Provider News

 

Are your billers and claims specialists receiving Department email notifications? Oftentimes, only the credentialing specialist who originally enrolled the provider is subscribed to our mailing list. To make sure the appropriate person within your practice is getting the information they need, please invite them to sign up hereUnder Email Lists, select 00 - All Provider Emails to receive: 1) a weekly Provider News & Resources newsletter, which includes Hot Topics, Featured Provider Resources, and status updates on Known Issues, 2) a monthly notification when the Provider Bulletin is published, and 3) occasional general announcements relevant for all providers. Select your provider type to subscribe to communications specific to your provider type, including status updates on Known Issues. Also, make sure to keep contact information up to date in the Provider Web Portal.

What's New

At-Home Over-The-Counter COVID-19 Test Coverage

Effective January 15, 2022, Health First Colorado covers At-Home Over-The-Counter COVID-19 tests through the Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) benefit. DMEPOS providers should use HCPCS procedure code E1399 with modifier U1 to bill for these products.

Claims billed for tests may begin suspending for EOB 0000 - "This claim/service is pending for program review." while the Colorado interChange is being updated. Claims will be released from suspense once the update is complete. More information will be provided in future communications.

Please note:

  • Member co-pays are not required.
  • Prior Authorization is not required.
  • Test coverage is limited to 15 units of service per month per member.
  • Span-billing is permitted for monthly allowance. See the DMEPOS billing manual for details.
  • One unit of service is equal to one individual test. If a package includes two tests, the provider should bill for two units of service.
  • Providers must bill Health First Colorado the same amount as the retail price on a per-test basis. For example, if the provider sells a two-test pack for $14, they would bill two units of service at $7 each to Health First Colorado.
  • A prescription is necessary to receive reimbursement, as is required for all DMEPOS. However, the Public Readiness and Emergency Preparedness Act allows for pharmacists to order these tests.
  • Providers must use the NPI of the ordering provider, such as the pharmacist, on all claims.
  • All claims for tests should be billed to Gainwell Technologies Fee-For-Service (FFS), including for members enrolled in the Denver Health and Rocky Mountain Health Plan managed care networks.

Contact Haylee Rodgers at Haylee.Rodgers@state.co.us with questions.

Marshall Wildfire Response: PARs Submitted to Kepro & Prescriptions to Magellan Rx Pharmacy Management

Health First Colorado (Colorado's Medicaid Program) is committed to ensuring members who were impacted by the devastating Marshall Fire have continued access to needed outpatient prescription medications and to any items, equipment or supplies destroyed or missing that require a Prior Authorization Request (PAR).

Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro)

Effective December 30, 2021, providers working with a member that needs a Prior Authorization Request (PAR) to address destroyed or missing equipment or supplies as a result of the wildfire or subsequent evacuations, may request an expedited PAR by selecting “expedited” as the request type through Kepro’s PAR system, Atrezzo.

Refer to the email communication Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 1-5-2022 for more information on submitting a expedited PAR.

Contact Kepro Customer Service at 720-689-6340 or email the UM inbox at hcpf_UM@state.co.us for questions regarding this process.

Prescriptions Submitted to Magellan RX Management Pharmacy

If a member's medications were destroyed, damaged or are otherwise not accessible, Health First Colorado will cover any needed refills. In the event of any refill denials, pharmacies should contact the Magellan Rx Management Pharmacy Call Center at 1-800-424-5725 for the required overrides.

If a prior authorization request cannot be obtained in time to fill a new prescription, pharmacies may dispense a 72-hour supply (three days) of covered outpatient prescription drugs to an eligible member. An emergency is any condition that is life-threatening or requires immediate medical intervention. Contact the Magellan Rx Management Pharmacy Call Center for authorization on the emergency three-day supply.

Refer to the the email communication Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022 for more information.

COVID-19 Vaccinations: Rate Increases & Additional Payment for Administration in a Member’s Home

Rate Increase For COVID-19 Vaccinations

Effective September 1, 2021, reimbursement for administration of the first dose of the Johnson & Johnson’s Janssen COVID-19 vaccine as well as the first and second doses of the Moderna and Pfizer COVID-19 vaccines increased to $61.77. The rate for subsequent doses will remain $41.18. The increased rate will apply to the following codes: 0001A, 0002A, 0011A, 0012A, 0031A, 0071A and 0072A. Providers must resubmit qualifying claims, with a date of service of September 1, 2021 or later, in order to receive reimbursement at the higher rate.

Additional Payment for Administration of COVID-19 Vaccination in a Member’s Home

Effective September 1, 2021, providers may submit claims for reimbursement for home administration of COVID-19 vaccines. The additional reimbursement is available when COVID-19 vaccine administration is the only service provided in the member’s home. Providers should use code M0201. Claims for M0201 are limited to once per home, per date of service. M0201 should be billed along with a COVID-19 vaccine code (ex: 91300) and a COVID-19 vaccine administration code (ex: 0001A).

Contact Christina Winship at Christina.Winship@state.co.us with any questions.

Claims for HCPCS 2022 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000

Effective January 1, 2022, claims billed with a HCPCS 2022 procedure code may begin suspending for EOB 0000 - "This claim/service is pending for program review." The Colorado interChange is being updated with the 2022 HCPCS billing codes based on the Centers for Medicare & Medicaid Services (CMS) annual release of deletions, changes and additions.

A special issue of the Provider Bulletin is expected for publication in mid or late January with the details. Claims will be released from suspense once the update is complete.

Providers are reminded to check the Provider Rates & Fee Schedule web page before billing, to ensure the codes are a covered benefit. All codes must be reviewed for medical necessity, prior authorization coverage standards and rates before the codes are reimbursable.

Provider Revalidation Update

The Department understands provider focus has been on member care throughout the Public Health Emergency. However, providers are reminded of the requirement to submit revalidation applications according to their scheduled due date. Revalidation applications are currently being processed within five (5) business days on average. 

Claims are currently not being denied or suspended if revalidation has not been completed. However, providers are strongly encouraged to submit their revalidation application by the scheduled due date. Visit the Revalidation web page and download the Provider Revalidation Spreadsheet to verify the next revalidation due date. Providers will also be contacted via email approximately six (6) months prior to their revalidation deadline with further instructions on submitting a Revalidation application. 

Providers are reminded that only one update can be processed at a time. If providers need to make an additional update while a revalidation application is in process, contact the Provider Services Call Center.

Provider Enrollment Application Fee Amount for Calendar Year 2022

The Affordable Care Act (ACA) requires certain providers to remit an application fee. Effective January 1, 2022, the Provider Enrollment Application Fee has been set at $631 for the 2022 calendar year.
 
Visit the Provider Enrollment web page for more information under the Enrollment News and Updates section. 

Reminder to Update Address for Internal Revenue Service (IRS) Form 1099 in Provider Web Portal 

Providers are encouraged to ensure the IRS 1099 form mailing address on file with Health First Colorado is accurate and current prior to January 2022. Providers may add, view or modify the IRS 1099 form mailing address through the Provider Maintenance option in the Provider Web Portal. A confirmation letter will be sent to all linked provider service locations when an update is completed. The letter will contain: 

  • The provider service location ID 
  • The user information who completed the change 
  • The details of the address changes made (previous and new) 

Note: The IRS 1099 form mailing address is linked to the associated tax ID. If multiple provider IDs share the same tax ID, and one provider changes the 1099 address, that address will change for all providers with that tax ID. 

Visit the Provider Maintenance – Provider Web Portal Quick Guide web page and view Address Changes for instructions to update an address in the Provider Web Portal. 

Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates 

Effective November 1, 2021, the Colorado interChange was updated with a temporary rate increase for some Home and Community-Based Services (HCBS) waiver benefits in response to the COVID-19 public health emergency. A temporary 2.11% rate increase will be applied to impacted services retroactively to April 1, 2021, and will be in effect through March 31, 2022.

The affected HCBS provider claims that have an increase due to the American Rescue Plan Act (ARPA) were reprocessed by the fiscal agent between December 10 and December 31, 2021. Only claims that were billed with the higher rate were reprocessed. Providers are instructed to submit an adjustment with an adjusted billed amount for claims billed at the original lower rate without the increase. 

Refer to the December 2021 Provider Bulletin (B2100471) for more information.

Providers should also refer to Operational Memo Number OM 21-071 for more information on impacted services, billing instructions, and the total percentage increase for each service. 

Extension of Public Health Emergency (PHE)

Health and Human Services Secretary Xavier Becerra has formally extended the Public Health Emergency (PHE). The PHE can be extended for up to 90 days at a time. This extension started January 16, 2022, and would end, unless extended again, on April 16, 2022.

 

 

Newsletters

2022
  • Provider News & Resources - Issue 42 1-21-2022 - This newsletter contains information on Federal Vaccine Guidance, Extension of Public Health Emergency (PHE), Pediatric Personal Care Rate Increase (Non-HCBS Providers), Pfizer Gray Cap COVID-19 Vaccine Code Updates, Respite Providers Respite Rates Billing Instructions, Psychiatric Residential Treatment Facilities (PRTF) Resources; Recently Published Billing Manuals; Known Issues - Home & Community Based Services (HCBS) Alternative Care Facility/Supported Living Program (ACF/SLP) Claims for T2031 with TU Modifier Denying for Explanation of Benefits (EOB) 1010; Resolved Issues - Resolved 11/18/21- Physician-Administered Drug (PAD) Claims Denying for Explanation of Benefits (EOB) 1381.
  • Provider News & Resources - Issue 41 1-17-2022 - This newsletter contains information on At-Home Over-The-Counter COVID-19 Test Coverage; Did You Know? Verify Insurance Coverage; COVID-19 Kepro PARs; COVID-19 Vaccine Rate Increase; Marshall Wildfire Response; Colorado interChange Updated for New Procedure Code 90677; Updated Billing Manuals; Resolved Known Issue: PAD Claims Denying EOB 0192; Resolved Known Issue: NEMT Claims Denying EOB 1512; Resolved Known Issue: EAPG Rates; Resolved Known Issue: 2022 CMS Diagnosis Code Release; Resolved Known Issue: Respite Care Claims for S5151 Paid with EOB 2391; Resolved Known Issue: HCBS IHSS T1019 Claims Paid at Incorrect Rate; Resolved Known Issue: HCBS American Rescue Plan Act (ARPA) Rates  
  • Provider News & Resources - Issue 40  01-03-2022 - This newsletter contains information on Provider Revalidation Update; 2022 Provider Enrollment Application Fee; Recently Published Billing Manuals; Known Issue: Claims for HCPCS 2022 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000; Resolved Known Issue: Resolved 12/23/21 - Home & Community-Based Services (HCBS) Respite Care Providers (Specialties 675 & 676) - Respite Care Claims for S5151 Paying Incorrectly with Explanation of Benefits (EOB) 2391. Resolved Known Issue: Resolved 11/1/21 - Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates.
2021
  • Provider News & Resources - Issue 39  12-13-2021 - This newsletter contains information on New Procedure Code 90677 for Adult Pneumococcal Vaccine Colorado interChange Updated; Reminder Health First Colorado Enrollment; Reminder Non-Emergent Medical Transportation (NEMT) Intelliride Billing; Rate Adjustment Information for: Alternative Care Facility (ACF) / Supported Living Program (SLP) Providers and Singe Entry Point (SEP) Case Managers; Expanded Coverage under the Emergency Medical Service (EMS) COVID-19 Only Benefit Plan; Recently Published Billing Manuals; Known Issues: Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates; Resolved Issues: Resolved 12/7/21 - Home & Community-Based Services (HCBS) In Home Support Services (IHSS) Claims for T1019 Paid at Incorrect Rate.
  • Provider News & Resources - Issue 38 12-6-2021 - This newsletter contains information on Did You Know? Provider Web Portal Password Reset; Reminder: Update Address for Internal Revenue Service (IRS) Form 1099 in Provider Web Portal; New Procedure Code 90677 for Adult Pneumococcal Vaccine; Pharmacy Providers - Reminder: Update Fax Numbers; Recently Published Billing Manuals; Home & Community-Based Services (HCBS) In Home Support Services (IHSS) Claims for T1019 Paid at Incorrect Rate; Resolved 11/18/21: Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381; Resolved 11/16/21: Home & Community-Based Services (HCBS) Residential Habilitation Claims for T2016 Paid at Incorrect Rate; Resolved 10/20/21: 2022 CMS Diagnosis Code Release - M5450 and R053 Diagnosis-Related Claim Denials
  • Provider News & Resources - Issue 37 11-22-2021 - This newsletter contains information on Health First Colorado Enrollment; Recently Published Billing Manuals; Upcoming Holidays; Resolved Issues: Resolved 11/18/21- Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381; Resolved 11/16/21 - Home & Community-Based Services (HCBS) Residential Habilitation Claims for T2016 Paid at Incorrect Rate; Resolved 11/10/21 - Upcoming Colorado interChange Update to Add Multiple Procedures Codes to Free-Standing Birth Centers (FSBC) Billing; Resolved 10/20/21 - 2022 CMS Diagnosis Code Release - M5450 and R053 Diagnosis-Related Claim Denials; COVID-19: News and Updates: CMS Issues Emergency Regulation Requiring COVID-19 Vaccine for Health Care Workers; COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro); Colorado interChange Update for Home and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates; Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates & Billing for Alternative Care Facility (ACF) and Supportive Living Program (SLP) Providers; Monoclonal Antibodies; Colorado interChange Update for New Pediatric COVID Vaccine Procedure Codes.
  • Provider News & Resources - Issue 36 11-5-2021 - This newsletter contains information on Children COVID-19 Vaccine; Upcoming Diabetes Webinar; Extension of Public Health Emergency (PHE); Recently Published Billing Manuals; Known Issues: Home & Community-Based Services (HCBS) Providers - Colorado interChange Update for HCBS American Rescue Plan Act (ARPA) Rates; 2022 CMS Diagnosis Code Release & Diagnosis-Related Claim Denials; Resolved Issues: Resolved 10/27/21 Physicians Services/Clinics, Women’s Health, Non-Physician Practitioners Women’s Health Claims for Procedure Code S4993 Denying for Explanation of Benefits (EOB) 0101.
  • Provider News & Resources - Issue 35 10-25-2021 - This newsletter contains information on Submission Methods for Claim Adjustments, Refunds, Voids and Attachments; Extension of Public Health Emergency (PHE); Did You Know? Diagnosis Codes; Reconsiderations and Appeal; Child Health Plan Plus (CHP+) Specialty Drug Guidance; Qualified Residential Treatment Program (QRTP) or Residential Child Care Facility (RCCF) Providers: Becoming an Instate Qualified Residential Treatment Program (QRTP); Home Health Providers: Prior Authorization Request (PAR) Requirement Re-start Information; Home and Community-Based Services (HCBS) Providers: Rate Increase; Physician-Administered Drugs (PADs) Providers: Prior Authorization Update; Featured Quick Guide: Administrative Password Reset Process; Recently Published Billing Manuals; Known Issue: 2022 CMS Diagnosis Code Release & Diagnosis-Related Claim Denials.
  • Provider News & Resources - Issue 34 10-4-2021 - This newsletter contains information on Holiday Reminder Frances Xavier Cabrini Day Monday, October 4; Holiday Reminder Frances Xavier Cabrini Day Monday, October 4; Provider Relief Fund Phase 4; Reminder: Enrollment Backdate Request; Therapy Providers: Reminder: Usage of Correct Modifiers; Home Health Providers: Prior Authorization Request (PAR) Requirement Re-start Information; Durable Medical Equipment (DME) Providers: Reminder: Orthotics Prior Authorization (PA); Home and Community-Based Services (HCBS) Providers Reminder: Enrollment Specialty; Recently Published Billing Manuals; Known Issues: Physicians Services/Clinics, Women’s Health, Non-Physician Practitioners Women’s Health Claims for Procedure Code S4993 Denying for Explanation of Benefits (EOB) 0101.
  • Provider News & Resources - Issue 33 09-13-2021 - This newsletter contains information on Recently Published Electronic Data Interchange (EDI) Companion Guides; Recently Published Billing Manuals; Durable Medical Equipment (DME) Providers: Procedure Code S1040 Cranial Remolding Orthosis; Submitting a Claim with Medicare Replacement Plan Information; Recoupments of Third-Party Liability (TPL) Claims by the Recovery Audit Contractor (RAC); Hospital Providers - Upcoming Enhanced Ambulatory Patient Groups (EAPG) Update to Drug Pricing and Reimbursement; Home & Community-Based Services (HCBS) Waiver Providers - Program Approved Service Agency (PASA); Reminder: Sign Up for Provider Email Communications; Resolved 9/1/21: Durable Medical Equipment (DME) Backup Wheelchair Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7814.
  • Provider News & Resources - Issue 32 08-26-2021 - This newsletter contains information on Upcoming Suspension: Professional and Outpatient Claims Due to a System Migration; COVID-19 Third Dose Vaccine; Food and Drug Administration (FDA) Gives Pfizer COVID-19 Vaccine Full Approval; Administrative Account Versus the Delegate Account in Provider Web Portal; Featured Quick Guide - Administrative Password Reset Process; Pharmacy & Therapeutics (P&T) Committee Open Positions; Recently Published Billing Manuals; Home & Community-Based Services (HCBS) Providers: Resolved 8/12/21 - Colorado interChange Updated with Rate Increase for Procedure Code H2021 with U8 Modifier.
  • Provider News & Resources - Issue 31 08-16-2021 - This newsletter contains information on Member Eligibility Determination for Monthly Child Tax Credit Payments; Member Eligibility Determination for Emergency Services; Upcoming Telehealth Changes Postponed: Home and Community-Based Services (HCBS) Waivers; Guidance for Resubmitting Denied Claims; COVID-19 Vaccine Update; Featured Quick Guide: Web Portal Registration; Recently Published Billing Manuals; Resolved Issues:  Home & Community-Based Services (HCBS) Providers - Resolved 8/12/21 Colorado interChange Updated with Rate Increase for Procedure Code H2021 with U8 Modifier; Resolved 8/12/21 Personal Care Claims for Procedure Code T1019 and Denver County Reimbursement; Resolved 8/10/21 Home and Community-Based Services (HCBS) Procedure Codes and the Denver Minimum Wage; Resolved 7/15/21 Telehealth Outpatient Crossover Claims for Procedure Code G2025 Denying for Explanation of Benefits (EOB) 5807.
  • Provider News & Resources - Issue 30 08-02-2021 -  This newsletter contains information on Coming Soon! Provider Enrollment Portal Updates; Colorado Indigent Care Program (CICP) Applications Extension; Remittance Advice (RA) Comma-Separated Values (CSV) File Update; What's New? Prescriber Tool; Skilled Nursing Facility Claims Reprocessing July 2021; Recently Published Billing Manuals;  Featured Quick Guide: Provider Enrollment Web Portal Quick Guide - Change of Ownership (CHOW);  Featured Quick Guide: Provider Web Portal Quick Guide - Disenrollment; Pharmacy Providers - Reminder: Update Fax Numbers; Known Issues: Durable Medical Equipment (DME) Backup Wheelchair Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7814.
  • Provider News & Resources - Issue 29  07-19-2021 - The newsletter contains information on Reminder: Timely Filing Guidelines; Reminder: Timely Filing Guidelines; Featured Quick Guide: Provider Maintenance; Resolved Issues: Resolved 7/16/21 - Colorado interChange Update for Practitioner Claims for Listed Physician Administered Drug (PAD) Codes; Resolved 7/15/21 - Telehealth Outpatient Crossover Claims for Procedure Code G2025 Denying for Explanation of Benefits (EOB) 5807; Resolved 7/7/21 - Supply Claims for E2359 Billed with Modifier RB Denying for Explanation of Benefits (EOB) 4211; Partially Resolved 5/14/21 - Hospital Claims with Split Eligibility Interim Solution.
  • Provider News & Resources - Issue 28 07-12-2021 - This newsletter contains information on Did You Know? CO Offered Programs; Child Health Plan Plus (CHP+) State Managed Care Network (SMCN) Transition: How to Bill for CHP+ Services after July 1, 2021; Recently Published Billing Manuals; Featured Quick Guide: Verifying Member Eligibility (Including Managed Care Assignment Details and Benefit Plan Information) and Co-Pay; Reminder: Sign Up for Provider Email Communications; Reminder: Member Eligibility Inquiries; Resolved Issues:  Resolved 7/7/21 - Supply Claims for Procedure Code A4421 Denying for Explanation of Benefits (EOB) 7827; Resolved 7/7/21 - Transportation Claims for Procedure Codes A0425 and A0429 with Modifier 76 Denying for Explanation of Benefits (EOB) 7817; Resolved 6/30/2021 - Vision Claims for Procedure Code 92071 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817; Resolved 6/30/21 - Professional Claims with Modifier 50 Denying for Explanation of Benefits (EOB) 7823 when Ambulatory Surgery Center (ASC) Claim Billed.
  • Provider News & Resources - Issue 27 06-28-2021 - This newsletter contains information on Prior Authorization Request (PAR) Inquiries for Home and Community-Based Service (HCBS) Providers; COVID-19 Vaccine Administration; Affordable Care Act (ACA) Update; First Notice: Home Dialysis Claims Reprocessing Retroactive to July 1, 2020; Child Health Plan Plus (CHP+) State Managed Care Network (SMCN) Transition; Recently Published Billing Manuals; Reminder: Featured Quick Guide - Administrative Password Reset Process; Known Issues: Vision Claims for Procedure Code 92071 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817; Professional Claims with Modifier 50 Denying for Explanation of Benefits (EOB) 7823 when Ambulatory Surgery Center (ASC) Claim Billed; Resolved Known Issues: Resolved 4/15/21 - Claims Reprocessed Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 26  06-07-2021 - This newsletter contains information on Did You Know? Verify Member Eligibility; Updated: Fee Schedules; Home and Community-Based Services (HCBS): COVID-19 Rate; Reminder: Timely Filing Policy for Delayed Member Notification; Featured Quick Guide: Administrative Password Reset Process; Recently Published Billing Manuals.
  • Provider News & Resources -  Issue 25  06-01-2021 - This newsletter contains information on Provider Revalidation Update; Electronic Submission of Claims with Attachments; Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835; Featured Quick Guide: Updating Disclosure Names; Reminder: Sign Up for Provider Email Communications; Known Issues: Partially Resolved 5/26/21 - Claims Denying for Explanation of Benefits (EOB) 4000 - "The Member Has Other Insurance"; Resolved Issues: Resolved 5/21/21 - Mid-Month Appendix X Update Not Completed Due to Transmission Issue; Resolved 5/14/21 - Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/6/21 - Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims.
  • Provider News & Resources - Issue 24 5-13-2021 - This newsletter contains information on Provider Web Portal Maintenance - Sunday, May 16; Vaccination Toolkit for Providers; New Division of Insurance (DOI) Brochures on Mental Health and Preventive Benefits; Telehealth Survey - Share Experiences Using Telehealth to Drive Statewide Innovation; Electronic Funds Transfer (EFT) Update in Provider Web Portal; Anticipated Resolution 5/14/21: Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 23 5-10-2021 - This newsletter contains information on Provider Responsibility to Review Delegate Provider Web Portal Accounts; Reminder - License Update Requirement; The Top Five Reasons Enrollment Applications are Returned to Providers; Featured Resources: Internal Control Number (ICN) & Region Codes Guides; Recently Published Billing Manuals; Resolved 5/6/21: Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 22 5-3-2021 - This newsletter contains information on Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Reconsiderations and Appeals; Reminder: New Utilization Management (UM) Vendor Starts May 1, 2021; Claim Information: Explanation of Benefits (EOB) 3110 - Claims Will Not Deny for Individual Not Being Linked to the Group; Featured Quick Guide: Verifying Member Eligibility and Co-Pay; Provider Revalidation Update; Extension: Public Health Emergency (PHE); Recently Published Billing Manuals; Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211; and Resolved 4/21/21: Supply Claims for B4149 Billed with Modifier BO Denying for Explanation of Benefits (EOB) 7802
  • COVID-19 Vaccine Special Issue Provider News & Resources - Issue III  04-23-2021 - This newsletter contains information on Health Resources and Services Administration (HRSA) COVID-19 Care and Vaccine Access Fact Sheets; Updated Information: COVID-19 Monoclonal Antibody Infusion Bamlanivimab; Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Resources to Support Vulnerable Populations; Resolved Issues: Resolved 4/20/21 - COVID-19 Monoclonal Antibody Codes Q0245 and M0245 a Covered Benefit for Dialysis Centers; Impacted Provider Types: Clinic-Practitioner (Physicians Services-Clinic), Federally Qualified Health Center (FQHC), Dialysis Centers, Rural Health Clinic (RHC), Indian Health Services (IHS) - Resolved 4/13/21: Claims for COVID-19 Vaccine Codes Billed with Place of Service 50 and 72 Denying for Explanation of Benefits (EOB) 0182 or 1030.
  • Provider News & Resources - Issue 21  04-12-2021 - This newsletter contains information on New Funding Opportunity Aims to Support Equitable Vaccine Access in Colorado; Updated: Fee Schedule; Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Load Letter Process; Colorado COVID-19 Vaccine Phase 2; Provider Responsibility to Review Delegate Provider Web Portal Accounts; Recently Published Billing Manuals; Resolved Issues: Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802; Resolved 4/1/21 - Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 20 04-02-2021 - This newsletter contains information on Reminder: Timely Filing Guidelines; Reminder: Verify Eligibility without ID Card; Did You Know?; Recently Published Billing Manuals; New Utilization Management (UM) Vendor Starts May 1, 2021; Featured Quick Guide: Billing from the Correct Account; Pharmacy Providers - Reminder: Update Fax Numbers; Resolved Issues: Resolved 3/24/21 - Home & Community Based Services (HCBS) Waiver Claims for A0120, A0130, H2023, S5100, S5102, S5105, T2003, T2019 & T2021 Not Paying at COVID-19 Enhanced Rate; Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 19 03-16-2021 - This newsletter contains information on Provider Revalidation Update; Announcing "Together We Protect": Colorado's COVID-19 Vaccine Equity Fund; Incorrect Member Billing; Featured Quick Guide: Benefit Plan & Program Aid Code Acronyms; Reminder - Sign Up for Provider Email Communications; ClaimsXten™ Known Issue: Anesthesia Claims for 01968 Denying for Explanation of Benefits (EOB) 7800.
  • Provider News & Resources - Issue 18  03-08-2021 - This newsletter contains information on Training Information - New Utilization Management (UM) Vendor for Prior Authorizations; Recently Published Billing Manuals; COVID-19 Vaccine Codes and Updated Fee Schedules; Featured Quick Guide - Verifying Member Eligibility and Co-Pay; Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211; Resolved Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101; Resolved 3/1/21 - Home & Community-Based Services (HCBS) Providers - Claims for Procedure Code H0038 with the U1 or UC Modifier and the Denver Minimum Wage Reimbursement; Resolved 3/2/21 - Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460.
  • Provider News & Resources - Issue 17 02-26-2021 -This newsletter contains information on Provider Services Call Center Hours of Operation, Did You Know? Medicare Replacement Plan Billing, Featured Quick Guide Prior Authorizations (PAs), 2021 Fee Schedule Updates, Incorrect Member Billing for COVID-19 Tests and Co-Pay Amounts, Emergency Medical Service (EMS) Benefit Plan, New Utilization Management (UM) Vendor for Prior Authorizations, Known Issues: Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211, Anticipated Resolution Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101.
  • Provider News & Resources - Issue 16 02-22-2021 - This newsletter contains information on Did You Know? TPL Updates, Outpatient Hospital Enhanced Ambulatory Patient Grouper (EAPG) Claims Reprocessed for 1% Rate Decrease, Resolved Known Resolved 2/17/21 - All Providers Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Resolved ClaimsXten™ Known Issue: Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817.
  • Provider News & Resources - Issue 15 02-15-2021 - This newsletter contains information on Enrollment Processing Timeline, Recently Published Billing Manuals, Temporary COVID-19 Enhanced Payments for Certain Home & Community-Based Services (HCBS) Providers, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Durable Medical Equipment (DME) Providers -DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 14 02-08-2021 - This newsletter contains information onCOVID-19 Vaccine Rate Update, Provider Services Call Center Updated Schedule, Colorado Exchange Re-opening Enrollment, Did You Know? Timely Filing, Recently Published Billing Manuals, Hospital Services Rendered Via Telemedicine, COVID-19 Home & Community-Based Services (HCBS) Rate Increase for Alternative Care Facilities (ACFs), Supportive Living Program (SLP) and Group Residential Services and Supports (GRSS), Reminder - Sign Up for Provider Email Communications, ClaimsXten™ Known and Resolved Issues: Vision Providers Claims for Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817, Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved 2/3/21 - Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 13 - 01-25-2021- This newsletter contains information onCOVID-19 New Diagnosis Codes, Healthcare Common Procedure Coding System (HCPCS) Updates for 2021, HCBS Providers Extension of Senate Bill (SB) 19-238 Reporting Tool, HCBS Providers Denver Minimum Wage Claim Processing Information, Recently Published Billing Manuals, Known Issues: Nurse Home Visitor Program (NHVP) Claims Billed with HD or TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: 1/13/21 DME Supply Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7802, 1/13/21 DME Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with NU Modifiers Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 12 - 01-18- 2021 - This newsletter contains information on Colorado interChange Update - COVID-19 Vaccination Procedure Codes, COVID-19 Vaccine Colorado Locations, Extension of Public Health Emergency (PHE), Martin Luther King, Jr. Holiday Schedule, 2021 Provider Enrollment Application Fee, Recently Published Billing Manuals, Home & Community-Based Services (HCBS) Providers: Updated Information Denver Minimum Wage Reimbursement Rates Effective January 1, 2021, Primary Care Medical Provider (PCMP) Substance Use Disorder (SUD)Updated Benefit, Known Issues: All Providers- Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802: Resolved Issues:DME Resolved Issue 9/30/20 - Geographic Rates Updated for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL), Resolved 12/9/20 Professional Claims Denying for Unbundling Explanation of Benefits (EOB) 7804, Resolved 12/12/20 - Behavioral Health Claims Billed by Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) or Indian Health Services (IHS) - FQHC Denying for Explanation of Benefits (EOB) 2029, Resolved 1/6/21 - Non-Emergent Medical Transportation (NEMT) Claims Billed with Modifier 77 Denying for Explanation of Benefits (EOB) 7802, Resolved 1/13/21 - Physical Therapy Claims for Procedure Codes 20560 & 20561 Billed with GP, 96 or 97 Modifiers Denying for Explanation of Benefits (EOB) 7802.

 

2020

 

  • Provider Enrollment Special Issue Provider News & Resources - Issue II December 28, 2020 - This newsletter contains guidance information on how to avoid having an application returned for errors: Enrollment Guidance Tips, Social Security Validation for Revalidation Applications, Provider Enrollment Resources.
  • Provider News & Resources - Issue 11 - 12-21-2020 - This newsletter contains information on COVID-19 Vaccines, HCBS Home Care Agency Providers - Accessing Reimbursement Reports for Senate Bill (SB) 19-238, Health Policy Summit, Recently Published Billing Manuals, Resolved Issues: Resolved 12/15/20 Professional Claims Denying for Explanation of Benefits (EOB) 7802 or 7817, Resolved 12/15/20 Behavioral Health Claims for Codes 97151, H0031, H0036, H2015 & TJ Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved 12/16/20 Case Managers/Transition Services Claims Suspending for Explanation of Benefits (EOB) 5765 - Targeted Case Mgmt-Trans Svcs (TCM-TS) is Limited to 240 Units per Transition.
  • 2020 Year End Special Issue - Provider News & Resources - Issue I - 12-17-2020 - This newsletter contains information on Update Address for IRS Form 1099 in Provider Web Portal, Home and Community Based Services (HCBS) Rate Increases for Denver Minimum Wage, 2021 Healthcare Common Procedural Coding System (HCPCS), National Provider Identifier (NPI) Law, Revalidation Section: Revalidation, National Provider Identifiers (NPIs) Cannot Be Updated During the Revalidation Process, Email Addresses to Receive Revalidation Letter, Revalidation Web Page.
  • Provider News & Resources - Issue 10 - 12-14-2020 - This newsletter contains information on Laboratory Providers: Health First Colorado Recovery Audit Contractor (RAC), Recently Published Billing Manuals, Known Issues & Updates: Professional Claims Denying for Explanation of Benefits (EOB) 7802 or 7817, Behavioral Health Claims for Codes 97151, H0031, H0036, H2015 & TJ Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 12/9/20 - Professional Claims Denying for Unbundling Explanation of Benefits (EOB) 7804, Resolved 12/10/20 - Claims for COVID-19 Procedure Codes 87636, 87637 & 87811 Suspending for Explanation of Benefits (EOB) 0000, Resolved 12/12/20 - Behavioral Health Claims Billed by Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) or Indian Health Services (IHS) FQHC Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 9 - 12-7-2020- This newsletter contains information on Update Address for IRS Form 1099 in Provider Web Portal, Physician-Administered Drug (PAD) Providers-Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together, HCBS Home Care Agency Providers Accessing Reimbursement Reports for Senate Bill (SB) 19-238, Recently Published Billing Manuals, Reminder - Durable Medical Equipment (DME) Oxygen For Members Enrolled in Denver Health Medicaid Choice or Rocky Mountain Health Plans Prime Managed Care Organizations (MCOs), Reminder - Sign Up for Provider Email Communications.
  • Provider News & Resources - Issue 8 11-25-2020 -This newsletter contains information on Physician-Administered Drug Providers - Billing for COVID-19 Monoclonal Antibody Infusion Bamlanivimab, Procedure Code Updates and Coverage, Known Issue: Behavioral Health Claims for Code 97151 & TJ Modifier Denying for Explanation of Benefits (EOB) 7802, Known Issue: Case Managers/Transition Services Claims Suspending for Explanation of Benefits (EOB) 5765 - Targeted Case Mgmt-Trans Svcs (TCM-TS) is Limited to 240 Units per Transition, Known Issue: Professional Claims Denying for Unbundling Explanation of Benefits (EOB) 7804.
  • Provider News & Resources - Issue 7 11-23-2020 -This newsletter contains information on Did You Know? Revalidation is Underway, Recently Published Billing Manuals, Reminder - Sign Up for Provider Email Communications, Resolved Issue 11/14/20 Home & Community-Based Services Children's Habilitation Residential Program(HCBS CHRP) Waiver Claims Denying for Explanation of Benefits (EOB) 4758 - Some HCBS CHRP claims were denying for EOB 4758 - "Billing Provider Type/Specialty Restriction on Procedure Coverage Rule."
  • Provider News & Resources - Issue 6 11-06-2020 - This newsletter contains information on Activate CO Exposure Notifications for COVID-19, COVID-19 Procedure Codes, Paper Mail during the COVID-19 State of Emergency, Telemedicine Providers: Upcoming Telemedicine Webinar, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) Telemedicine Visits Limited to Appropriate Procedure Codes.
  • Provider News & Resources - Issue 5 11-02-2020 -This newsletter contains information on Updating 1099 Address in Provider Web Portal, Extension for the Colorado Indigent Care Program (CICP) Applications, Billing Guidance for Vaccine Administration Codes 90460, 90461, 90471-90474, Health & Human Services Announcement Relief Fund Eligibility and Updates Reporting Requirements, Resolved 10/29/20 Telemedicine Place of Service (POS) Being Added to Current Procedural Terminology (CPT) Codes 92630 and 92633, Known Issues & Updates: Resolved 10/28/20 Delegate Provider Web Portal Users Unable to Resume Revalidation Application, Resolved 10/21/20 COVID-19 Laboratory Procedure Codes U0002 and 87635 Included as Clinical Laboratory Improvement Amendments (CLIA) Waived Tests, Resolved 9/30/20 Geographic Rates Updated for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL), ClaimsXten™ Known Issues & Updates:Resolved 10/28/20 Vision Claim Denials for Explanation of Benefits (EOB) 7817 - Payment Modifier Not Appropriate When Billed with Modifier 55, Resolved 10/28/20 Claims Denying for Evaluation & Management (E&M) Services and Procedure Code 99050 for Explanation of Benefits (EOB) 7801 - "Content of Service of Another Procedure on Current/Previous Claim" When Billed with Other E&M Services.
  • Provider News &Resources - Issue 410-26-2020- This newsletter contains information on Claim Submission Methods for Adjustments, Refunds, Voids and Attachments, Outpatient, Physical and Occupational Therapy Providers: 48-Unit Benefit Limit in Provider Web Portal, Providers Who Utilize eQHealth: Prior Authorization Requests (PARs) for Members Affected by Wildfires, Known Issues & Updates: Resolved 10/21/20 Outpatient Claims Receiving Explanation of Benefits (EOB) 3054 - EVV Record Required and Not Found When Submitted After Professional Claim, Resolved 9/30/20 Geographic Rates Updated for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL).
  • Provider News &Resources - Issue 3 10-19-2020-This newsletter contains information on National Provider Identifier (NPI) Backdate Form, Reminder: Laboratory Services, Resolved 9/30/20 - Rate Updates for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL), Known Issue - Vision Claim Denials for Explanation of Benefits (EOB) 7817 - Payment Modifier Not Appropriate When Billed with Modifier 55, Known Issue - Claims Denying for Evaluation & Management (E&M) Services and Procedure Code 99050 for Explanation of Benefits (EOB) 7801 - "Content of Service of Another Procedure on Current/Previous Claim" When Billed with Other E&M Services.
  • Provider News & Resources - Issue 2 10-12-2020- This newsletter contains information on Fiscal Agent Name Change, Outpatient Hospital - Enhanced Ambulatory Patient Grouping (EAPG) Update, New Intercept Process for Child Support, Sign up for Communications, Known Issue - Delegate Unable to Resume Revalidation Application, Known Issue Resolved for Pediatric Home Health Therapy Denying for Prior Authorization.
  • Special Newsletter III - Revalidation 10-5-2020 - This newsletter contains information on Ensure Provider Contact Information For Revalidation Notices Are Updated, Keeping Delegate Information Current on the Provider Web Portal, Provider Revalidation Manual, Revalidation Dates Spreadsheet, Revalidation Web Page, Revalidation Assistance Through the Provider Services Call Center.
  • Special Newsletter - ClaimsXten™ Now Live! 9-28-2020 - This newsletter contains information on ClaimsXten™ Claims Editing Solution Now Live!, ClaimsXten™ Training, Contact Information for Further Questions.
  • Provider News & Resources Issue 1 - 9-4-2020- This newsletter contains information on Provider Rates & Fee Schedule Web Page, COVID-19 Labor & Delivery and Breastfeeding Guidance, ClaimsXten™ Training Schedule & Information, Resolved 8/24/20: Duplicate Payments for Some Pharmacy Claims, Healthy Communities Transition to the Accountable Care Collaborative (ACC), Health First Colorado App Now Available for Members, Here for YOU, Colorado! Web Page Now Available for Members, Colorado Indigent Care Program (CICP) Application Signature Collection End Date Extended,Home Community Based Services (HCBS) Adult Day Service Update
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 8-5-2020 - This newsletter contains information on Cut-Off Date Extension for Colorado Indigent Care Program (CICP) Applications, Telemedicine Utilization Data Now Available, Health Alert Network Update, COVID-19 Guidance for Home & Community-Based Service (HCBS) Providers and Long-Term Services and Supports
  • Special Newsletter - Provider Enrollment Reminders & Updates 7-27-2020 - This newsletter contains information on Current Licensure Requirement, Common Reasons Enrollment Applications Are Returned to Providers, Change of Ownership, End Date/Expiration Date Fields in the Provider Enrollment Application, Updated Provider Enrollment Web Page, Additional Resources
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 7-17-2020 - This newsletter contains information on Reminder: Application to Apply for CARES Act Provider Relief Funding Deadline is July 20, 2020, Colorado interChange Update for Inpatient Subacute Care Pricing Process During the COVID-19 Public Health Emergency in Non-Psychiatric Hospitals & Approved Alternative Care Sites (ACS), New Provider Leader Resource Center Web Page, Telemedicine Services Reminders, COVID-19 Guidance for Home & Community-Based Service (HCBS) Providers and Long-Term Services and Supports
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 7-6-2020 - This newsletter contains information on Application Information for Colorado Indigent Care Program (CICP) Extended, Guidance for Assisting COVID-19 Patients Experiencing Homelessness, Loans Available to Dental Providers for COVID-19 Hardship, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Special Newsletter - National Provider Identifier (NPI) Billing Updates 7-2-2020 - This newsletter contains information on Who Is Impacted by the Colorado NPI Law? Who Is Not Impacted by the Colorado NPI Law?, Enrollment, Eligibility Verification, Update Billing Software for Providers Submit via Batch, Provider Web Portal Access & Security - Update or Validate the Appropriate Access to the Provider Web Portal, Submitting Claims Using Unique NPIs, Claim Status Inquiries via the Provider Web Portal, Provider-Specific Rate Reimbursement, Remittance Advices (RAs), New Claim Explanation of Benefit (EOB) Codes, Frequently Asked Questions, Resources
  • Provider Recruitment & COVID-19 Funding Special Newsletter 6-22-2020 - This newsletter contains information on Upcoming Webinars on Medicaid Provider Relief Portal and Application Process, New COVID-19 Frequently Asked Questions Document for Certain Provider Types, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Provider Recruitment & COVID-19 Funding Special Newsletter 6-10-2020 - This newsletter contains information on New Health First Colorado (Colorado's Medicaid Program) Providers Needed to Treat Influx of New Members, Additional Funding Available to Eligible Providers Through CARES Act Provider Relief Fund, Provider Enrollment Web Page, Provider Enrollment Web Page
  • Special Newsletter II - Revalidation 6-10-2020 - This newsletter contains information on Revalidation Testing Period Now Complete, New National Provider Identifier (NPI) Must Be Obtained Prior to Revalidating, Provider Enrollment Updates Limited to One Per Service Location, Revalidation Application Accessible Only Through Provider Web Portal, Email Addresses to Receive Revalidation Letter, Disclosure of Ownership/Controlling Interest on Revalidation Application, Cost of Revalidation, Revalidation Web Page, Revalidation Assistance Through the Provider Services Call Center
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 6-8-2020 - This newsletter contains information on COVID-19 Tests Billable by Pharmacists, Reminder: New Secondary Provider Specialties for COVID-19 Long-Term and Temporary Enrollment, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 6-1-2020 - This newsletter contains information on Client Application Signatures for Colorado Indigent Care Program, Health First Colorado Fee Schedule Update, New COVID-19 Antibody Testing Codes for Practitioner, Clinic and Laboratory Providers, Billing for COVID-19 Rate Increases for Certain Home & Community-Based Services (HCBS), Resolved 5/27/20: Home & Community Based Services (HCBS) Alternative Care Facility (ACF) for Elderly, Blind or Disabled (EBD) and Community Mental Health Services (CMHS) (ACF) for Elderly, Blind or Disabled (EBD) and Community Mental Health Services (CMHS) Waiver Claims for T2031 Denying for EOB 1010 and 0101, Resolved 5/27/20: Home & Community Based Services (HCBS) Developmental Disabilities (DD) Waiver Level 7 Claims for T2016 Denying for EOB 2384, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 5-22-2020 - This newsletter contains information on Upcoming Holiday Reminder - Memorial Day, Guidance for COVID-19-Related Services for Recipients of Emergency Medicaid Services, Continued Enrollment During the Public Health Emergency for Recipients of Emergency Medicaid Services, Home & Community-Based Services (HCBS) Alternative Care Facility (ACF) for Elderly, Blind or Disabled (EBD) and Community Mental Health Services (CMHS) Waiver Claims for Blind or Disabled (EBD) and Community Mental Health Services (CMHS) Waiver Claims for T2031 Denying for EOB 1010 and 0101, Home & Community-Based Services (HCBS) Developmental Disabilities (DD) Waiver Level 7 Claims for T2016 Denying for EOB 23847, Resolved 5/9/20: Home & Community Based Services (HCBS) Brain Injury (BI) Waiver Claims for T2033 Denying for EOB 1553, Telemedicine Grant Opportunities Through COVID-19 Emergency Funding
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 5-15-2020 - This newsletter contains information on Upcoming Holiday - Memorial Day, Home & Community-Based Services (HCBS) Brain Injury (BI) Waiver Claims for T2033 Denying for EOB 1553, ConnectToCareJobs.com, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Updated Special Newsletter - Revalidation 4-30-2020 - This newsletter contains information on The Revalidation Application Process, Revalidation Timeline, Provider Enrollment Updates Limited to One per Service Location, Cost of Revalidation, New Provider Web Portal Revalidation Quick Guide - Now Available, Revalidation Web Page, Revalidation Application Only Accessible Through Provider Web Portal, What Information Can Be Updated Through Revalidation?, Revalidation Assistance Through the Provider Services Call Center
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 4-27-2020 - This newsletter contains information on Emergency Operations During the COVID-19 State of Emergency, Reminder: Inpatient Hospital Review Program (IHRP) Suspension and New Known Issue for Long Term Acute Care (LTAC) and Maternity Claims Denials, COVID-19 Specific Rate Schedules for Home & Community-Based Service (HCBS) Providers, Replacement Files (Quarter 2 of 2020) Related to the COVID-19 Public Health Emergency, COVID-19 Guidance for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 4-20-2020 - This newsletter contains information on COVID-19 CPT, Diagnosis and HCPCS Coding Information, Colorado interChange Updated to Receive HCPCS Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests, New HCPCS Codes for Specimen Collection for 2019 Novel Coronavirus (COVID-19), Member Eligibility Verification Without ID Card, Payment Error Rate Measurement (PERM) Audit Suspended, New Provider Specialties for COVID-19 Long Term and Temporary Enrollment
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 4-13-2020 - This newsletter contains information on Fraud Alert from the U.S. Department of Health and Human Services' Office for Civil Rights (OCR), New HCPCS Codes for Specimen Collection for 2019 Novel Coronavirus (COVID-19), No Co-Pay for Health First Colorado Members on COVID-19 Treatment Related Claims, Durable Medical Equipment (DME) and Oxygen Supplies During the COVID-19 State of Emergency, Emergency Benefits for Uninsured Coloradans for COVID-19 Laboratory Testing, Medication Prior Authorization (PA) Deferments, Recently Added COVID-19 Provider Resources, New Web Page for Home & Community Based Service (HCBS) Providers and Long-Term Services and Supports COVID-19 Guidance
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 4-6-2020 - This newsletter contains information on Member Eligibility Verification Without ID Card, Telemedicine Place of Service Code, Hospital Providers - Inpatient Hospital Review Program (IHRP) Suspension, Outpatient Hospital Providers - COVID-19 Update to 3M Enhanced Ambulatory Patient Grouping (EAPG) Grouper, Recently Added COVID-19 Provider Resources
  • Last Week in Review - 2019 Novel Coronavirus COVID-19 Updates 3-30-2020 - This newsletter contains information on Colorado interChange Update to Receive New ICD-10 Code for COVID-19, Colorado interChange Update to Receive New CPT Code for Laboratory Testing for COVID-19, Temporary Authorization of Telemedicine Services During COVID-19 State of Emergency, Temporary Authorization of Teledentistry Services During COVID-19 State of Emergency, Open Enrollment for Uninsured Coloradans, Operations During the COVID-19 State of Emergency, Recently Added COVID-19 Provider Resources
  • Last Week in Review - 2019 Novel Coronavirus_COVID-19_Updates 3-23-2020 - This newsletter contains information on Colorado interChange Updated to Receive HCPCS Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests, New ICD-10 Code for COVID-19, Temporary Authorization of Telemedicine Services During COVID-19 State of Emergency, Behavioral Health Providers and Telemedicine Services During COVID-19 State of Emergency, Guidance for Surgical Providers to Delay Non-Essential Surgery Due to COVID-19, COVID-19 Guidance for Prescribers, Operations During the COVID-19 State of Emergency, Home & Community-Based Service Provider Resources
  • Last Week in Review - Known Issues & Updates 3-2-2020 - This newsletter contains information on Billing Health First Colorado (Colorado Medicaid) Members for Services, Timely Filing Requests, March Provider Bulletin - Now Available, New Benefit for HCBS-CES Waiver Providers - Youth Day Services, Sign Up for Provider Email Communications, Upcoming Reprocessing of Third Party Liability (TPL) Recoupments, Durable Medical Equipment (DME) Claim Denials for EOB 5110, Resolved 2/25/20: Pharmacy Claim Denials for Procedure Code K0554 With Modifier NU for Explanation of Benefits (EOB) 4211 - Modifier Is Invalid for Procedure Code and EOB for Explanation of Benefits (EOB) 4211 - Modifier Is Invalid for Procedure Code and EOB 0182 - "Billing PT/PS Restriction on Proc Billing Rule 0182 - "Billing PT/PS Restriction on Proc Billing Rule, Resolved 2/26/20: Long Term Acute Care (LTAC), Rehabilitation (Rehab) and Spine/Brain Injury Treatment Specialty Hospital Hospitals Changed to Per Diem Reimbursement
  • Last Week in Review - Known Issues & Updates 2-24-2020 - This newsletter contains information on Enrollment Updates Limited to One Per Service Location, Explanation of Benefits (EOBs) Filtering for Home & Community-Based Services (HCBS) Providers, Upcoming Mass Adjustment of Certain 13X Type of Bill Claims with Medicare Primary, Provider Services Call Center New Hours, Recoupment of Funds Complete for Overpayment of Surgery Claims Performed by Assistant Surgeons, Electronic Health Records (EHR) Incentive Program Year 2019 Attestation Dates, Health First Colorado (Colorado's Medicaid Program) Selected for Federal Program to Reduce Maternal Opioid Misuse, Calendar Year 2020 Provider Enrollment Application Fee Amount, Durable Medical Equipment (DME) Claim Denials for EOB 5110, Resolved 2/13/20: Incorrect Quantity of Physical and Occupational Therapy Units Displayed in the Provider Web Portal, Resolved 2/13/20: Provider Web Portal Eligibility Display and Short-Term Behavioral Health Service Limits, Resolved 2/13/20: Provider Web Portal Error when Atypical Providers Add Taxonomy Using the Additional Taxonomies Section
  • Last Week in Review - Known Issues & Updates 2-10-2020 - This newsletter contains information on Member Eligibility Update, CMS Transition Period Ended - Only MBIs Returned for 834 and 271 Transactions, What Will the Revalidation Experience be Like?, Upcoming Holiday - Presidents Day, How to Bill for Short-Term Behavioral Health Services in the Primary Care Setting, Timely Filing and Resubmissions, Surgery Providers - Overpayment of Surgery Claims Performed by Assistant Surgeons, Laboratory Providers - Overpayment of Laboratory Claims Affected by Clinical Diagnostic Laboratory Rate Decrease
  • Last Week in Review - Known Issues & Updates 1-27-2020 - This newsletter contains information on Upcoming Changes to Provider Services Call Center Hours, Provider Revalidation Timeline, Rates Schedule & Immunization Rates Schedule 2020, Now Available - Special Provider Bulletin - Laboratories, Incorrect Quantity of Physical and Occupational Therapy Units Displayed in the Provider Web Portal, Resolved 1/15/19: Claims Suspending for HCPCS 2020 Procedure Codes for EOB 0000 - This Claim/Service Is Pending for Program Review
  • Last Week in Review - Known Issues & Updates 1-13-2020 - This newsletter contains information on Provider Web Portal Update to Add New National Provider Identifiers (NPIs), Current Licensure Requirement, Calendar Year 2020 Provider Enrollment Application Fee Amount Update, Prior Authorization for Emergency Services, January Provider Bulletin - Now Available, Upcoming Holiday - Martin Luther King, Jr. Day, Denver Health Medicaid Choice Provider Portal Changes, Claims Suspending for HCPCS 2020 Procedure Codes for EOB 0000 - This Claim/Service Is Pending for Program Review, Provider Web Portal Error When Atypical Providers Add Taxonomy Using the Additional Taxonomies Section.

 

Emails to Providers

All Provider Types
Ambulatory Surgery Center (ASC)
Anesthesia
Audiologist
Behavioral Health Organization
Birthing Center
Case Manager
Certified Registered Nurse Anesthetist (CRNA)

 

Colorado Choice Transitions (CCT)
Community Clinic and Community Clinic with Emergency Center (CC/CCEC)
Community Mental Health Center
Dental
Developmental Evaluation Clinic
Dialysis Center
Durable Medical Equipment (DME)/Supply
Federally Qualified Health Center (FQHC)
Health Maintenance Organization (HMO)
Home & Community Based Services (HCBS)
Home Health
Hospice
Hospital - General
Hospital - Mental
Independent Laboratory
Indian Health Services
Non-Physician Practitioner - Group
Non-Physician Practitioner - Individual
Nursing Facility
Occupational Therapist
Pediatric Behavioral Therapy
Pharmacy
Physical Therapist
Physician Services/Clinics
Podiatrist
Primary Care Medical Provider (PCMP)
Psychiatric Residential Treatment Facilities
Psychologist
Public Health
Qualified Residential Treatment Program
Rehabilitation Agency
Residential Child Care Facility
Rural Health Clinic
School Health Services
Speech Therapy
Substance Use Disorder
Transportation
Vision Services
Women's Health
X-Ray Facility

Provider Association Newsletter

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2020
2019