1

Provider News

Provider Bulletin

Join the Mailing List

Stay current! Providers, billers, claims specialists, and credentialing specialists can subscribe to ongoing Department communications to receive the latest information on key topics.
Sign Up for Communications

Sign-Up Tips

  1. Select "00 – All Provider Emails" to receive a weekly Provider News & Resources Newsletter, a monthly Provider Bulletin, and general communications relevant to all providers. 
  2. Select a specific provider type to receive communications tailored to that type, including status updates on the Known Issues and Updates web page.
  3. Change or update subscriber contact information in the Provider Web Portal.

What's New

Provider Disenrollment due to Missing Revalidation

Providers are reminded of the requirement to revalidate in the program at least every five (5) years to remain an active provider. Providers are contacted via email with instructions six (6) months before the revalidation deadline. Providers who have failed to revalidate with a revalidation date in 2023 will be disenrolled beginning May 1st, 2024.

HCBS Program Aid Code Changes for Member Eligibility

Home and Community-Based Services (HCBS) providers may now see Universal Aid Code “MH” associated with some Waiver Benefit Plans for eligible members when they check a member's eligibility in the Provider Web Portal. The new MH Universal Aid Code replaces thirteen (13) prior aid codes, beginning March 1, 2024. Waiver Benefit Plans for eligible members may be missing from their Benefits Details list due to a known delay by the counties in determining the benefit plans. Refer to the Benefit Plan & Program Aid Code Acronyms Provider Web Portal Quick Guide for benefit plan and program aid code acronyms.

Non-Emergent Medical Transportation (NEMT) Enrollments Continue to be Closed 

The state imposed a moratorium on new enrollments for Non-Emergent Medical Transportation (NEMT) due to a significant potential for fraud, waste, or abuse to the Medicaid program. An extension of a maximum of six months was requested and approved by CMS, effective April 1, 2024. New enrollments continue to be closed.

Revalidation Explanation of Benefits (EOB) and Requirements for Billing, Individual and OPR Providers

Providers who need to revalidate as Health First Colorado (Colorado's Medicaid program) providers may see Explanation of Benefits (EOB) reasons on Remittance Advice reports that indicate that revalidation is required.  The flexibility that paused disenrollment for providers past their revalidation date during the COVID-19 Public Health Emergency (PHE) has ended. Claims are now being denied for providers who have not revalidated.

Providers are reminded to take action to complete the revalidation process ahead of the due date so that claims will not be suspended or denied due to revalidation delays. Groups and facilities are encouraged to confirm that all individuals on a claim have been revalidated, including all Ordering, Prescribing and Referring (OPR) providers. All OPR providers indicated on a claim must be actively enrolled as an individual with Health First Colorado (42 CFR § 455.410(b)).

Even if the billing provider has revalidated, claims may suspend if an individual has not revalidated.

Providers can locate revalidation dates on the Provider Revalidation Dates Spreadsheet located on the Revalidation web page under the Revalidation Resources section.

BHA Coverage Type Not Eligible for Medicaid or Child Health Plan Plus (CHP+)

Providers may now see a new “Coverage” type for Behavioral Health Administration Benefits, shown in the Provider Web Portal as “BHA Benefit Plan” and “BHAB.” Behavioral Health Administration Benefits (BHAB) is a new program utilizing the Colorado interChange system. It is overseen by BHA, a separate entity that is addressing behavioral health needs of individuals not covered by other medical assistance programs. BHAB “benefits” are not the same as BHO+B benefits provided through the Regional Accountable Entities (RAEs).

Note: This program is not part of Health First Colorado (Colorado's Medicaid program) or CHP+. Individuals who only have “BHA Benefit Plan” listed are not eligible for any service under Medicaid or CHP+.

Reminder: Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) providers must confirm coverage types before rendering any Medicaid or CHP+ services or submitting claims.

Eligibility coverage types (not an all-inclusive list):
•    Medicaid: "Medicaid State Plan" and "TXIX" (Title XIX)
•    Child Health Plan Plus: “CHP+B”
•    Behavioral Health Coverage through the Regional Accountable Entities (RAEs): "Medicaid Behavioral Health Benefits" and "BHO+B"

Claims submitted for individuals who do not have current Medicaid or CHP+ coverage listed will be denied.


COVID-19 News and Resources

 

Provider Newsletters

2024

Provider News & Resources - 04-22-2024  Issue 91 - This newsletter contains information on Did You Know? Provider Disenrollment Due to Missing Revalidation; HCBS Program Aid Code Changes for Member Eligibility; Immunization Providers: Code 90611 Now a Covered Benefit; Reminder: STI Laboratory Testing is a Covered Benefit; LTSS Provider Webinar Announcement; Public Health Order – Syphilis Testing During Pregnancy; HCBS: Direct Care Workforce Stabilization Board Public Hearings; Updated Billing Manuals; Known Issue: Some Speech Therapy Claims for Evaluation Services are Denying for EOB 5551; Resolved Known Issue:  Some BHS Claims with SC Modifier Denying for EOB 2029; Resolved Known Issue: Some PT/OT Claims Denying for EOB 2305; Featured Resource: April 2024 Provider Bulletin (B2400507)

Provider News & Resources - 04-08-2024  Issue 90 - This newsletter contains information on Did You Know? Claim Submissions; PAD Providers: Quarter 2 Rate Update 2024; Updated Billing Manuals; NEMT Enrollments Continue to be Closed; Public Meeting to Gauge Community Interest in Potential Application to Federal Transforming Maternal Health (TMaH) Model; HCBS Program Aid Code Changes for Member Eligibility; LTSS Provider Webinar Announcement; HCBS: Direct Care Workforce Stabilization Board Public Hearings; Featured Resource: Revalidation FAQ; Known Issue: Some PT/OT Claims Denying for EOB 2305; Resolved Known Issue: Some Claims Billed by Optical Outlets Denying EOB 1997; Resolved Known Issue: Some Claims for PAD Denying EOB 7827.

Provider News & Resources - 03-25-2024  Issue 89 - This newsletter contains information on Did You Know? License Update Requirement; Moratorium on New Enrollments for NEMT; OPR: Enrollment Requirement; PAR Process When Health First Colorado is the Secondary Payer; HCBS: Benefit Plan Extension; Featured Resource: Revalidation FAQ; Reminder: Update Fax Numbers; Updated Billing Manuals; Resolved Known Issue: Professional Claims for DME Services Denying EOB 3530; Resolved Known Issue: Professional Claims for DME Services Denying EOB 7827; Resolved Known Issue: Institutional Claims Denying EOB 0192.

Provider News & Resources - 03-11-2024  Issue 88 - This newsletter contains information on Did You Know? Claim Submission Methods; Optum Change Healthcare (CHC) Cyber Security Issue; OPR Providers Required on Claims; Featured Resource: Revalidation FAQ; Updated Billing Manuals; Ambulatory Surgical Center Payment Methodology - Virtual Meetings; Known Issue: Behavioral Health Services Claims with SC Modifier Are Denying Incorrectly for EOB 2029; Resolved Know Issue: Claims for HCPCS 2024 PAD Procedure Codes Suspending EOB 0000.

Provider News & Resources - 03-04-2024  Issue 87 - This newsletter contains information on Did You Know? Enrollment Processing Time; Some Claims for HCPCS 2024 PAD Procedure Codes Suspending EOB 0000; Inpatient Hospital Base Rates Fiscal Year (FY) 23-24 Update; Supplemental Rate Increases; PAD Providers: Record Keeping and Retention; Updated Billing Manuals and Fee Schedules.

Provider News & Resources - Special Newsletter - Durable Medical Equipment (DME) Known Issues - 03-04-2024 - This newsletter contains information on Known Issue: Some Professional Claims with Durable Medical Equipment (DME) E2599, K0108 and T5999 Procedure Codes Denying for Explanation of Benefits (EOB) 7827; Resolved Known Issue: Resolved 02/27/24: Some Professional Claims for Durable Medical Equipment (DME) Services for Procedure Code A4287 Denying for Explanation of Benefits (EOB) 0192; Resolved 02/24/24: Some Professional Claims for Durable Medical Equipment (DME) Services for Procedure Code E0955 with Modifier NU Suspending for Explanation of Benefits (EOB) 2861.

Provider News & Resources - 02-26-2024  Issue 86 - This newsletter contains information on Doula Survey; Updated Billing Manuals; Claims for HCPCS 2024 Procedure Codes were Suspending EOB 0000; Updates to Network Participation/Affiliations Available During Revalidation; PT/OT Providers: Satisfaction Survey; Pharmacy: Prescriber Tool Alternative Payment Model; HCBS LTSS Providers: Provisional Provider Payment; ColoradoPAR Program; Featured Resource: Revalidation FAQ; Sign Up for Provider Email Communications; Known Issue: Institutional Claims Denying EOB 0192.

Provider News & Resources - 02-05-2024  Issue 85 - This newsletter contains information on Did You Know? 2024 HCPCS Updates; Revalidation Requirements for Billing Providers; OPR: Enrollment Requirement; NEMT: Claim Attachment Requirements; NEMT: IntelliRide Reminder; Behavioral Health Stakeholder Webinar; Updated Billing Manuals; Known Issue: Professional Claims for DME Services Denying EOB 2861; Resolved Known Issue: Professional Claims for DME Services Suspending EOB 1512; Resolved Known Issue: Claims for Physical Therapy and Occupational Therapy Denying EOB 4211.

Provider News & Resources - 01-15-2024  Issue 84 - This newsletter contains information on HCBS: Career Resources for Direct Care Workers; 2024 Medicare Part A and Part B Deductible Amounts; 2024 Provider Enrollment Application Fee; BHA Coverage Type Not Eligible for Medicaid or CHP+; Requirements for Eyewear Providers; Updated Billing Manuals; Resolved Known Issue: Some Speech Therapy Claims were Denying for EOB 5550, 5551 and 5552.

Provider News & Resources - 01-08-2024  Issue 83 - This newsletter contains information on Did You Know? License Update Requirement; 2024 Provider Enrollment Application Fee; Claims for HCPCS 2024 Procedure Codes Suspending for EOB 0000; New System Error for Attachments in the Provider Web Portal; New Language Proficiency Field Available for Providers; HCBS: Money Follows the Person (MFP) Capacity Building Grant; Incorrect Speech Therapy (ST) Sessions in Provider Web Portal and Incorrect ST Denials; Immunization Rate Update; Pharmacist-Administered Vaccines; NOVAVAX COVID-19 Vaccines; Immunization Updates and Reminders; Updated Billing Manuals; Resolved Known Issue: Some Claims for Speech Therapy are Denying for EOB 5550, 5551 and 5552.

2023

Provider News & Resources - Issue 82  12-11-2023 - This newsletter contains information on Provider Stakeholder Opportunity - Serving Justice-Impacted Members; Claims for HCPCS 2024 Procedure Codes Suspending for EOB 0000; Incorrect Speech Therapy (ST) Sessions in Provider Web Portal and Incorrect ST Denials; Updated Billing Manuals; Known Issue: Some Claims for Speech Therapy are Denying for EOB 5550, 5551 and 5552; Resolved Claims with DME Procedure Codes E2599, K0108 and T5999 Denying EOB 7577; Resolved Known Issue: Professional Claims with Procedure Code S0190 with a G7 Modifier Denying EOB 7802.

Provider News & Resources - Issue 81  12-04-2023 - This newsletter contains information on Did You Know? Third Party Liability (TPL); Updated Billing Manuals; Verifying Medicaid Coverage - New Coverage Types: New Coverage Type Not Eligible for Medicaid or Child Health Plan Plus (CHP+); Resolved Known Issue: Claims for Speech Therapy Denying for Non-Physician Practitioner Group Providers; Resolved Known Issue: Claims with DME Procedure Codes E2599, K0108 and T5999 Denying EOB 7577; Resolved Known Issue: Professional Claims with Procedure Code V5267 Denying EOB 7827; Resolved Known Issue: Professional Claims with Procedure Code S0190 with a G7 Modifier Denying EOB 7802.

Provider News & Resources - Issue 80  11-27-2023 - This newsletter contains information on Provider Enrollment Application Fee Amount for Calendar Year 2024; Provider Enrollment Revalidation; Updated HCBS Rate Schedules; Reminder: Update Fax Numbers; Updated Billing Manuals; Known Issue: Claims for Speech Therapy Denying for Non-Physician Practitioner Group Providers; Known Issue: Claims with DME Procedure Codes E2599, K0108 and T5999 Denying EOB 7577; Known Issue: Professional Claims with Procedure Code V5267 Denying EOB 7827; Known Issue: Professional Claims with Procedure Code S0190 with a G7 Modifier Denying EOB 7802.

Provider News & Resources - Issue 79  11-13-2023 - This newsletter contains information on Did You Know? Provider Enrollment Revalidation; HCBS: Career Resources for Direct Care Workers; Provider Enrollment Revalidation; Reminder: Submission Request for Paper Claims; COVID-19 Public Health Emergency (PHE) Unwind; Coverage of RSV Vaccine; Delegate Provider Web Portal Accounts; Behavioral Health Administration (BHA) Benefits (BHAB); OPR Upcoming Enrollment Requirement; Sign Up for Provider Email Communications; Updated Billing Manuals; Resolved Known Issue: Maternity Claims Denying EOB 1087 and EOB 1088.

Provider News & Resources - Issue 78  10-16-2023 - This newsletter contains information on Provider Enrollment Reminder; Provider Resources for Outages; Moratorium on New Enrollments for NEMT; Did You Know? Member Eligibility; Direct Care Worker Survey; Immunization Providers: Vaccine Code Updates; Pediatric Behavioral Therapies, Outpatient Speech Therapy, Occupational Therapy and Physical Therapy Co-Treatment; Updated Billing Manuals and Fee Schedules; Resolved 10/04/23: Updated COVID Vaccine Codes.

Provider News & Resources - Revalidation Special Newsletter - 09-29-2023 - This newsletter contains information on Did You Know? Revalidation Spreadsheet; Provider Enrollment Revalidation; Accessing the Provider Web Portal; Featured Resources.

Provider News & Resources - Issue 77  09-22-2023 - This newsletter contains information on Rate Change for Providers Conducting Psychological or Neuropsychological Testing; Timely Filing Resubmission Instructions; Speech Therapy Session Information; Training Grants Available for Direct Care Workers; Updated COVID Vaccine Codes; Updated Billing Manuals; Featured Quick Guide: Verifying Member Eligibility and Co-Pay.

Provider News & Resources - Issue 76  09-11-2023 - This newsletter contains information on Did You Know? Third-Party Liability; Verifying Member Eligibility; Fee Schedules; DORA License Providers: License Portal Panel Field Changes and License Reminder; Lower of Pricing Logic for Rate Increases; HCBS Providers: Provider Training Grants Available; SUD Providers: Third Annual Substance Use Disorder Stakeholder Forum; Updated Billing Manuals; Known Issue: Claim Processing Times for New Procedure Codes; Resolved 08/16/23: Outpatient Hospital Claims Paying Incorrect Rate.

Provider News & Resources - Issue 75  08-18-2023 - This newsletter contains information on Did You Know? Keeping a Claim in Timely Filing; Certification Panel Changes in the Provider Web Portal; PAD Providers: Prior Authorization (PA) Requirements; Family Planning Access in Colorado; Written Appeals Process; Updated Billing Manuals; Resolved Known Issue: Vaccine Claims with Procedure Code 0113A Denying EOB 3280; Resolved Known Issue: Outpatient Hospital Claims Paying Incorrect Rate.

Provider News & Resources - Issue 74  08-07-23 - This newsletter contains information on Did You Know? New Virtual Agent Option for Case Managers; Updated Billing Manuals; Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services; Reminder: Update Fax Numbers; Resolved Known Issue: COVID Booster Claims Using Procedure Code 0174 Denying for EOB 3261; Resolved Known Issue: Prevention of Duplicate Injectables within Seven Days of Billing.

Provider News & Resources - Issue 73  07-20-23 - This newsletter contains information on Did You Know? Electronic Claims Requirement; Reminder: Signatures on Paper Claims; Updated Billing Manuals; Sign Up for Provider Email Communications; Resolved Known Issue: EBD Claims for Procedure Code S5170 Denying for EOB 1544 and EOB 4758; Resolved Known Issue: Prevention of Duplicate Injectables within Seven Days of Billing; Resolved Known Issue: PDN Claims Denying Incorrectly for EOB 5548.

Provider News & Resources - Special Newsletter - Durable Medical Equipment (DME) Known Issues - 07-14-2023 - This newsletter contains information on Resolved Known Issue 07/07/23: Claims for DME Denying for EOB 4070 or EOB 2861.

Provider News & Resources - Issue 72  07-10-23 - This newsletter contains information on Did You Know?  Timely Filing; New Portal to Support the FAMLI Program; Member Co-Pay Reductions; COVID-19 Vaccine CPT Codes; Prevention of Duplicate Injectables within Seven Days of Billing; Updated Billing Manuals; Resolved Known Issue: NPI Error with Revalidation Applications; Resolved Known Issue: PETI PAR Error Message.

Provider News & Resources - Special Newsletter - Durable Medical Equipment (DME) Known Issues - 07-07-2023 - This newsletter contains information on Resolved Known Issues: Resolved 07/07/23: Claims for DME Denying for EOB 4070 or EOB 2861; Resolved 05/04/23: Some DME Supply Claims Paying at Incorrect Rate; Resolved 04/07/23: DME Supply Claims Paying at Incorrect Rate.

Provider News & Resources - Issue 71  06-26-23 - This newsletter contains information on ARPA 4.02 Promoting Single Occupancy Grant; Member Co-Pay Reductions; eConsult Platform Informational Update; Member ID Card Phone Numbers; Updated Billing Manuals and Fee Schedules; Known Issue: NPI Error with Revalidation Applications; Resolved Known Issue: PAD Claims Paid or Denying due to HCPCS/NDC Crosswalk File; Resolved Known Issue: DME Supply Claims Suspending EOB 3530.

Provider News & Resources - Special Newsletter - Durable Medical Equipment (DME) Known Issues - 06-19-2023 - This newsletter contains information on Known Issue: DME Supply Claims Suspending EOB 3530; Resolved Known Issues: Resolved 06/09/23: DME Supply Claims Suspending EOB 2861; Resolved 05/19/23: DME Supply Claims Suspending EOB 2861; Resolved 05/04/23: Some DME Supply Claims Paying at Incorrect Rate; Resolved 04/26/23: DME Supply Claims Paying at Incorrect Rate; Resolved 04/07/23: DME Supply Claims Paying at Incorrect Rate.

Provider News & Resources - Issue 70 06-12-2023 - This newsletter contains information Did You Know? Enrollment Requirements; Health First Colorado Enrollment; NPI Updates in the Provider Web Portal; New COVID-19 Vaccine CPT Codes; Multi-Payer Portal Values; Updated Billing Manuals; Known Issue: DME Supply Claims Suspending EOB 286; Resolved Known Issue: Claims Suspending EOB 7900; Resolved Known Issue: Hospital and PAD Claims Paid or Denying due to HCPCS/NDC Crosswalk File; Resolved Known Issue: Claims for Immunizations Denying EOB 7803; Resolved Known Issue: Adult Home Health Denying for PA; Resolved Known Issue: DME Supply Claims Suspending EOB 2861.

Special Newsletter - Public Health Emergency (PHE) Unwind Resources - 05-22-2023 - This newsletter contains information on Scammer Alert; The COVID-19 Public Health Emergency (PHE); Provider Revalidations; Resources and How to Stay Informed

Provider News & Resources - Issue 69 05-05-2023 - This newsletter contains information on Provider Communication Resources; Provider Revalidation Timelines; Care and Case Management (CCM) System; Member ID Card Phone Numbers; Updated Billing Manuals; Known Issue: Trading Partners and/or Submitters: Batch Files; Resolved Known Issue: Claims for Adult Home Health Services Denying for Prior Authorization; Resolved Known Issue: Hospital Inpatient Claims Denying EOB 2303; Resolved Known Issue: DME Supply Claims Paying at Incorrect Rate.

Provider News & Resources - Issue 68  05-01-2023 - This newsletter contains information on Did You Know? Verifying Member Eligibility; Public Health Emergency (PHE) Unwind Resources; Updated Billing Manuals; Known Issue: DME Supply Claims Suspending EOB 2861; Resolved Known Issue: DME Supply Claims Paying at Incorrect Rate; Resolved Known Issue: Adult Long Term Home Health Claims Denying for PA.

Provider News & Resources - Issue 67  04-14-2023 - This newsletter contains information on ICN and Region Codes Guide; Updated Billing Manuals; Integrated Behavioral Health Care Grant Application; Nursing Facilities and Assisted Living Residences: FAQ Document; Featured Quick Guide:  Verifying Member Eligibility; Known Issue: Adult Long Term Home Health Claims Denying for PA; Resolved Known Issue: Home Health Claims Denying for EOB 4761; Resolved Known Issue:  Home Health PDN Claims Denying for EOB 1331; Resolved Known Issue: Outpatient Speech, Physical, and Occupational Therapy Claims Denying for EOB 3054; Resolved Known Issue: Dental Rate Updates for New HCPCS Effective January 1, 2023.

Provider News & Resources - Issue 66  04/10/2023 - This newsletter contains information on Did You Know? Provider Web Portal URL; Reminder: New Diagnosis or Procedure Codes; Enrollment License Requirements and License Panel Updates; Opioid Treatment Providers: Take-Home Buprenorphine; Critical Incident Reporting for Residential Providers; Updated Billing Manuals; Known Issue: Hospital Inpatient Claims Denying EOB 2303; Known Issue: Home Health Claims Denying for EOB 1331; Known Issue: Some Durable Medical Equipment (DME) Supply Claims Paying at Incorrect Rate; Resolved Known Issue: Dental Rate Updates for New HCPCS Effective January 1, 2023; Resolved Known Issue:  Home Health PDN Claims Denying EOB 1331; Resolved Known Issue: DME Supply Claims Paying at Incorrect Rate.

Provider News & Resources - Issue 65  03-20-23 - This newsletter contains information on Public Health Emergency (PHE) Ending May 11, 2023; Revalidation Reminder; New Provider Web Portal URL: Claims Processing and Provider Services Call Center Unavailable Friday, March 24, 2023; Kepro® - ColoradoPAR Annual Provider Satisfaction Survey; Dental Rate Updates for New HCPCS Effective January 1, 2023; Integrated Behavioral Health Care Grant Application Opens March 22, 2023; Prior Authorization Requests with Private Duty Nursing Services; Updated Billing Manuals; Resolved Known Issue: Claims Denying for Invalid Prior Authorization (PA).

Provider News & Resources - Issue 64 03-13-23 - This newsletter contains information on Timely Filing Guidelines; 2022-2023 RSV Season and Synagis® Vaccine Benefit; Kepro® - ColoradoPAR Provider Satisfaction Survey; New Provider Web Portal URL; Enrollments Requiring Affiliated Practitioners; Reminder: Known Issues and Provider Resources Web Pages; Featured Resource: Virtual Agent Routing Tips; Updated Billing Manuals and Fee Schedules; Sign Up for Provider Email; Resolved Known Issue: Claims Denying for Invalid Prior Authorization; Resolved Known Issue: Claims for HCPCS 2023 Procedure Codes Suspending for EOB 0000.

Provider News & Resources - Issue 63 02-16-23 - This newsletter contains information on Early Closure: Provider Services Call Center; Holiday Closure: Presidents Day; Update: COVID-19 Monoclonal Antibody Injection Evusheld; PAD HCPCS Verify Benefit Coverage; Featured Resource: General Provider Information Manual; Updated Billing Manuals; Known Issue: Claims for HCPCS 2023 Procedure Codes Suspending for EOB 0000.

Provider News & Resources - Issue 62 02-03-2023 - This newsletter contains information on Authenticating When Contacting the Provider Services Call Center; Did You Know? Known Issues and Provider Resources; New PPA Effective March 1, 2023; HCBS Providers: Stakeholder Opportunities Feedback Sessions and Surveys; Featured Quick Guides and Resources: Interpreting Claim Numbers; Pharmacy Providers: Update Fax Numbers; Updated Billing Manuals; Resolved Known Issue:  NEMT Claims with Procedure Codes and Modifier 76 Denying EOB 7817; Resolved Known Issue:  NEMT Claims with Procedure Code A0427 and Modifier 76 Denying EOB 7817.

Provider News & Resources - Issue 61 01-16-2023 - This newsletter contains information on Authenticating When Contacting the Provider Services Call Center; Enrollment Processing Timelines; Revalidation Reminder; PHE Extension; Reminder: Verify Primary Insurance Coverage; Updated Billing Manuals; Known Issue: COVID-19 Vaccine Claims with Procedure Codes 0044A and 90471 Denying EOB 7809 and/or EOB 1381; Resolved Known Issue: HCBS: IHSS Claims for H0038 with the U5 Modifier Paid at Incorrect Rate.

Provider News & Resources - Issue 60 01-09-2023 - This newsletter contains information on Authenticating When Contacting the Provider Services Call Center; COVID-19 Pediatric Bivalent Boosters;  Hospital Providers: Inpatient Hospital Review Program Survey;  Flu Vaccine Code Configuration Correction; Recently Updated Billing Manuals;  Known Issue: Transportation Claims With Procedure Codes and Modifier 76 Are Denying for EOB 7817;  Known Issue: Transportation Claims With Procedure Code A0427 and Modifier 76 Are Denying for EOB 7817 Known Issue: Claims for HCPCS 2023 Procedure Codes Suspending for EOB 0000;  Resolved Known Issue: HCBS Providers: IHSS Claims for H0038.

 

 

Emails to Providers

All Provider Types
Ambulatory Surgery Center (ASC)
Anesthesia

 

Audiologist
Behavioral Health Organization

 

Birthing Center
Case Manager
Certified Registered Nurse Anesthetist (CRNA)
 
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