COVID-19 Information for Health First Colorado and CHP+ Providers and Case Managers

COVID-19 Back-to-School Guidance: The Colorado Department of Public Health and Environment (CDPHE) released new P-12 school guidelines as teachers, students, and staff prepare for the 2021- 2022 school year.  Refer to the State Health Officials Release COVID-19 Back-to-School Guidance for more information. 

COVID-19 Vaccine Provider Toolkit: The Colorado Department of Public Health and Environment (CDPHE) has created the Colorado COVID-19 Health Care Provider Vaccine Information Toolkit as a centralized location for providers to access information about resources for COVID-19.

COVID-19 Vaccine Communications Toolkit for Primary Care Physicians (PCPs): The Colorado Department of Public Health & Environment (CDPHE) created a communications toolkit for Primary Care Physicians (PCPs) to help encourage patients to get vaccinated for COVID-19 through primary care providers, a trusted source of information for Health First Colorado members. The toolkit contains ready-to-use email, text and social media messages as well as graphics and print resources encouraging patients to get vaccinated or to set up an appointment. Messages have also been translated into Spanish.

COVID-19 Vaccine InformationBilling GuidanceGeneral ResourcesCOVID-19 Coding InformationCommunicationsColorado Indigent Care ProgramLong-Term Services and Supports COVID-19 ResponseProvider Leader Resource Center

The Department knows providers will have many questions about COVID-19 and will post updates on policies, codes and other important information to providers on this site. Communications will continue to be sent out via bulletins and newsletters. Please sign up for updates on the Provider News web page.

For information about COVID-19 in Colorado, refer to the Department of Public Health & Environment website. This website includes special resources for health care providers on Patient Evaluation, Testing, Personal Protective Equipment and many more topics.

Provider Enrollment Specialties
For more information on new provider specialties for long-term and temporary enrollment during COVID-19, refer to the Provider Enrollment web page.

 

COVID-19 Vaccine Information

COVID-19 vaccines are a covered benefit for Health First Colorado (Colorado's Medicaid Program) members. Claims may be reimbursed for enrolled and qualified providers for administration of COVID-19 vaccines approved by the U.S. Food and Drug Administration (FDA) under their Emergency Use Authorization (EUA) authority. Pharmacists enrolled with Health First Colorado may submit claims for reimbursement of the administration of COVID-19 vaccines to Health First Colorado members. Providers will receive vaccine products from the federal government at no cost. Only the administration fee associated with the vaccines may be reimbursed to providers.

Resources

 

Add your phone to fight COVID-19

An app to help fight COVID-19 is now available for download. CO Exposure Notifications will quickly send notifications if virus exposure is likely within the last 14 days, allowing the ability to seek timely medical attention and take action to protect others. The app is free and does not share personal information. Visit AddYourPhone.com to watch a short video about how it works and how to turn it on with Apple or Android devices.


ConnectToCareJobs Website

The website ConnectToCareJobs.com has been launched to help prevent health care workforce shortages in Colorado during the coronavirus disease (COVID-19) public health emergency and beyond. Focused entirely on health care, ConnectToCareJobs.com quickly connects residential care facilities and providers with health care professionals seeking employment.

 

 

Billing Guidance

Behavioral Health
Durable Medical Equipment and Oxygen Supplies
Home and Community-Based Services (HCBS)
Integrated Care Providers
Maternity Services
Pharmacy and Prescribers
Primary Care Medical Providers
Surgical Providers
Telemedicine

General Resources

 

COVID-19 CPT, Diagnosis and HCPCS Coding Information

New Codes Related to COVID-19

Diagnosis Codes CPT Codes HCPCS Codes
U07.1 U07.0 XW033E5 XW043E5 87635 87636 87637 0223U U0001 U0003
XW033G5 XW043G5 XW033H5 XW043H5 86328 87811 86413 0224U U0002 U0004
XW13325 XW14325 XW013F5 XW033F5 86769 87426 86408 0225U G2023 G2024
XW043F5 XW0DXF5     86409 87428 0202U 0226U    
        0240U 0241U        
Colorado interChange Updated to Receive HCPCS Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests

Effective March 20, 2020, the Colorado interChange has been updated to receive and process claims billed with new HCPCS codes U0001 and U0002 for dates of service on or after February 4, 2020. Providers who test members for the 2019 Novel Coronavirus (COVID-19) using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill using code U0001. Providers may use code U0002 to bill for non-CDC laboratory tests for COVID-19.

Billing with these specific codes will allow for better tracking of the public health response for COVID-19. Rates for U0001 and U0002 can be found on the Provider Rates and Fee Schedule web page under the Health First Colorado Fee Schedule.

Colorado interChange Update to Receive New CPT Code for Laboratory Testing for COVID-19

The Colorado interChange has been updated to receive and process claims billed with new CPT code 87635 for the laboratory testing of the novel coronavirus (COVID-19) for dates of service on or after March 13, 2020.

Colorado interChange Update to Receive New CPT Code for Laboratory Testing for COVID-19 was sent out to providers via email on 3/27/20.

Colorado interChange Update to Receive New ICD-10 Code for COVID-19

The Colorado interChange has been updated to receive and process claims billed with the new ICD-10 code for the diagnosis of COVID-19 U07.1 for dates of service on or after April 1, 2020.

Colorado interChange Update to Receive New ICD-10 Code for COVID-19was sent out to providers via email on 3/27/20.

New HCPCS Codes for Specimen Collection for 2019 Novel Coronavirus (COVID-19)

New HCPCS codes G2023 and G2024 (used to identify and reimburse specimen collection for COVID-19 testing) have been released for dates of service on or after March 1, 2020. The Colorado interChange has been updated to receive and process claims for these codes for an independent laboratory provider type only.

New HCPCS Codes for Specimen Collection for 2019 Novel Coronavirus (COVID-19)was sent out to providers via email on 4/13/20.

New ICD-10 Code for COVID-19 (U07.1)

The new ICD-10 code U07.1 for the diagnosis of COVID-19 has been released but will not become effective until April 1, 2020. The Colorado interChange is being updated to accept claims billed with this new ICD-10 code. More information will be provided in future communications.

Outpatient Hospital Providers - COVID-19 Update to 3M Enhanced Ambulatory Patient Grouping (EAPG) Grouper

The 3M software which utilizes the EAPG methodology has been updated to accommodate the new COVID-19 Current Procedural Terminology (CPT) code, Healthcare Common Procedure Coding System (HCPCS) codes, and ICD-10 diagnosis code. The Colorado interChange has been updated accordingly as listed below:

March 30 - Updated to include COVID-19 CPT code 87635 and HCPCS codes U0001 and U0002.

April 29 - Updated to include COVID-19 diagnosis code U07.1.

For more information on EAPG, refer to the IP and OP Hospital Billing Manual under the UB-04 drop-down and Appendix G under the Appendices drop-down on the Billing Manuals web page.

Outpatient Hospital Providers - COVID-19 Update to 3M Enhanced Ambulatory Patient Grouping (EAPG) Grouper was sent out to providers via email on 4/3/20.

Communications

COVID-19 Provider Newsletters
COVID-19 Newsletters for case managers, and county and eligibility partners

Completing Colorado Indigent Care Program (CICP) Applications During the COVID-19 Pandemic

Q: Many providers are completing client applications remotely. How should we collect signatures from these clients for the CICP application?
A: Several options are available to collect signatures remotely:
  • Mail, email or fax. An applicant may sign an application and return it via mail, email or fax.
    • Pictures of the signed documents taken with an applicant's phone or camera and emailed are also acceptable, as long as the information is all legible.
    • An applicant who can receive the application via email but who has no way to print it may agree to the rating via return email, which shall act as their signature.
  • Phone. If an applicant does not have any way to access the application and return it, phone verification of the applicant's agreement to their determination and rating is acceptable. This method should be used as infrequently as possible, and only for applicants who do not have access to email or a printer, or who are quarantined in the hospital and it is not feasible for them to physically sign the application. Documentation of the phone call, including when it occurred, who from the facility made the call, and confirmation that the applicant or their appointed representative agreed to the rating must be included in the application.
The flexibility to collect signatures by email or phone is only available until midnight October 31, 2021.
Q: Does the new signature policy above apply to the lawful presence affidavit signatures, as well?
A: Yes. However, applicants are still responsible for providing a lawful presence document to prove they are lawfully present. Under current CICP rules, providers are allowed to accept copies of these documents, so scans or pictures are acceptable, as long as all information is legible. The flexibility to collect signatures by email or phone is only valid until midnight October 31, 2021.
Q: If eligibility techs are working from home, what should we do if they don't have access to some of the normal systems (SAVE, printer, scanner, etc.)?
A: Providers should do everything possible to ensure eligibility techs have access to everything they need to complete applications from home. If applications cannot be completed from home, providers should wait to bill the patient until the application can be completed to ensure the CICP discount is being applied if the applicant qualifies. Providers should also extend the backdate to make up for the eligibility tech not being able to complete applications from home.
Q: Can providers also verbally collect income information over the phone?
A: No. Providers must still collect physical documentation of the applicant's income, deductions, liquid resources, etc. The intention of collecting client "signatures" via email and phone is to help reduce in-person application rating sessions. Applicants may not have easy access to be able to print the applications in order to sign them once their ratings have been calculated, which is the reason we are allowing the flexibility for signatures. clients should always be able to send in their income documentation via email, mail, fax, etc., and therefore, the temporary flexibility for signatures will not apply to income information.
Q: We have less staff available in the Emergency Room to complete emergency applications. Can we complete an emergency application for a patient even after they are discharged?
A: Due to the current situation, the Department will allow providers to complete emergency applications for applicants who were seen in the emergency room for up to two business days after the applicant was seen in the Emergency Room or was discharged. Since the emergency application would be completed remotely, every effort should be made to complete a full application. The emergency application should be used as sparingly as possible in these situations. Providers may complete emergency applications up to two business days after the patient has left only until midnight October 31, 2021.

Q: Are telehealth visits (both screen-to-screen and over the phone) eligible for discount under CICP?
A: Yes, providers are allowed to discount telehealth visits under CICP and report them in the annual data.
Q: Are providers allowed to create a lower co-pay structure or even waive co-pay amounts for telehealth visits?
A: Yes, providers are allowed to charge a lower co-pay or waive co-pay amounts for telehealth visits for CICP clients. However, providers must inform the Department of what the co-pay structure will be or if co-pay amounts will be waived and what dates those lower or waived co-pay amounts will be applied to the telehealth visits. Failure to inform the Department of the altered telehealth co-pay amounts will result in the provider being responsible for reporting the full CICP co-pay as the co-pay collected for those visits even if a lower co-pay was collected, per CICP rules.
Q: Are there any other co-pay amounts that the Department is altering during the COVID-19 pandemic?
A: The Department is not altering any co-pay amounts for the CICP, but providers have the option to lower co-pay amounts if they feel it is necessary for their community. Providers must inform the Department of which co-pay amounts are being lowered, what the new co-pay structure will be and how long the altered co-pay amounts will be in effect. Failure to inform the Department of the altered co-pay amounts will result in the provider being responsible for reporting the full CICP co-pay as the co-pay collected for those visits even if a lower co-pay was collected, per CICP rules.
Q: How should CICP providers handle COVID vaccines and copayments?
A: CICP providers can include patients receiving the vaccine in their patient counts for the CICP as long as the patients are charged according to the CICP or alternate approved copay schedule, or the vaccine is provided free of charge. In addition, CICP providers can include the write-off cost (i.e., cost less any reimbursement received from HRSA, insurance, or other sources) for vaccines administered to CICP clients in their reporting to the CICP program. CICP will be enacting a blanket policy for the allowance of waived copays for all CICP clients related to the administration of the vaccine to reduce any barriers to vaccination.

Any client receiving a novel coronavirus disease (COVID-19) vaccine during a normal office visit would not have any additional charge above the outpatient co-pay, as is normal for any vaccine administered during an office visit. If the visit is solely for the vaccine, the co-pay can be waived. If the vaccine is administered through the provider's pharmacy, the co-pay can be waived. If a vaccination clinic is being held to administer the vaccine, those copays can be waived as well.

Q: Can the 90 day backdating period be extended due to the COVID-19 pandemic?
A: Providers always have the ability to extend the backdating period for applicants whose situations warrant a longer backdating period. During the pandemic, providers can set a blanket policy to backdate a certain number of days or to a specific date. A copy of the temporary blanket policy, including the effective dates, should be included with the provider's normal policies so that it would be accessible during an audit. It may also make sense to state that the temporary policy was used to extend the backdate in the client applications so that it can be easily identified why the backdate does not follow the standard 90-day rule.
Q: Can we extend current CICP clients' end dates for clients whose ratings are expiring during the pandemic if they do not feel comfortable completing an application by phone or who do not have access to email?
Yes. Clients whose CICP ratings expire on or before October 31, 2021, may have their end dates extended if the client is uncomfortable coming into the facility to complete an application and/or is otherwise unable to complete the application remotely. For clients whose ratings expire between March 24, 2020, and September 30, 2021, their end date can be extended to October 31, 2021. For clients whose ratings expire during the month of October 2021, their end date can be extended to November 30, 2021.

Q: Are we allowed to extend the 15-day deadline for applicants to send in additional documentation for their application if they are sending it through the mail?
A: Yes, the 15-day deadline can be waived for clients submitting documents or returning signatures through the mail.
Q: If an applicant's Colorado ID is expired and they cannot renew it due to the pandemic, can we accept the expired ID?
A: Expired documents are never allowed to be used to complete the CICP application, and that is no different during the pandemic.
  • Applicants who are U.S. citizens may attest to their lawful presence if their ID is expired or provide another form of proof of lawful presence.
  • Applicants who are not U.S. citizens will need to provide some other form of proof of lawful presence.
The applicant will also need to provide proof of address through something other than the expired ID.
Q: Can we accept IDs via email, phone or fax?
A: Under current CICP rules, providers can accept copies of lawful presence documentation, including IDs. Providers would be able to accept them through email or fax, but not by phone.

Q: A lot more applicants are reporting they have lost their job due to COVID-19. How should we calculate income for these applicants?
A: All applicants' situations are going to be different, so providers should use their best judgment as to how income is calculated. It is the Department's direction that providers should rate these applicants using any income they currently have, including unemployment insurance payments, furlough pay, side job income, etc., and their ratings should only be issued for six months instead of a year. The current version of the CICP application allows for begin and end dates to be changed on the card, so changing the date should not be an issue. There should be no issue using the application as normal with the six-month end date. Annual income calculated through the application should not be manipulated to "fit" the six month time period. An applicant making $1,000 a month being rated for a year has the same Federal Poverty Level (FPL) calculation as they would if they are rated for six months because their monthly income does not change. The applicant should be informed that if they do go back to work or get a new job, they will need to report this to the provider and be rerated.
Q: If a patient has a previous visit or admission for which they already applied for CICP and were denied, can those visits be covered now if they apply again after losing their job and the previous visit or admission falls within the 90-day backdating period?
A: If you have already screened a patient for previous visits and they did not qualify in that month, they cannot be covered in the 90-day backdating period if they apply again after they have lost their job. This is consistent with Health First Colorado (Colorado's Medicaid Program) policy, as well. If the patient was never screened to cover previous visits or admissions, those can be covered under their new application.
Q: How do we rate an applicant who has applied for unemployment but has not received a determination?
A: It would be best to wait to screen this applicant until after they receive their determination. As always, medical services should not be withheld from these applicants just because their application can't be completed yet - their visits should be covered by the typical 90-day backdate.
Q: If an applicant has applied for unemployment and has received their determination, do we just use that income for their monthly amount, or should we include the income they received in the previous month?
A: In this situation, you should only use the unemployment amount (plus any other income they are still receiving) since the application looks at the income for the applicant from the point of the application forward. Since the applicant may have permanently lost their job or have no idea when they will be working again, it wouldn't make sense to include income from the previous month. The applicant should be informed that if they do go back to work or get a new job, they will need to report that to the provider and be rerated.
Q: How do we count income for an applicant who has lost their job but receives their final paycheck in the month they are applying? For instance, if they lost their job in March, their final paycheck may come in April.
A: In this situation, you should count the gross amount of the final paycheck as a one-time income source and then use any unemployment or other income to calculate their monthly income.
Q: Should we include the federal or state stimulus payments in the income calculation?
A: No. The federal and state stimulus payments should not be included in the income calculation. This is consistent with Health First Colorado policy.
Q: For applicants who qualify for unemployment, should we count the federal expanded unemployment benefit in the income calculation?
A: No. The federal expanded unemployment benefit should not be included in the income calculation for unemployed applicants. This is consistent with Health First Colorado policy.

Contact Information for Providers

For local public health agencies and healthcare providers only:

From Monday through Friday, 8:30 a.m.- 5:00 p.m., please call 303-692-2700.
For after-hours, holidays, and weekends, please call 303-370-9395.

For general questions about COVID-19:
Call CO-HELP at 303-389-1687 or 1-877-462-2911.
Email COHELP@RMPDC.org for answers in English.

Contact the Provider Services Call Center for billing questions.