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What's New

Action Required for Providers that use a Trading Partner

A standardized file naming convention for X12 files has been implemented for all Trading Partners. A Trading Partner is an entity that submits batch X12 transactions on behalf of a Provider. Providers should contact their Trading Partner to confirm they are using the new X12 file naming standards and that the vendor has adjusted their system to retrieve reports before they expire.  Refer to the X12 File Naming Standards Quick Guide for details on X12 file naming standards and format changes to response files.

Claims for Healthcare Common Procedure Coding System (HCPCS) 2026 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000

Claims billed with a HCPCS 2026 procedure code may begin suspending for EOB 0000 - "This claim/service is pending for program review," beginning January 1, 2026. The Colorado interChange is being updated with the 2026 HCPCS billing codes based on the Centers for Medicare & Medicaid Services (CMS) annual release of deletions, changes and additions.

Claims will be released from suspense once the update is complete. Providers are reminded to check the Provider Rates and 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.

Risk Levels for Enrollment and Revalidation for Hospice Providers

Fingerprinting background checks and site visits are required for all High Risk Level providers. 

For Hospice providers enrolled on or after January 1, 2024, the Enrollment Risk Level will be set to High in beginning 2026, and the Revalidation Risk Level will remain Moderate. Newly enrolled Hospice providers were set to High Risk Level in effective in 2025.

Hospice providers that have not met the requirements for fingerprinting and site visits will be notified by letter and email. Refer to Elevate Risk Levels for Hospice Providers - 01-12-26 located under the Hospice Providers drop-down on the Provider News web page.

Refer to the Enrollment FAQ Section of the Provider Enrollment web page for information regarding the fingerprint process.

Providers are reminded to maintain updated contact information on their profile in the Provider Web Portal.

Risk Levels for Enrollment and Revalidation for Skilled Nursing Facility (SNF)

Fingerprinting background checks and site visits are required for all High Risk Level providers.

For Skilled Nursing Facility (SNF) providers that were enrolled or revalidated on or after January 1, 2023, the Enrollment Risk Level will be set to High and their Revalidation Risk Level set to Moderate in beginning in 2026. Newly enrolled SNF providers were set to High Risk Level in effective in 2025. 

SNF providers that have not met the requirements for fingerprinting and site visits will be notified by letter and email. Refer to Elevate Risk Levels for Skilled Nursing Facility Providers - 01-12-2026 located under the Nursing Facility drop-down on the Provider News web page.

Refer to the Enrollment FAQ section of the Provider Enrollment web page for information regarding the fingerprint process.

Providers are reminded to maintain updated contact information on their profile in the Provider Web Portal. 

Prepayment Reviews may be Required for Some Pediatric Behavioral Therapy (PBT) Providers

Beginning 2/1/26, the Department of Health Care and Finance (the Department) will conduct prepayment reviews of some Pediatric Behavioral Therapy (PBT) providers.  

Reviews will focus on specific PBT coding. Review parameters will be posted publicly once finalized. Individual providers that are asked to participate in prepayment reviews will receive a direct notice from the Department prior to 2/1/26 that outlines the scope of the review and provides general instructions.

Calendar Year (CY) 2026 Provider Enrollment Application Fee

For Calendar Year (CY) 2026, the Medicare, Medicaid and Children's Health Insurance Program (CHIP) provider enrollment application fee for institutional providers is $750, adjusted from the $730 fee in 2025 for inflation, rounding up from $749.71. This fee applies to new enrollments, revalidations and adding new locations, and is based on Consumer Price Index (CPI-U) increases.

Key Details:

• Fee Amount: $750.
• Effective Date: For applications submitted in CY 2026 (January 1, 2026, to December 31, 2026).
• Who Pays: Institutional providers enrolling, revalidating, or adding a new Medicare practice location.
• How it's Calculated: The Centers for Medicare & Medicaid Services (CMS) adjusts the fee annually using the CPI-U, rounding to the nearest whole dollar. 

Where to Find More Information:

• Federal Register (for the official notice).
• CMS MLN (Medicare Learning Network) for resources on enrollment.

Provider Newsletters

2026

Provider News & Resources 01-20-2026 Issue 137 - In This Issue: Did You Know? Provider Load Letters; Reconsiderations and Appeals; Claims for HCPCS 2026 Procedure Codes Suspending for EOB 0000; EDI: File Naming Information for Providers that Use a Trading Partner; Pharmacy: Fee-For-Service PBM Change; Recently Updated Billing Manuals and Fee Schedules; Known Issues: FQHC & RHC: Some Institutional Claims with Revenue Code 900 Denied Incorrectly; PBT: Prepayment Reviews May Be Required for Some PBT Providers; SUD: Resolved 1/15/26: Some SUD Providers Were Incorrectly Disenrolled; Behavioral Health: Resolved 1/14/26: Some Claims for Short Term Behavioral Health Services Were Denying for EOB 2029; Pharmacy: Resolved 1/7/26: Some CGM Claims May Have Paid at an Unexpected Rate; Featured Resources: Updating Electronic Funds Transfer (EFT) Information Quick Guide; Provider Trainings: Intermediate Billing Training; Billing Training: Medicare & Third Party Liability; Provider Enrollment Training; Member Eligibility Training
 

Provider News & Resources 01-05-2026 Issue 136 - In This Issue: All Providers: Reconsiderations and Appeals; EDI: File Naming Information for Providers that Use a Trading Partner; Claims for HCPCS 2026; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Case Managers: Pre Prior Authorization (PPA) Certification Dates in the Bridge; Immunization: Resolved 12/23/25: Some Professional Claims for Immunization Procedure Codes were Denying for EOB 1030; Speech Therapy: Resolved 12/23/25: Inaccurate Portal Display for Speech Therapy; Transportation: Resolved 12/18/25: NEMT Claims for Rural County Members were Denying for EOB 5527; Featured Resources: Monthly Provider Bulletin; Upcoming Holidays: Martin Luther King Jr. Day - Monday, January 19, 2026

2025

Provider News & Resources 12-22-2025 Issue 135 - In This Issue: All Providers: Calendar Year (CY) 2026 Provider Enrollment Application Fee; Reminder: Update Address for Internal Revenue Service (IRS) Form 1099 in Provider Web Portal; Reconsiderations and Appeals; EDI: File Naming Information for Providers that Use a Trading Partner; Claims for HCPCS 2026 Procedure Codes Suspending for EOB 0000; Recently Updated Billing Manuals and Fee Schedules; Resolved Known Issues: HCBS - Resolved 12/01/25: Prior Authorization must be on File; Outpatient Hospitals -Resolved 12/17/25: Institutional Claims for Outpatient Hospital Services were Paying at an Incorrect Rate; Speech Therapy - Resolved 12/04/25: Some Professional Claims for Speech Therapy Services are Denying for EOB 2305; SUD - Resolved 12/16/25: Some Professional Claims for Substance Use Disorder (SUD) Continuum Services were Denying for Explanation of Benefits (EOB) 1082; Featured Resources - Provider Maintenance - Essential Safety Net Provider (ESNP) Quick Guide; Provider Training -Provider Training Opportunities in January; Upcoming Holidays - Christmas Day - Thursday, December 25, 2025; Day after Christmas - Friday, December 26, 2025

Provider News & Resources 12-08-2025 Issue 134 - In This Issue: All Providers: Did You Know? Reporting for Medicare Replacement Plans; Reminder: Update Address for IRS Form 1099 in Provider Web Portal;  Reconsiderations and Appeals; EDI: File Naming Information for Providers that Use a Trading Partner; Durable Medical Equipment (DME)/Supply: Pharmacy and Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) Continuous Glucose Monitors (CGMs): Medicare Alignment Updates; Transportation: Out-of-State NEMT Authorization; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Durable Medical Equipment (DME)/Supply: Some CGM Claims May be Paying at an Unexpected Rate; NEMT: Claims for Rural County Members are Denying for EOB 5527;  Resolved Known Issues: Therapy: Resolved 11/17/25: Some Claims for Physical or Occupational Therapy Procedures were Denying for Invalid Referring Provider; HCBS: Resolved 11/20/25: Claims Billed with Procedure Code T1017 were Denying for Explanation of Benefits (EOBs) 2030 and 2031; Featured Resources: Provider Maintenance Quick Guide; File Naming Guide; Provider Training: Provider Enrollment; Professional Beginner Billing

Provider News & Resources 11-24-2025 Issue 133 - In This Issue: HCBS: Specialties No Longer Tied to Taxonomies in the Provider Web Portal; All Providers: Timely Filing Resubmission Instructions; Reconsiderations; Enrollment Type Changes; QRTP/PRTF: Enhanced Standard Assessment; Vision Providers: Eyeglass Coverage; Laboratory Services Providers: Update on Billing Manual; Recently Updated Billing Manuals and Fee Schedules; Known Issues: HCBS: Claims Billed with Procedure Code T1017 are Denying for EOBs; HCBS: Prior Authorization Request (PAR) Must be on File; Substance Use Disorder (SUD): Professional Claims for SUD Continuum Services are Denying for EOB 1082; Resolved Known Issues: ESNP: Professional Claims Submitted by Some Providers with an ESNP Designation were Denying Incorrectly; All Providers: Some Provider Web Portal Users were Receiving an Error During Eligibility Verification; HCBS: Providers were Unable to Add Facility IDs for Specialties; SUD: Providers Were Unable to Add a “Unique Taxonomy;” Immunization: RSV Vaccine Claims were Denying Incorrectly; Featured Resources: Update Electronic Funds Transfer (EFT) Information Quick Guide; Upcoming Holidays: Thanksgiving Day - Thursday, November 27, 2025; Day after Thanksgiving - Friday, November 28, 2025

Provider News & Resources 11-07-2025 Issue 132 - In This Issue: All Providers: Enrollment Processing Time; Non-Emergency Medical Transportation (NEMT) Member Eligibility Requirements Recently Updated Billing Manuals and Fee Schedules; Known Issues: All Immunization Providers: Administrative Codes on Some Professional Claims for the RSV Vaccine are Denying Incorrectly; FQHC and RHC: Some Institutional Claims Previously Billed were Reprocessed Incorrectly; Resolved Known Issues: DMEPOS/Supply Providers: Resolved 11/5/25: Professional Claims for Supply Services were Denying for EOB 3958; ESNP: Resolved 11/6/25: Professional Claims Submitted by Some Providers with an Essential Safety Net Providers (ESNP) Designation were Denying Incorrectly; Featured Resources: Internal Control Number (ICN) Information Sheet; Region Code Information Sheet; Meetings & Announcements: Pediatric Behavioral Therapy (PBT) Providers - Follow-up Meeting; Upcoming Holidays: Veteran's Day - Tuesday, November 11, 2025

Provider News & Resources 11-03-2025 Issue 131 - In This Issue: Did You Know? Third Party Billing; Pharmacy and Durable Medical Equipment, Prosthetics, Orthotics & Supplies (DMEPOS) Continuous Glucose Monitors (CGMs): Medicare Alignment Updates; Provider Web Portal Login Reminders; Update Provider Mailing Addresses Before 1099 Distribution; Recently Updated Fee Schedules; Known Issues: Physical Therapy/Occupational Therapy: Some Claims for Physical or Occupational Therapy Services are Denying for Invalid Referring Provider; Speech Therapy: Some Professional Claims for Speech Therapy Services are Denying for EOB 2305; Featured Resources: Provider Enrollment Manual; Provider Maintenance Quick Guide; Updating Electronic Funds Transfer (EFT) Information Quick Guide; Meetings & Announcements: Upcoming Provider Trainings; Upcoming Holidays: Veteran's Day 

Provider News & Resources 10-27-2025 Issue 130 - In This Issue: Important Revalidation Requirements; Risk Level for Newly Enrolling Skilled Nursing Facility (SNF) and Hospice Providers; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Some Professional Claims for Substance Use Disorder (SUD) Continuum Services are Denying for Explanation of Benefits (EOB) 1082; Resolved Known Issues: Resolved 10/23/2025: Professional Claims for Supply Providers with Certain Procedure Codes and a Modifier of BO were Denying; Featured Resources: Provider Enrollment Resource for Individual Providers wanting to get paid under a TAX ID.; Meeting Announcements: Intermediate Billing Training; Feedback Requested: Feedback Requested: H.R.1 Survey; Upcoming Holidays: Veteran's Day 

Provider News & Resources 10-20-2025 Issue 129 - In This Issue: Non-Emergent Medical Transportation Moratorium on New Enrollments; Prescriber Tool Update; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Professional Claims for Supply Providers with Certain Procedure Codes and a Modifier of BO are Denying; Resolved Known Issues: Resolved 9/29/25: Professional Claims Submitted by DME/Supply Providers for Specific Procedure Codes were Denying for EDOB 7826; Resolved 9/16/25: Some Professional Claims for DME/Supply Providers were Paid at an Incorrect Rate; Resolved 10/1/25: Some Providers Were Not Seeing Additional Taxonomies During Maintenance; Resolved 9/25/25: Clinics Billing for Hospital Observations on Professional Claims Forms (CMS1500) were Denying Incorrectly for EOB 0182; Featured Resources: Timely Filing: Frequently Asked Questions (FAQs) and Billing Resources Web Page; Viewing Prior Authorizations in the Portal Quick Guide; Meeting Announcements: Intermediate Billing Training; Upcoming Holidays: Veteran's Day 

Provider News & Resources 10-03-2025 Issue 128: This newsletter contains information for: Did You Know? Submit Paid Claims as Adjustment; NEMT Moratorium on New Enrollments; Prescriber Tool Update; Pediatric Behavioral Therapy: Targeted Rates for Pediatric Behavioral Therapy Providers; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Some Provider Web Portal Users are Receiving an Error During Eligibility Verification; Professional Claims for Supply Providers with Certain Procedure Codes and a Modifier of BO are Denying; Direct Care Services Calculator (DCSC) Miscalculating Units for Community First Choice In-Home Support Services/Agency Services; Resolved Known Issues: Resolved 9/25/25: Clinics Billing for Hospital Observations on Professional Claims Forms (CMS1500) were Denying Incorrectly for EOB 0182 - "Billing Provider Type and/or Specialty is not allowable for the service billed"; Resolved 9/26/25: Professional or Institutional Claims for Some Essential Safety Net Providers (ESNP) Provider Types Were Denying for Explanation of Benefits (EOB) 0182; Resolved 9/30/25: "Unknown Error" Message when Editing Service Address in Provider Web Portal; Resolved 10/2/25: Some Professional Claims for Services Billed with Procedures Codes 90837, 90832, 90834, 90846 or 90847 were Denying Incorrectly for Explanation of Benefits (EOB) 2861; Incorrect Units and Dollars Were Applied to Some Prior Authorizations (PAs) for Professional Claims for In-Home Support Services (IHSS) and Agency Services; Meeting Announcements: SUD Continuum Invitation: 2025 Annual 1115 Waiver Substance Use Disorder Stakeholder Forum; Upcoming Holidays: Francis Xavier Cabrini Day - Monday, October 6, 2025; Featured Resources: October 2025 Provider Bulletin (B2500530); September Special Provider Bulletin - Synagis® Vaccine Benefit (B2500529); September Special Provider Bulletin - Rate Reductions (B2500528)

Provider News & Resources 09-22-2025 Issue 127: This newsletter contains information for: Rate Reductions for Services Billed on Professional Claims and Institutional Hospital Claims; Electronic Data Interchange (EDI) New File Naming Requirement for Trading Partners X12 Transaction; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Institutional Claims for Outpatient Hospital Services are Paying at an Incorrect Rate; Resolved Known Issues: Resolved 9/5/2025: Claims for Comprehensive Safety Net Provider Services were Denying for Explanation of Benefits (EOB) 1040; Resolved 8/11/25: Some Institutional Claims for Rural Health Clinic (RHC) Services Billed for Procedure Codes 99213 or 99214 Were Denying for Explanation of Benefits (EOB) 2029; Meetings Announcements: Substance Use Disorder Continuum Invitation: 2025 Annual 1115 Waiver Substance Use Disorder Stakeholder Forum; Featured Resources: Billing Manuals web page; Provider Rates and Fee Schedules web page

Provider News & Resources 09-08-2025 Issue 126 - This newsletter contains information for: Did You Know? Keeping Claims within Timely Filing; High Risk Level for Newly Enrolling; Skilled Nursing Facility (SNF) and Hospice Providers; Reminder: Non-Emergent Medical Transportation Revalidation; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Institutional Claims Billed with Revenue Code 900 are Denying for EOBs 2028, 2030 or 2031 Provider Web Portal Registration Instruction Letters; Some Professional Claims for Home and Community-Based Service (HCBS) Providers May Have Been Denied for EOB 4758; Some Providers May Not See Additional Taxonomies During Maintenance; Resolved Known Issues: Resolved 8/28/25: Professional Claims for Obstetrical Care were Denying for EOB 6503; Resolved 9/4/25: Rates Updated for Hospice Claims Effective October 11, 2024 (FFY 24-25); Resolved 9/5/25: Outpatient Claims Billed with Hospital Specialty Drug Appendix Z Codes without Modifier SE Were Denying Incorrectly for EOB 6505; Meetings and Training Announcements: All Providers: Pregnancy-Related Services Stakeholder Engagement Meeting; Provider Training for September - Billing Training

Provider News & Resources 08-22-2025 Issue 125 - This newsletter contains information for: Reminder: Provider Revalidation Dates Spreadsheet; All Providers: Pregnancy-Related Services Stakeholder Engagement Meeting; New Quick Guide: Updating Trading Partner Contact Information; Provider Training for September - Billing Training; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Some Home and Community-Based Services (HCBS) Providers are Unable to Add Facility Identifications (IDs) for Specialties in the Provider Web Portal; Some Professional Claims for Home and Community-Based Service (HCBS) Providers May Have Been Denied for Explanation of Benefits (EOB) 4758; Professional Claims for Obstetrical Care are Denying for Explanation of Benefits (EOB) 6503 “Maternity - Multiple Baby Deliveries”; Resolved Known Issues: Resolved 8/11/25: Claims Billed with Revenue Code 911 or with Procedure Code H0019 were Denying for Explanation of Benefits (EOB) 2029; Resolved 8/21/25: Ambulatory Surgical Centers (ASC) Procedure Code List Updated; Upcoming Holidays: Labor Day – Monday, September 1, 2025; State Offices, Acentra, AssureCare, DentaQuest, Gainwell Technologies, Optum and Prime Therapeutics will be closed

Provider News & Resources 08-11-2025 Issue 124 - This newsletter contains information for: Did You Know? Provider Revalidation Dates Spreadsheet; All Providers: Pregnancy-Related Services Stakeholder Engagement Meeting; Bicillin® L-A Recall Guidance, Shortage and Alternative Medications; Provider Training for August - Provider Enrollment and Billing with Other Payers; Reminder: Load Letters; What Information can be Updated During Revalidation?; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Claims Billed with Revenue Code 911 or with Procedure Code H0019 are Denying for Explanation of Benefits (EOB) 2029; Some Professional Claims for Home and Community-Based Service (HCBS) Providers May Have Been Denied for Explanation of Benefits (EOB) 4758; Resolved Known Issues: Claims are Denying for Non-Emergent Medical Transportation Services with Code S0215; Featured Resources: Load Letters FAQ

Provider News & Resources 07-28-2025 Issue 123 - This newsletter contains information for: Prevent Inactivation of Provider Web Portal Accounts; Updating Legal Name and Tax Identification Number; August Provider Training - Provider Enrollment and Billing with Other Payers; Recently Updated Billing Manuals and Fee Schedules; Resolved Known Issues: Resolved 7/15/25: Some Claims Billed with PAD Code J0578 were Paid at an Incorrect Rate; Resolved 7/14/25: Some HCBS Claims were Denying when Billed Using Code S5130 U2; Featured Resources: Updating Legal Name and Tax Identification Number Quick Guide

Provider News & Resources 07-14-2025 Issue 122 - This newsletter contains information for: Reminder: Provider License Status, Revalidation and Enrollment; HCPF Website Maintenance Outage; Reminder: Load Letters; Recently Updated Billing Manuals and Fee Schedules; Known Issues: Clarification for Substance Use Disorder (SUD) Continuum Providers: Ending Specialty Type 64/477; Some Claims Billed with Procedure Code J0578 are Being Paid at an Incorrect Rate; Some Home & Community Based Services (HCBS) Claims are Denying when Billed Using Code S5130 U2; Resolved Known Issues: Temporary Disenrollment for Some Substance Use Disorder (SUD) Continuum Providers; Non-Emergent Medical Transportation (NEMT) Claims are Denying for Explanation of Benefits (EOB) 1040; Some Laboratory Services Claims were Paid at an Incorrect Rate; Featured Resources: Provider Maintenance Quick Guide; Provider Revalidation Quick Guide; Provider Revalidation Manual

Provider News & Resources 06-30-2025 Issue 121- This newsletter contains information for: Facility ID Now Included on Certain Home and Community-Based Services (HCBS) Provider ID Files; Health-Related Social Needs - Nutrition Benefit Stakeholder Webinars; Recently Updated Billing Manuals and Fee Schedules; Recently Updated Companion Guides; Featured Resources: Provider Maintenance Quick Guide; Upcoming Holiday: Independence Day

Provider News & Resources 06-23-2025 Issue 120 - This newsletter contains information for: Member Eligibility Update - Community First Choice (CFC) Benefit Plan; Reminder: Provider License Status for Freestanding Birth Centers (FSBCs); Health-Related Social Needs - Nutrition Benefit Stakeholder Webinars; Phase III of the Accountable Care Collaborative (ACC) Goes Live on July 1, 2025; Recently Updated Billing Manuals; Featured Resources: Provider Maintenance Quick Guide

Provider News & Resources 06-16-2025 Issue 119 - This newsletter contains information for: Reminder: Timely Filing; Reminder: Provider Revalidation; New Procedure Codes Implemented in the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10 PCS); Regional Accountable Entities (RAEs) Region Count Consolidation and Reduction; Help Shape the Future of Health First Colorado: Apply to Join the Medical Care Advisory Committee (MCAC); Recently Updated Billing Manuals and Fee Schedules; Known Issues: Inaccurate Portal Display for Speech Therapy Units; Featured Resources: Ordering, Prescribing and Referring Claim Identifier Project web page; Provider Revalidation Date Spreadsheet; Upcoming Holiday: Juneteenth

Provider News & Resources 06-09-2025 Issue 118 - This newsletter contains information for: Did You Know? End of Grace Period for OPR Providers; Reminder: Self Service Provider Web Portal Registration Available; New Quick Guide Available for Password Reset Process for Delegates; Help Shape the Future of Health First Colorado: Apply to Join the Medical Care Advisory Committee (MCAC); Recently Updated Billing Manuals and Fee Schedules; Featured Resources: June Provider Bulletin; Password Reset Process for Delegates Quick Guide

Provider News & Resources 05-27-2025 Issue 117 - This newsletter contains information for: Reminder: Provider License Status; Behavioral Health Providers Meeting; Reminder: Self-Service Provider Web Portal Registration Available; Clarification for Substance Use Disorder (SUD) Continuum Providers on Terming Specialty Type 64/477; Help Shape the Future of Health First Colorado: Apply to Join the Medical Care Advisory Committee (MCAC); Recently Updated Billing Manuals and Fee Schedules; Known Issues: Case Managers and Home & Community-Based Services (HCBS): New Children with Complex Health Needs (CwCHN) Waiver; Comprehensive Safety Net Providers: Claims for Comprehensive Safety Net Provider Services Are Denying for Explanation of Benefits (EOB) 1040; Substance Use Disorder (SUD): Clarification for SUD Continuum Providers on Terming Specialty Type 64/477; Resolved Known Issues: All Providers: Resolved 5/14/25: Providers Who Utilize Electronic Visit Verification (EVV) Were Experiencing a Delay in the Creation of The EVV Sandata Account; Case Managers: Resolved 5/12/25: A Defect in the Bridge was causing Non-CDASS Claim Service Line Dollar Amounts to Default to $0.01; Featured Resources: Provider Web Portal Password Reset Quick Guide; Verifying Tax ID Quick Guide

Provider News & Resources 05-12-2025 Issue 116 - This newsletter contains information for: Provider Services Call Center Self-Service Options; Provider Services Call Center Vendor Transitioned Effective May 1, 2025; New Password Reset Webform Available; Non-Emergent Medical Transportation (NEMT) Billing Guidelines for the Denver County Areas; Attachment File Size for Provider Enrollment and Provider Web Portal; Provider Enrollment Training; Provider Enrollment Processing Timelines; Provider Enrollment Approval Letters; Group Affiliations: EOB 3110: Claims will Not Deny for Individual Not Being Linked to the Group; Apply to Join the Medical Care Advisory Committee (MCAC); Recently Updated Billing Manuals and Fee Schedules; Known Issues: Claims for Comprehensive Safety Net Provider Services Are Denying for Explanation of Benefits (EOB) 1040; Some Claims Billed by Pediatric Behavioral Therapy Providers Enrolled as Provider Type 24 with Date of Services (DOS) on or after 4/1/25 are Denying for Explanation of Benefits (EOB) 3385; Providers Who Utilize Electronic Visit Verification (EVV) are Experiencing a Delay in the Creation of The EVV Sandata Account; Resolved Known Issues: Physician Services/Clinics: Resolved 4/16/25: Practitioner and Clinic Services Denying for Explanation of Benefits (EOB) 1030; Physician Services/Clinics: Resolved 5/9/25: Some Practitioner and Clinic Services Billed with Procedure Codes on Professional Claims were Denying for Explanation of Benefits (EOB) 1997; Featured Resources: Provider Maintenance Quick Guide.

Provider News & Resources 05-02-2025 Issue 115 - This newsletter contains information for: Did You Know? Submitted Claims with Medicare Advantage Primary; Provider Services Call Center Vendor Transition; Password Reset Process Change to Self-Service Web Form; New "Primary Owner" and "Primary Employer" Fields Required in the Provider Web Portal; Third-Party Liability (TPL); Recently Updated Billing Manuals and Fee Schedules; Resolved Known Issues: Home & Community-Based Services (HCBS) Providers: Resolved 04/29/25: Some HCBS Professional Claims Were Denying Due to Incorrect Benefit Plans or Eligibility; Physician Services/Clinics Providers: Resolved 04/25/25: Some Practitioner and Clinic Services Billed with Procedure Codes 97161, 97162, 97163, 97164, 97165, 97166 and 97168 on Professional Claims are Denying for Explanation of Benefits (EOB) 1997; Women's Health Providers: Resolved 04/23/25: Claims billed with the lactation support services procedure code S9443 were denying for Explanation of Benefits (EOB) 2022; May 2025 Provider Bulletin (B2500523).

Provider News & Resources 04-21-2025 Issue 114 - This newsletter contains information for: Provider Web Portal Secure Correspondence Link Decommissioned Effective April 17, 2025; Provider Services Call Center Vendor Transition to Optum Will be Effective May 1, 2025; Billing Training: Medicare & Third-Party Liability; Important Billing Information Regarding Child Health Plan Plus (CHP+); Recently Updated Billing Manuals and Fee Schedules; Featured Resources: Verify Member Eligibility and Copay Quick Guide and View Prior Authorizations in the Portal Quick Guide.

Provider News & Resources 04-14-2025 Issue 113 - This newsletter contains information for: Non-Emergent Medical Transportation (NEMT) Moratorium on New Enrollments; Provider Web Portal Secure Correspondence Link Decommission; Update to Fingerprinting Requirements; Billing Training: Medicare & Third-Party Liability; New Extension for Community Health Outcomes (ECHO) Workshop on Syphilis; Congenital Syphilis Review Board Meeting; Vision Providers: Ordering, Prescribing and Referring (OPR) Claim Identifier Mandate; Vision Providers: Aspheric Lenses; Suspended Claims; Recently Updated Billing Manuals and Fee Schedules; Recently Updated Training; Known Issues: Lactation Support Services Providers: Claims billed with the Lactation Support Services procedure code S9443 are denying for Explanation of Benefits (EOB) 2022.

Provider News & Resources – 03-31-2025 Issue 112 – This newsletter contains Did You Know? Provider License Status; Billing Training: Medicare & Third-Party Liability; Provider Web Portal Secure Correspondence Link Decommission; Vision Providers - Ordering, Prescribing and Referring (OPR) Claim Identifier Mandate; Recently Updated Billing Manuals and Fee Schedules; Known Issue: Substance Use Disorder (SUD) Providers Are Unable to Add an “Unique Taxonomy” When Adding “Additional Specialties” to a Provider Profile During Maintenance; Resolved Known Issues: Physicians Services/Clinics - Resolved 03/20/25: Practitioner and Clinic Services Billed with Procedure Code 87428 on Professional Claims were Denying for Explanation of Benefits (EOB) 1599; Featured Resources: April 2025 Provider Bulletin (B2500522).

Provider News & Resources - 03-17-2025 Issue 111 - This newsletter contains Did You Know? Members Requiring Non-Emergent Medical Transportation (NEMT) Services; Reconsiderations and Appeals; Stakeholder Meeting: County Administration Rules; Provider Call Center Transition; Vision Providers: Ordering, Prescribing and Referring (OPR) Claim Identifier Mandate; Revalidation Reminder: Name Matching; Recently Updated Billing Manuals and Fee Schedules; Known Issue: Lactation Support Services Providers: Claims billed with the Lactation Support Services procedure code S9443 are denying for Explanation of Benefits (EOB) 2022 – “A National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) that sets when the units of service are billed in excess of established standards for services that a member would receive on a single date of service for a given CPCS/CPT code;” Resolved Known Issue: Pharmacy Providers: Resolved 3/14/2025: Some Professional Claims Billed by Pharmacy Providers were Denying for Explanation of Benefits (EOB) 1381 – "No Billing Rule for Procedure;" Resolved Known Issue: Clinic – Practitioner Providers: Resolved 3/10/25: Some Professional Claims Billed with Procedure Code G0416 for Clinic Surgery Services were Paying Incorrectly when Billed with Modifier 26; Resolved Known Issue: Home and Community-Based Services (HCBS) Providers: Resolved 2/27/25: In-Home Support Service (IHSS) Claims were Denying for Explanation of Benefits (EOB) 3054 – “EVV Record Required and Not Found”

Provider News & Resources - 02-21-2025 Issue 110 - This newsletter contains Did You Know? Third Party Liability (TPL); Members Requiring Non-Emergent Medical Transportation (NEMT) Services; Provider Web Portal Extended Maintenance Starts Friday, February, 21, 2025 at 6:00 PM MT; Reminder: Signatures on Paper Claims; Reminder: Mailing Address for Paper Claims; Stakeholder Meeting: County Administration Rules; Home and Community-Based Services (HCBS): Working Adults with Disabilities Stakeholder Meeting Announcement and Invitation; Bariatric Surgery Rule Revision – Upcoming Stakeholder Meeting on March 13, 2025; Recently Updated Billing Manuals and Fee Schedules; Home and Community-Based Services (HCBS) Providers - Known Issue: In Home Support Service (IHSS) Claims Are Denying for Explanation of Benefits (EOB) 3054 – “EVV Record Required and Not Found.” 

Provider News & Resources - 02-14-2025 Issue 109 - This newsletter contains information on Did You Know? Missed Revalidation Date; Healthcare Common Procedural Coding System (HCPCS) Codes for 2025; Members Requiring Non-Emergent Transportation (NEMT) Services; Load Letters; Important Update Regarding Handling Exception Acknowledgments for Providers Using Provider Choice Systems For Electronic Visit Verification (EVV); Stakeholder Meeting: County Administration Rules; Home and Community-Based Services (HCBS): Working Adults with Disabilities Stakeholder Meeting Announcement and Invitation; Bariatric Surgery Rule Revision – Upcoming Stakeholder Meeting on March 13, 2025; Recently Updated Billing Manuals and Fee Schedules; All Provider Types: Resolved Known Issue: Some Sandata Provider Electronic Visit Verification (EVV) Portals may not have been be functioning as expected, and claims may have been impacted; Home & Community-Based Services (HCBS): Resolved Known Issue: Some HCBS Services Claims Were Denied Incorrectly; Featured Resources: February 2025 Provider Bulletin (B2500519), Special Newsletter - Revalidation, Special Bulletin – Non-Emergent Medical Transportation (NEMT) (B2400515); Upcoming Holidays: President's Day - Monday, February 17, 2025.

Provider News & Resources - Revalidation Special Newsletter - 01-27-2025 - This newsletter contains information on Federal Mandate for Revalidation; Did You Know?; Provider Notifications; Other Change Applications During Revalidation; Recently Asked Questions & Answers

Provider News & Resources - 01-13-2025 Issue 108 - This newsletter contains information on Did You Know? Revalidation Update; Claims for Healthcare Common Procedure Coding System (HCPCS) 2025 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000, 2025 Medicare Part A and Part B Deductible Amounts; Intermediate Billing Training; Non-Emergent Medical Transportation (NEMT) Recorded Training; Non-Emergent Medical Transportation (NEMT) Providers Meeting; Provider Services Call Center Transition Coming This Spring; Enrollment Reminder for Community Mental Health Center Providers; Recently Updated Billing Manuals and Fee Schedules; Physician Services/Clinics: Resolved Known Issue: Incorrect Rate on Fee Schedule for Procedure Code 20680; DME Supply Providers: Resolved Known Issue: Inaccurate Rates in Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Manual; Home and Community-Based Services Providers: Resolved Known Issue: Denied HCBS Services Claims Were Reprocessed on 12/31/24; Featured Resources: Internal Control Number (ICN) Information Sheet and Fingerprinting Enrollment Frequently Asked Questions (FAQ); Upcoming Holiday: Martin Luther King Jr. Day.