare Jobs Website for Health Care Employers, Fiscal Year 2020-2021 Provider Rate Adjustments, Help for the Uninsured During the Coronavirus (COVID-19) Pandemic, "Lower of" Pricing Logic for Rate Increases, Provider Recruitment - New Health First Colorado Providers Needed, Revalidation, Telemedicine Services, Contacting the Department's Prior Authorization Vendor, 1% Across the Board Rate Reduction Effective July 1, 2020, Temporary Suspension of Prior Authorization Request (PAR) Requirements, General Updates, Hospital Transformation Program (HTP) Update, Inpatient Hospital Review Program (IHRP) Suspended, Replace Current Procedural Terminology (CPT) Codes With Healthcare Common Procedure Coding System (HCPCS), Transportation Broker Expansion, Nasal Atomizer Billing, Pharmacy and Therapeutics (P&T) Committee Meeting, Guidelines for Early Intervention (EI) Therapy Providers, Quarter 3 Rate Updates 2020, July and August 2020 Provider Billing Webinar-Only Training Sessions.


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000449 - 06/20) - This bulletin contains information on Did You Know - Provider Revalidation Started, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Guidance for COVID-19-Related Services for Recipients of Emergency Medicaid Services (EMS), Upcoming Improvements to Claims Review, Developmental Screening Changes, Pediatric Behavioral Therapy Criteria, Community Centered Boards and Single Entry Points Providing Case Management to Eligible HCBS Members, Nursing Facility National Provider Identifier (NPI), General Updates, Clinical Diagnostic Laboratory Upper Payment Limit Rates, Updates to Visit Documentation Policy, Preferred Drug List (PDL) Announcement of Preferred Products, Injectable Opioid Antagonists, Physician-Administered Drug (PAD) Billing Manual, Policies Relating to Ordering, Prescribing and Referring (OPR), June and July 2020 Provider Billing Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000448 - 05/20) - This bulletin contains information on Did You Know - Provider Web Portal and Revalidation, Suspension of Payment Error Rate Measurement (PERM) Activities, Provider Benefits of Billing Third-Party Liability (TPL) (Commercial) Insurance, New ASC Grouper, General Updates, Requirement for OPR Providers to Enroll with Health First Colorado, Drug Utilization Review (DUR)Health First Colorado DUR Board Positions, HCPCS and NDC Crosswalk for Billing Physician-Administered Drugs (PADs), Preferred Drug List (PDL) Highlights, COVID-19-Related Pharmacy News, Centers for Disease Control and Prevention (CDC) Recommendations for Childhood Immunizations During COVID-19, May and June 2020 Provider Billing Webinar-Only Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000447 - 04/20) - This bulletin contains information on Did You Know - License Update Requirement, New Format for Provider Billing Manuals, Milliman Care Guidelines (MCG) 24th Edition Updates, Payment for Routine Dialysis Services, Electronic Visit Verification (EVV) Mandate Timeline, General Updates, Hospital Transformation Program (HTP) Update, Inpatient Hospital Review Program (IHRP) Suspension, Changing or Updating Surgical Procedure Codes on a Prior Authorization Request (PAR), Appeals Forms, Preferred Drug List (PDL) Announcement, April and May 2020 Provider Billing Training Sessions


Special Provider Bulletin - Long Acting Injectable Antipsychotics(B2000446 - 03/20) - This bulletin contains information on Coverage, Payment, and Billing for Long Acting Injectable Antipsychotics, Payment for Long Acting Injectables (LAIs), Physician Administered Drugs (PADs) Billing, Pharmacy, Rate Methodology


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000445 - 03/20) - This bulletin contains information on Did You Know - Timely Filing Requests, Change in Provider Services Call Center Hours, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Provider Enrollment Updates Limited to One per Service Location, Timely Filing and Resubmissions, Explanation of Benefits (EOBs) Filtering for HCBS Providers, New Benefit - Youth Day Services, General Updates, Swing Bed Rate Effective January 1, 2020, Preferred Drug List (PDL) Announcement of Preferred Products, Updates to Healthcare Common Procedure Coding System (HCPCS), Health First Colorado (Colorado Medicaid) Selected for Federal Program to Reduce Maternal Opioid Misuse, Quarter 1 Rate Updates 2020, March and April 2020 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000444 - 02/20) - This bulletin contains information on Did You Know - Provider Enrollment Address Must Match NPPES, Adding a New National Provider Identification (NPI) Number, Out-of-State Emergency Services, Provider Affiliations, Reconsiderations and Appeals, Reducing Prescription Drug Costs in Colorado, Verifying Eligibility, Unit Change to the Independent Living Service Training (ILST) on the Brain Injury (BI) Waiver, General Updates, Billing for Immediate Post-Partum Long-Acting Reversible Contraceptives (IPP-LARCs), Interim Billing for Diagnosis Related Group (DRG) Hospitals, Clinical, Diagnostic Laboratory Upper Payment Limit Rates, Genetic Testing Prior Authorization Requirement, Urinalysis Tests Information Update, Pharmacy Cost of Dispensing Survey, Drug Utilization Review Updates, Preferred Brand Updates, Quarter 1 Rate Updates 2020, Bi-Monthly Rural Health Clinic (RHC) Stakeholder Engagement Meetings, February and March 2020 Provider Billing Training Sessions


Special Provider Bulletin - Laboratories (B2000443 - 01/20) - This bulletin contains information on the Genetic Testing Prior Authorization Requirement and Clinical Diagnostic Laboratory Upper Payment Limit Rates


Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000442 - 01/20) - This bulletin contains information on Did You Know - Current Licensure Requirement, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Payment Error Rate Measurement (PERM) Audit, Prior Authorization Vendor Training, Changes to Billing Method for Home Accessibility Adaptations Benefit, Changes to Supported Living Program (SLP) Rate Methodology, Targeted Rate Increases Effective January 1, 2020, General Updates, Hospital Transformation Program (HTP), Inpatient Hospital Review Program (IHRP) Materials, Inpatient Hospital Review Program (IHRP) Admission Date, Immediate Post-Partum Long-Acting Reversible Contraception (IPP-LARC) Carve-Out From All Patient Refined-Diagnosis Related Group (APR-DRG) Payment Methodology, Genetic Testing Prior Authorization Requirement, Rx Review Program, Preferred Drug List (PDL) Announcement of Preferred Products, Eligibility Criteria for Enbrel, Humira, Cosentyx or Xeljanz IR, Pharmacy and Therapeutics (P&T) Committee Meeting, Pharmacy & Therapeutics (P&T) Committee Open Positions, Quarter 1 Rate Updates 2020, January and February 2020 Provider Billing Training Sessions


Special Provider Bulletin - Healthcare Common Procedure Coding System (HCPCS) Updates for 2020 (B2000441 - 01/20) - This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS)Updates for 2020, Discontinued Codes, New Procedure Codes, Procedure Codes with Description Changes.

2019: B1900425 - B1900440

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900440 - 12/19) -This bulletin contains information on Did You Know - Provider-Member Billing Reminder, Deficit Reduction Act of 2005 Provider Requirements, eQSuite® Trainings, Load Letters, Prior Authorization Requests (PARs) Determination Letter Change Reminder, Update on Known Issue for Claims Paying at Zero Incorrectly, Changes to Room and Board and Personal Needs Amounts, General Updates, Hospital Back Up (HBU) Rate Corrections - December 2019, Hospital Transformation Program (HTP), Inpatient Hospital Review Program (IHRP), Inpatient Medicare Part B-Only and Medicare Part A Exhaust Claims Pricing, Brand Name Medication Favored Over Equivalent Generic, Preferred Drug List (PDL) Announcement of Preferred Products, Vivitrol Administration Enhanced Reimbursement, Dry Needling 97799 Update, Rates Updates for Non-Clinical Diagnostic Laboratory Upper Payment Limit (CDL-UPL), December 2019 and January 2020 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900439 - 11/19) -This bulletin contains information on Did You Know - Unlocking or Resetting a Provider Web Portal Password, Colorado National Provider Identifier (NPI) Law Implementation, Fingerprint - Federal Criminal Background Check, Payment Error Rate Measurement (PERM) Audit, eQSuite® User Administrators, Pre-Admission Screening and Resident Review (PASRR), General Updates, Inpatient Hospital Review Program (IHRP) Updates, New Skin Substitute Rates, Quarter 4 Rate Updates 2019, Reallocation Change Form Templates, Brand Name Medication Favored Over Equivalent Generic, October and November 2019 Provider Billing Training Sessions


Special Provider Bulletin - Synagis® & Seasonal Influenza Vaccines (B1900438 - 10/19) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine Benefit, Reimbursement of Synagis®, Prior Authorization Requests (PARs) Submission Methods, Prior Authorization Requests (PARs) Criteria and Guidelines, Billing Instructions, Synagis® and Home Health Agencies, Seasonal Influenza Vaccine is a Benefit for Children and Adults, Children/Adolescents and Adults, and Billing Information for Seasonal Influenza Vaccine


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900437 - 10/19) - This bulletin contains information on Did You Know - Process for Refunding Payments, Enrollment Application Date of Birth (DOB) Requirement Reminder, Updated Process for Member Date of Death Verification, Non-Covered Modalities Under the Occupational Therapy Benefit, Child Health Plan Plus (CHP+) Prenatal Dental Benefit, Unit Limit Update for Procedure Code T2003, Electronic Visit Verification (EVV) Training Announcement, Hospice Facility Fiscal Year 2019-2020 Rate Updates, General Updates, Hospital Transformation Program (HTP) Program Updates, Medicare Crossover Claim Billing and Payment Updates for State Funded Mental Health Institutes (MHIs), Urinalysis Test Policy Clarification, Drug Utilization Review Update to Pharmacy Prior Authorization Form for Medications Administered in a Member's Home or in a LTCF by a Healthcare Professional, Preferred Drug List (PDL) Announcement of Preferred Products, Total Annual Prescription Volume (TAPV) Survey, Tobacco Cessation Reminder, PAD Billing Guidance, Quarter 4 Rate Updates 2019, Abortion Services Update, October and November 2019 Provider Billing Training Sessions


Special Provider Bulletin - Reporting Service Units for Outpatient Physical, Occupational and Speech Therapy Benefits (B1900436 - 10/19) - This bulletin contains information on the Reporting of Service Units for the Outpatient Physical, Occupational and Speech Therapy Benefits


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900435 - 09/19) - This bulletin contains information on Did You Know -Prior Authorization Request (PAR) Must Be Approved When Claim is Submitted, Annual ICD-10 Coding Updates Effective October 1, 2019, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, National Provider Identifier (NPI) Regulations, Payment Error Rate Measurement (PERM) Audit, Provider Web Portal Update to Add Remove Link to Service Details Section, Claims Must Match Documentation, Federal Upper Payment Limit (UPL) Requirement, Peristeen - Pricing, Data Analysis & Coding (PDAC)-Appropriate Coding, General Updates, Hospital Transformation Program (HTP) - Program Updates, Quarter 3 Rate Updates 2019, Drug Utilization Review Updates, September and October 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900434 - 08/19) - This bulletin contains information on Did You Know - Medicare Replacement Plan, Billing Education-Only Telemedicine Services, Reminder to Update Contact Information for Member Search, Billing Guidelines for Bus Passes, In-Home Support Services (IHSS) Provider Updates, New Services for the Home & Community-Based Services - Children's Habilitation Residential Program (HCBS-CHRP) Waiver, Personal Care & Homemaker Provider Meetings, General Updates, Hospital Transformation Program (HTP), Billing Modifiers for Bilateral Radiology Procedures, Drug Utilization Review Updates, Medications Administered in a Member's Home or in a Long Term Care Facility (LTCF) by a Health Care Professional, Dispense-As-Written (DAW) Reminders, Preventive Services Billing, Quarter 3 Rate Updates 2019, New Non-Emergent Medical Transportation (NEMT) Broker, August and September 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900433 - 07/19) - This bulletin contains information on Did You Know - Electronic Claim Submission Requirement, Clinical Trial Coverage, "Lower of" Pricing Logic for Rate Increases, Payment Error Rate Measurement (PERM) Audit, Updates to Eligibility Verification, PAR Determination Letter Change, General Updates, Hospital Transformation Program (HTP) Update, Inpatient Medicare Part B-Only and Medicare Part A Exhaust Interim Solution Update, End-Stage Renal Disease (ESRD) Vascular Access Procedures for Recipients of Emergency Medicaid Services, New Grant Opportunity, Medication Administration, Quarter 3 Rate Updates 2019, July and August 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900432 - 06/19) - This bulletin contains information on Did You Know - TPL Updates via Provider Web Portal, Fiscal Year 2019-2020 Provider Rate Increases and Adjustments, "Lower of" Pricing Logic for Rate Increases, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Delta Dental Switch to DentaQuest, General Updates, Hospital Transformation Program (HTP) Community and Health Neighborhood Engagement (CHNE), Inpatient Hospital Review Program (IHRP) Update, Newborn Hearing Screening, Newborn Metabolic Screening, Laboratory Rate Rebalancing Effective July 1, 2019, Genetic Testing Prior Authorizations and Rates Information, 340B Drug Pricing Program, Stiripentol (Diacomit), Brand Name Medication Favored Over Equivalent Generic, Drug Utilization Review Updates, Pharmacy and Therapeutics (P&T) Committee Meeting, Preferred Drug List (PDL) Announcement of Preferred Products, Instructions for Claims Submission with Procedure Code 38439, Supervision Requirements for Reimbursable Services, June & July 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) Special Bulletin - Newborn Screenings (B1900431 - 05/19) - This bulletin contains information on Newborn Hearing Screening and Newborn Metabolic Screening


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900430 - 05/19) - This bulletin contains information on Did You Know -Timely Filing for Claim Resubmissions, "Lower of" Pricing Logic for Rate Increases, Regulatory Efficiency Review Public Notice - 30-Day Comment Period, Duplicate Billing of Services Rendered by a Certified Registered Nurse Anesthetist (CRNA) Supervised by an Anesthesiologist, Medicare Crossover Claim Reimbursement, Colorado Choice Transitions (CCT) Program Extension, New Services Available, Under the HCBS-CHRP Waiver, New Sustainability Services Available Under Certain HCBS Waivers, New Targeted Case Management - Transition Coordination Benefit for Colorado Choice Transitions Transition Coordination Agency (CCT-TCA) Providers, Training for In-Home Support Services Now Available, Billing Guidelines for Bus Passes, Self-Audit for Active Certifications and Licenses, General Updates, Hospital Transformation Program (HTP) Overview & Resources, Inpatient & Outpatient CHASE Supplemental Payment Percentage Adjustment Factors, Code Updates, 340B Drug Pricing Program, Brand and Generic Equivalent Changes for Non-Preferred Medications, Quarter 2 Rate Updates 2019


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900429 - 04/19) - This bulletin contains information on Did You Know - Member Eligibility Verification Availability, Fingerprint Criminal Background Check (FCBC), Verifying Member Eligibility and Appealing Claim Denials for Eligibility, Claims Must Match Documentation, Geographical Reimbursement Rates, Modifiers, Updated Prior Authorization Request (PAR) Requirements for Prosthetics & Orthotics, Effective April 1, 2019, House Bill (HB) 18-1407 Implementation, Billing Guidance for End-Stage Renal Disease as an Emergency Medical Condition, Inpatient Hospital Review Program (IHRP) Implementation Notification, General Updates, 340B Drug Pricing Program, Pharmacy Acquisition Cost Survey, April Preferred Drug List (PDL) Announcement, Drug Utilization Review Updates, Changes to Sleep Study and Pulmonary Testing Procedure Codes, Place of Service (POS) 19 and 22 for Hospital-Based Clinics, Policy Update Requiring a Prior Authorization Request (PAR) for Back Surgery and Other Select Surgical Codes, Unlisted Surgical Code Pricing and Billing Bilateral Procedures, Prior Authorization Required for Outpatient Speech Therapy, April and May 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900428 - 03/19)- This bulletin contains information on Did You Know - Service Limits, Prior Authorizations and the EPSDT Benefit, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Requesting a Backdated Enrollment Effective Date, Reminder to Verify Member Eligibility Prior to Rendering Services, Peristeen® Expanding to Adults, Policy Clarification Requiring Provider IDs for FQHCs, CCT Reauthorization, Urinalysis Tests Information, General Updates, Dispense as Written (DAW) Override Code Reminder, Brand Name Medications in Generic Mandate-Exempt Classes on the Preferred Drug List (PDL), Drug Utilization Review Updates, Quarter 1 Rate Updates 2019, Policy Update Requiring a Prior Authorization Request (PAR) for Back Surgery and Other Select Surgical Codes, Policy Update Requiring Prior Authorization (PA) for Speech Therapy, Non-Emergent Medical Transportation (NEMT) Process Change, March and April 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900427 - 02/19) - This bulletin contains information on Did You Know- National Provider Identifier (NPIs) and Multiple Locations, Remittance Advices (RAs) and ERA X12 835 Reports Schedule Change, Remittance Advice (RA) Reports Must Be Obtained Through the Provider Web Portal, Remittance Advice (RA) Update to Help Providers Reconcile Payments, How to Bill for Short-Term Behavioral Health Services in the Primary Care Setting, Quarter 1 Rate Updates 2019 for Physician-Administered Drugs, Policy Clarification for Health First Colorado Benefit on Wipes, General Updates, End-Stage Renal Disease to be Considered an Emergency Medical Condition, Vivitrol® Injections and Pharmacist Immunizations, February & March 2019 Provider Billing Training Sessions


Health First Colorado (Colorado's Medicaid Program) Special Bulletin - HCPCS Updates 2019 (B1900426 - 01/19)- This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2019, Discontinued Codes, New Procedure Codes, and Procedure Codes with Description Changes


Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900425 - 01/19) - This bulletin contains information on Did You Know - Suspended Claims and Timely Filing, Healthcare Common Procedure Coding System (HCPCS) Updates for 2019, New Fraud, Waste and Abuse Web Page, Provider Enrollment Change Regarding a Backdated Enrollment Effective Date, Colorado Choice Transitions (CCT) Program Ending, Federal Upper Payment Limit (UPL) Requirement, Targeted Rate Increase, Colorado Adult Protective Services (CAPS) Data System, Non-Medical Transportation Services Targeted Rate Increase Approved, General Updates, End-Stage Renal Disease to be Considered an Emergency Medical Condition, Update to Outpatient Speech Therapy Prior Authorization Requirement, New Immunization Codes Added for Shingrix and Heplisav, Hospital Back-Up (HBU) Reimbursement Methodology Update, Post-Eligibility Treatment of Income (PETI) Prior Authorization Request (PAR) Approver for Nursing Facilities, Preferred Drug List (PDL) Announcement, Drug Utilization Review Updates, Vivitrol Injections and Pharmacist Immunizations, January & February 2019 Provider Billing Training Sessions

2018: B1800409 - B1800424

Medicaid Program News and Updates (B1800424 - 12/18) - This bulletin contains information on Did You Know - Current Processing Times for Provider Enrollment, Delayed Notification of Member Eligibility, Healthy Communities Program, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Revenue Codes Under the Capitated Behavioral Health Benefit, Service, Mailing and Billing Addresses, Enrollment Required for CC and CCEC Providers, Peristeen Expanding to Adults, Cost-of-Living Adjustment (Increases), General Updates, Upcoming Policy Stakeholder Meeting Regarding Emergency Dialysis Policy and Hospital Readmission, New Billing Manual for IHS Providers, Preferred Drug List (PDL) Announcement, Drug Utilization Review (DUR) Updates, 340B Drug Pricing Program, 340B Policy and Procedures Manual, Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations, and December 2018 and January 2019 Provider Billing Training Sessions


Medicaid Program News and Updates (B1800423 - 11/18) - This bulletin contains information on Did You Know - Known Issues Web Page, Fingerprint - Federal Criminal Background Check (FCBC), Backdate Enrollment Form, Upcoming Improvements to Remittance Advice (RA) Financial Transactions Page, General Updates, Telligen Selected for Long-Term Care Utilization Management Contract, Outpatient PT/OT Policy Updates, Pharmacy & Therapeutics (P&T) Committee Open Positions, Drug Utilization Review Updates, 340B Drug Pricing Program, 340B Policy and Procedures Manual, Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations, Pricing for Unlisted Surgery CPT Codes, Upcoming Changes to Outpatient Speech Therapy Prior Authorizations Requirements, and November and December 2018 Provider Billing Training Sessions


Special Provider Bulletin - Synagis® & Seasonal Influenza Vaccines (B1800422 - 10/18) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine Benefit, Reimbursement of Synagis®, Prior Authorization Requests (PARs) Submission Methods, Prior Authorization Requests (PARs) Criteria and Guidelines, Billing Instructions, Synagis® and Home Health Agencies, Seasonal Influenza Vaccine is a Benefit for Children and Adults, Children/Adolescents and Adults, and Billing Information for Seasonal Influenza Vaccine


Medicaid Program News and Updates (B1800421 - 10/18) - This bulletin contains information on Quick Guides and Webinars Web Page, Load Letters, Member Contact Center Hours Changing, ColoradoPar Training with eQHealth Solutions Inc®, Health First Colorado (Colorado's Medicaid Program) Recovery Audit Contractor (RAC) Begins Work, Provider Enrollment Type Changes, Reminder: Request for Reconsideration is Not Necessary for Denied Claims, Ear Mold Coverage Policy, HCBS Waiver Program Post Payment Review Contract, Final Notice: Vision Therapy Services for Children and Youth Enrolled in the Children's Extensive Services (CES) Waiver Are Now Provided Under State Plan, Hospice Legislative Rate Increases Effective October 1, 2018, Hospital General Updates, 340B Drug Pricing Program, 340B Policy and Procedures Manual, Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations, Total Annual Prescription Volume (TAPV) Survey, Drug Utilization Review Updates, October Preferred Drug List (PDL) Announcement, Q4 Rate Updates, Multiple Surgery Billing Procedures, Billing Bilateral Procedures, and October and November 2018 Provider Billing Training Sessions.


Medicaid Program News and Updates (B1800420 - 09/18)- This bulletin contains information on Checking Member Usage for PT/OT Services on Provider Web Portal, NCCI Notification of Quarterly Updates, Billing Gender-Specific Procedures for Transgender Members, Upcoming Improvements to Remittance Advice (RA) Financial Transactions Page, New Medicare Cards, Prosthetics & Orthotics PAR Announcement, ACF Targeted Rate Increase Approved, Environmental Survey on Current Technology Usage of HCBS Providers, General Updates, Enrollment Now Open for CC and CCEC Providers, Circumcision PAR Requirements, 340B Drug Pricing Program, New 340B Policy and Procedures Manual, Rx Review Program Update, October Preferred Drug List (PDL) Announcement, Colorado MAPIR Accepting Health First Colorado EPs and EHs Attestations, and September and October 2018 Provider Billing Training Sessions.


Medicaid Program News and Updates (B1800419 - 08/18) - This bulletin contains information on Member Contact Center Phone Number, Using a Previous Internal Control Number (ICN), Accountable Care Collaborative (ACC) Phase II - What Providers Need to Know, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services and Requests, Uniform Service Coding Standards Manual July 2018, Continuation of Benefits During a Member Appeal, Hospital - General Updates, Update to Imaging and Radiology Billing and Policy Manual, 340B Drug Pricing Program Provider Notice, Drug Utilization Review Announcements, Physician-Administered Drugs, Rendering Provider Number Requirement, and Physician-Administered Drug Acquisition Cost Surveys.


Medicaid Program News and Updates (B1800418 - 07/18) - This bulletin contains information on Change of Ownership, Accountable Care Collaborative (ACC) Phase II Launches July 1, 2018, eQSuite® User Administrators for Colorado PAR Portal, Fiscal Year 2018-2019 Provider Rate Increases and Adjustments, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Behavioral Health Provider Type Changes, Physician-Administered Drug (PAD) Acquisition Cost Surveys, Children with Autism (CWA) Waiver Has Ended, Hospital General Updates, Inpatient & Outpatient Colorado Healthcare Affordability & Sustainability (CHASE) Supplemental Health First Colorado Payment Percentage Adjustment Factors, Nursing Facility Fiscal Year 2018-2019 Rate Updates, July 2018 Physical and Occupational Therapy (PT/OT) and Speech Therapy Updates, Pharmacy Updates, Colorado Medical Assistance Provider Incentive Repository (MAPIR) Accepting Health First Colorado-Eligible Professionals (EPs) and Eligible Hospitals (EHs) Attestations


Medicaid Program News and Updates (B1800417 - 06/18) - This bulletin contains information on Do Not Submit Paper Claims for Dates of Service Over 365 days, Reminder: Reference the Special Provider Bulletin for Colorado interChange Common Questions, Timely Filing Period Extended to 365 Days - Effective June 1, 2018, Fiscal Year (FY) 2018-2019 Provider Rate Increases and Adjustments, Co-Pay Collection, Managed Care Organization (MCO) Laboratory Policy, Fingerprint Criminal Background Check, Children with Autism Waiver Ending June 30, 2018, Rate Updates, Hospital Meetings, Technical and Professional Component Modifiers on Outpatient Hospital Claims, Preferred Drug List (PDL) Announcement, Technical and Professional Component Modifiers on Professional Claims, Non-Emergent Medical Transportation (NEMT) Non-Covered Services, Supplemental Payment for University of Colorado School of Medicine


Anesthesia Provider Bulletin (B1800416 - 05/18) - This bulletin contains information on Anesthesia Payment Policy Changes.


Medicaid Program News and Updates (B1800415 - 05/18) - This bulletin contains information on Keep Your Provider Profile Information Up to Date, Fingerprint Criminal Background Check (FCBC), Accountable Care Collaborative (ACC) Phase II: Important Information about Provider Contracting, Prior Authorization Requests (PARs) Through eQHealth Solutions Guidance, Federal Upper Payment Limit (UPL) Requirement, Manual Pricing Billing Process Change - By Invoice, Reminder to Providers: Claims Must Match Documentation, General Updates, PAR Not Needed for Emergencies, Kyleena: New HCPCS Code and Other Long-Acting Reversible Contraceptive (LARC) Information, Preventive Services Billing, PAD - Drugs and Biologicals Discarded/Not Administered to Any Member (JW Modifier), Opioid Treatment Naive Policy, Drug Utilization Review (DUR) Announcements


Special Provider Bulletin - Accountable Care Collaborative: Important Information for Primary Care & Behavioral Health Providers (B1800414 - 04/18) - This bulletin contains information on Provider Contracting, Resources Available on the ACC Phase II Web Page, Contacting Your RAE, Stay Informed

Special Provider Bulletin - Colorado interChange Common Questions (B1800413 - 04/18) - This bulletin contains information on Do Not Send Reconsiderations for Denied Claims, Electronic Submission of Claims with Attachments, Provider Web Portal Void Claim Option Appears Only on Eligible Claims, When to Attach Explanation of Benefits (EOB) on Third Party Liability (TPL) and Medicare Claims, Unique National Provider Identifiers (NPIs): Making Claim Submission Easier, Paper Claim Form Signature Requirements, Claims Paid with 0 Date, Suspended Claims, "Lower of" Pricing Logic for Rate Increases, Rates and Fee Schedules, Finding Information About Your Submitted Claims (What Is an ICN?), Timely Filing, Ordering, Prescribing or Referring (OPR) Application Not Required for Individual Within a Group (IWG) Providers with Prescriptive Authority, Individual Providers Enrolling with an SSN May Only Have One Medicaid ID, Department Grace Period for Updating Provider Affiliations, Retroactive Updates to Member Eligibility Files, Alternative Benefit Plan


Medicaid Program News and Updates (B1800412 - 04/18) - This bulletin contains information on Did You Know? - "Lower of" Pricing Logic for Rate Increases, Fingerprint - Federal Criminal Background Check (FCBC), Reminder: Health First Colorado (Colorado's Medicaid Program) Members Cannot Be Billed for Services, Accountable Care Collaborative (ACC): New Resources for Providers, Health First Colorado Recovery Audit Contractor (RAC) Begins Work, Updates to CMS 1500 Specialty Manual and Appendix T Billing Guidance, Federal Upper Payment Limit (UPL) Requirement, Manual Pricing, DMEPOS Billing Manual Update, Reminder to Providers: Claims Must Match Documentation, State Requirements to Receive the Medicare Low Volume Payment (LVP) Adjustment in Hospital's Medicare Base Rate, Monthly Enhanced Ambulatory Patient Groups (EAPG) Meetings, Mass Adjustment of Xerox EAPG Claims Update, Specialty Hospital Meetings, Hospital Engagements Meetings, Rule Changes for In-Home Support Services (IHSS), April Preferred Drug List (PDL) Announcement, Upcoming Changes for Sedative Hypnotic Medications, Requiring Indications for Growth Hormone Agents, Drug Utilization Review (DUR) Announcements, Date of Service (DOS) Reminder, Pharmacy Cost of Dispensing Survey, Pricing for Unlisted Surgical Procedure Codes, Physician-Administered Drug Rates, Diabetes Self-Management Education (DSME) Coverage, Speech Therapy Coverage Determination Notice, Hospital Discharge Process


Medicaid Program News and Updates (B1800411 - 03/18) - This bulletin contains information on Sign Up for Provider Email Communications, Fingerprint - Federal Criminal Background Check, Healthcare Common Procedure Coding System (HCPCS) Updates for 2018, National Correct Coding Initiative (NCCI) Notification of Quarterly Updates, Pediatric Behavioral Therapies (PBT) Fiscal Year (FY) 2017-2018 Rate Updates, Revised Psychological/Neuropsychological Billing Policy, Brand/Generic Changes, April Preferred Drug List (PDL) Announcement, Federal Upper Payment Limit (UPL) Requirement, Manual Pricing, Reminder to Providers: Claims Must Match Documentation, Addressing Reimbursable Claims that Pay Zero, General Updates, March 2018 PT/OT/ST Billing Manual Update, Pharmacy Updates, New Circumcision Rates Effective March 1, 2018, Hospital Discharge Transportation Billing Update, Updated Billing Manuals, Supplemental Payment for University of Colorado School of Medicine


Medicaid Program News and Updates (B1800410 - 02/18) - This bulletin contains information on Did You Know? - Verifying member eligibility, Child Health Plan Plus (CHP+) Update, Fingerprint Criminal Background Checks, 2018 Health Care Procedural Coding System (HCPCS) Codes Annual Update, Effective March 1, 2018 - Checks for Refund Payment Must Be Made Out to Colorado Department of Health Care Policy and Financing, CMS 1500 and UB-04 Paper Claim Form Reminder, Spinal Cord Injury Pilot Waiver Annual Report Published, Community Mental Health Supports (CMHS)
Fiscal Year (FY) 2017-18 Rates Updates Approved, Long-Term Home Health (LTHH) Services Prior Authorization Requests (PARs), Hospital General Updates, Emergency Supply While Waiting for Prior Authorization (PA) Determination, Drug Utilization Review (DUR) Updates, Provider Type Restrictions, New Provider Types, Drug Recall and Safety Alert: Clopidogrel 75 mg tablets, Pharmacy Cost of Dispensing Survey, Date of Service Reminders, Unenrolled Prescribers: NEW Prescriptions Written by Prescribers Not Enrolled with Health First Colorado Began Denying on January 1, 2018.

Medicaid Program News and Updates (B1800409 - 01/18) - This bulletin contains information on Did You Know? - Void Claim Option, Fiscal Year (FY) 2017-2018 Provider Rate Increases and Adjustments, Child Health Plan Plus (CHP+) Update, Health First Colorado (Colorado's Medicaid Program) and CHP+ Member Feedback Wanted, How Organizations Can Utilize Colorado's Newly Approved Health IT Roadmap, Tax Year 2017 1099-MISC Forms, Transportation Benefits Collaborative Meeting, Co-Pay Policy Update, Physician-Administered Drugs Billed with Miscellaneous J Codes Require National Drug Code (NDC) Number, Healthcare Common Procedure Coding System (HCPCS) Code, and NDC Units, Physician-Administered Drug Rate Update, Drug Utilization Review (DUR) Updates, Unenrolled Prescribers: NEW Prescriptions Written by Prescribers Not Enrolled with Health First Colorado Will Deny Beginning January 1, 2018, Pharmacy Provider Updates, HCPCS 0159T No Longer Covered, Non-Emergent Medical Transportation (NEMT) Bus Ticket Modifiers, Guidance for Billing CPT 92015 for Determination of Refractive State.