Provider News

Attention: The Provider Services Call Center will be closed on Friday, 3/24. Eligibility verification will be available through the Provider Services Call Center virtual agent until Saturday, 3/25. The provider web portal and batch processing will be unavailable on Friday, 3/24 through Sunday, 3/26. Claims that are not processed before 5:00 p.m. MT on Thursday, 3/23 will be on the following week’s remittance cycle. All services are scheduled to resume on Monday, 3/27. We apologize for the inconvenience.

HCPCS - interChange Implementation Complete

Effective 1/1/23, claims billed with a HCPCS 2023 procedure code were suspending for EOB 0000 - "This claim/service is pending for program review." The Colorado interChange has been updated with the 2023 HCPCS billing codes based on the Centers for Medicare & Medicaid Services (CMS) annual release of deletions, changes and additions. Claims were released 3/10/23.

Public Health Emergency (PHE) - Ending May 11, 2023

Health and Human Services Secretary Xavier Becerra has formally ended the Public Health Emergency (PHE). The end date is May 11, 2023.

Visit the Public Health Emergency Planning web page for more information. 

Updated: Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services

A temporary administrative approval process for Private Duty Nursing (PDN) Prior Authorization Requests (PARs) was announced to be effective until December 31, 2022. Note this is an administrative approval process not a pause. Providers will still need to submit all necessary documentation. This process has been extended through April 2, 2023.

Refer to the February 13, 2023 email, Updated: Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services for more information.

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.

Emails to Providers

All Provider Types

• New Provider Web Portal URL - 03-16-2023
• Authenticating When Contacting the Provider Services Call Center - 01-19-2023
• Authenticating When Contacting the Provider Services Call Center - 01-03-2023
• SFTP Post-Migration Update - 11-11-2022
• Family Planning Benefit Expansion - 08-08-2022
• Waived Enrollment Application Fee Providers Update - 05-10-2022
• 2021 Deficit Reduction Act - 10-2-2021
• COVID-19 Vaccine Rate Update 2-2-2021
• From the Executive Director: Federal Government Announces New Open Enrollment Period 2-2-2021
• Extension of Public Health Emergency (PHE) 1-26-2021
• COVID-19 Vaccine Information for Health First Colorado and CHP+ Providers 1-15-2021
• A Message from Executive Director Kim Bimestefer 1-8-2021
• 2021 Healthcare Common Procedural Coding System HCPCS Updates 12-30-2020
• New COVID-19 Frequently Asked Questions (FAQs) Section Added to Telemedicine Web Page 3-23-2020
• Temporary Authorization of Telemedicine Services During COVID-19 State of Emergency 03-18-2020
• Special Update Concerning Coronavirus (COVID-19) 3-16-2020
• New COVID-19 Provider Information Web Page and Healthcare Common Procedure Coding System (HCPCS) Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests 3-13-2020

Ambulatory Surgery Center (ASC)

• Resolved 07/01/22: Reclassification of ASC Grouper Rate for Procedure Code 36561 - 07-07-2022
• Reclassification of Ambulatory Surgical Center (ASC) Grouper Rate for Procedure Code 36561 2-15-2022
• Monoclonal Antibodies - 11-16-2021
• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• Guidance to Delay Non-Essential Surgery due to COVID-19 3-19-2020

Anesthesia

•  

Audiologist

• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations 2-22-2021

Behavioral Health Organization

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• Behavioral Health Independent Provider Network Forum Update - 02-28-2022
• Behavioral Health Independent Provider Network Forum 2-4-2022
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021

Birthing Center

• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• COVID-19 Labor & Delivery and Breastfeeding Guidance 8-7-2020

Case Manager

• New Link for Bridge - 3-17-23
• Non-Medical Transportation Experience Survey 3-14-2023
• Developmental Disabilities (DD) Waiver Prior Authorization Requests 2-9-2023
• Upcoming Care and Case Management Training - 1-3-2023
• Consumer-Directed Attended Support Services Reminder - 10-10-2022
• Care & Case Management Help Desk Email - 09-21-2022
• Benefits Utilization System (BUS) Maintenance Beginning 5:00 p.m. MT on August 2, 2022 - PT 11 Specialties 330, 770, 771
• Resolved Issue: Password Reset Functionality Issue in Production MEUPS 2-23-2022
• Known Issue: Password Reset Functionality Issue in Production MEUPS 2-22-2022
• Update - Bridge Error Messages for Service Plan Authorization Limits 9-1-2021
• Bridge Error Messages for Service Plan Authorization Limits 8-25-2021
• Case Management Redesign Member and Family Listening Sessions - 7-14-2021
• Additional Session: Case Management Redesign Update Featuring the Care and Case Management (CCM) System 2-22-2021
• Update: Transition to the New Care and Case Management System 1-25-2021
• Transition to the New Care and Case Management System 1-20-2021
• Denver Minimum Wage Increase Effective January 1, 2021 - PT 11 (HCBS Case Managers) 12-24-2020

Certified Registered Nurse Anesthetist (CRNA)

 

Community Clinic and Community Clinic with Emergency Center (CC/CCEC)

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• EAPG Version Update - 07-27-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Hospital Claims with Split Eligibility Interim Solution - 04-21-2022
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• Resolved Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-18-2021
• Update Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-17-2021
• Claims for Procedure Code J0585 Denying for Explanation of Benefits EOB 1381 11-16-2021
• Monoclonal Antibodies - 11-16-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020

Community Mental Health Center

• Billing Changes for Gender Identity Disorders - 03-09-22
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Alternative Funding Strategies for Community Mental Health Centers (CMHCs) During COVID-19 State of Emergency Fact Sheet 4-3-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020

Dental

• DentaQuest Processing Delay - 1-25-2022
• COVID-19 Guidance for Dental Providers 3-23-2020
• COVID-19 Guidance for Prescribers 3-20-2020
• Health First Colorado Child Plan Orthodontic Updates 11-23-2022

Developmental Evaluation Clinic

 

Dialysis Center

• Home Dialysis Claims Reprocessing Retroactive to July 1, 2022 - 12-1-2022
• Update: Recoupment of Overpaid In-Home Dialysis Claims 9-14-2021

Durable Medical Equipment (DME)/Supply

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Temporary Changes to Prior Authorization Request (PAR) Requirements - 12-15-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Listening Sessions for Therapy, Supply and Home Health Prior Authorization Process 2-4-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Incorrect Claim Payment for DME Codes Subject to Geographic Rate and Medicare UPL 10-29-2021
• Procedure Code S1040 Cranial Remolding Orthosis 9-3-2021
• Resolved Issue: Same Day Deliveries of Back-up Wheelchairs Claim Denials 9-3-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• Known Issue: Durable Medical Equipment (DME) Backup Wheelchair Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7-22-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Resolved Issue - DME Claims Billed with Multiple Modifiers Denying for EOB 7802 2-9-2021
• Durable Medical Equipment (DME) - Clarification for Authorization Guidance 1-20-2021
• Known Issue - DME Claims Billed with Multiple Modifiers Denying for EOB 7802 1-7-2021
• Durable Medical Equipment (DME) and Oxygen Supplies During the COVID-19 State of Emergency 4-8-2020

Federally Qualified Health Center (FQHC)

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Physician-Administered Drug Prior Authorization Request Policy Clarification 4-28-2022 
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Increases in Health First Colorado Reimbursement for All COVID-19 Vaccines 3-25-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together 12-9-2020
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020
• COVID-19 Guidance for Prescribers 03-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020

Health Maintenance Organization (HMO)

• Distribution of EDI X12 834 Transactions Delayed - 1-26-2023
• Distribution of  EDI X12 834 Transactions Delayed - 12-13-2022
• Distribution of  EDI X12 834 Transactions Delayed - 10-27-22
• Distribution of  EDI X12 834 Transactions Delayed - 10-25-22
• Updated Disenrollment Rules for ACC Program - 07-07-2022
• Distribution of EDI X12 834 Transactions Delayed - 06-20-2022
• Distribution of EDI X12 834 Transactions Delayed - 06-16-2022
• June 2021 Distribution of EDI X12 834 Transaction Delayed - 6-17-2021
• Update - Distribution of Encounter Report Delayed 5-18-2021
• Distribution of Encounter Reports Delayed 5-17-2021
• Short Notice - Fireside Chat on Vaccine Safety - 1-6-2021 (Specialty Code 393)

Home & Community Based Services (HCBS)

• Non-Medical Transportation Experience Survey 3-14-2023
• Digital Tools Investment Grant Information - 10-3-2022
• Home and Community-Based Services (HCBS) - Technology and Digital Tools Investment Grant - 08-15-2022
• Updated HCBS Rate Schedule Available 8-5-2022
• July 1, 2022, ACF/SLP Rate and Auto-PETI Updates - 06-29-2022 - (Specialties 602, 680)
• July 1, 2022, Auto-PETI Updates for Case Managers Revisions Can Start - 06-24-2022 - (Specialty 330)
• Resolved 5/26/22: HCBS Procedure Codes T2025 for EOB Codes 4758 and 1553 - 05-26-2022
• HCBS Procedure Codes T2025 for EOB Codes 4758 and 1553 5-19-2022
• HCBS Benefits Utilization System Member Cleanup - 05-18-22 - (Specialties 330, 770, 771)
• HCBS Providers Adding a Specialty - 05-18-22
• Claims Denying for EOB 4758 - Billing Provider Type/Specialty Restriction on Procedure Coverage Rule - 05-12-2022
• Resolved Known Issue EBD Claims Denying with Procedure Code S5130 5-6-22
• (SEPs/CCBs) CDASS PAR Revision Guides for Case Managers 4-18-2022
• April 1, 2022 Alternative Care Facility (ACF)/Supported Living Program (SLP) Rate and Post-Eligibility Treatment of Income (PETI) Updates 3-8-2022 - (Specialties 602 & 680)
• April 1, 2022 Alternative Care Facility (ACF) Rate and Post-Eligibility Treatment of Income (PETI) Updates for Case Managers 3-8-2022 - (SEPs & SEPs/CCBs) 
• April 1, 2022 Supported Living Program (SLP) Rate and Post-Eligibility Treatment of Income (PETI) Updates for Case Managers 3-8-2022 - (SEPs & SEPs/CCBs)
• Resolved Issue: 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 - (Specialties 602 & 680)
• Respite Rates Billing Instructions (Specialty Codes: 615, 616, 675, 676) - 01-24-2022
• Update Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates 1-5-2022 - (Specialties - 601, 602, 613, 619, 634, 639, 652, 656, 659, 660, 661, 664, 666, 669, 673, 674, 675, 676, 679, 680, 713)
• Resolved Issue Home & Community-Based Services (HCBS) Respite Care Claims for S5151 Paying Incorrectly with Explanation of Benefits (EOB) 2391 12-27-2021 - (Specialties 675 & 676)
• Home & Community-Based Services (HCBS) Respite Care Claims for S5151 Paying Incorrectly with Explanation of Benefits (EOB) 2391 12-22-2021 - (Specialties 675 & 676)
• ACF and SLP Providers - Rate Adjustment Information for ACF and SLP - 12-10-2021 - The Percentage Increase/Decrease column was updated since originally published. (1/28/22)
• SEP Case Managers - Rate Adjustment Information for ACF and SLP - 12-10-2021 - The Percentage Increase/Decrease column was updated since originally published. (1/28/22)
• Email Series: Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates 11-23-2021 (Specialties - 601, 602, 613, 619, 634, 639, 652, 656, 659, 660, 661, 664, 666, 669, 673, 674, 675, 676, 679, 680, 713)
• Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates & Billing for Alternative Care Facility (ACF) and Supportive Living Program (SLP) Providers 11-19-2021 (Specialties 602 & 680)
• Update Automated Processing of Home & Community-Based Services (HCBS) Denver Minimum Wage Reimbursement Rates Claims 6-21-2021
• COVID-19 Vaccination Survey for Homecare Home and HCBS Providers 3-11-2021
• Updated Information 01-27-21 Denver Minimum Wage Reimbursement Rates Effective January 1, 2021 - 1-27-2021
• Short Notice - Fireside Chat on Vaccine Safety - 1-6-2021 (Specialty Codes: 602, 673, 680, 682,734)
• Denver Minimum Wage Reimbursement Rates Effective January 1 2021 - 12-31-2020
• Denver Minimum Wage Increase Effective January 1, 2021 (HCBS Providers) 12-24-2020
• COVID-19 Testing for Home Health and Home & Community-Based Services (HCBS) Providers 11-11-2020
• DEADLINE EXTENDED - ACTION REQUIRED - Federal Vaccination Distribution Program for LTC Residents - Strongly Recommended by CDPHE 11-4-2020 (Specialty 602 & 673)
• Action Required - White House Announces Vaccination Distribution Program for Long-Term Care (LTC) Residents 10-19-2020 (Specialty 602, 673, & 734)
• Colorado National Provider Identifier (NPI) Law and Claim Submission Update (HCBS) 9-24-2020
• Claims Reprocessed - Home & Community Based Services (HCBS) Alternative Care Facility (ACF) for Elderly, Blind or Disabled (EBD) and Community Mental Health Services (CMHS) Waiver Claims for T2031 Denying for EOB 1010 and 0101 5-29-2020
• Update with Billing Example - COVID-19 Rate Increases for Certain Home & Community-Based Services (HCBS) Alternative Care Facility (ACF) Providers 5-29-2020
• Update with Billing Example - COVID-19 Rate Increases for Certain Home & Community-Based Services (HCBS) Consumer Directed Attendant Support Services (CDASS) Providers 5-29-2020
• Update with Billing Example - COVID-19 Rate Increases for Certain Home & Community-Based Services (HCBS) Residential Habilitation Providers 5-29-2020
• Update with Billing Example - COVID-19 Rate Increases for Certain Home & Community-Based Services (HCBS) Supported Living Program (SLP) Providers 5-29-2020

Home Health

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• Updated: Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services - 02-13-2023
• Updated: Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services - 12-06-2022
• Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services - 10-26-2022
• Prior Authorization Requirement - 08-17-2022
• Update: Temporary Suspension of Prior Authorization Requirements for Pediatric Long-Term Home Health 3-8-2022
• Temporary Suspension of Prior Authorization Requirements for Pediatric Long-Term Home Health - 02-18-2022
• Listening Sessions for Therapy, Supply and Home Health Prior Authorization Process 2-4-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Monoclonal Antibodies - 11-16-2021
• Reminder: Restart PDN/PLTHH Information - 11-01-2021
• Prior Authorization Request PAR Requirement Re-start Information - 10-20-2021
• Prior Authorization Request PAR Requirement Re-start Information 9-24-2021
• Prior Authorization Request PAR Requirement Re-start Delay 9-9-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• COVID-19 Testing for Home Health and Home & Community-Based Services (HCBS) Providers 11-11-2020
• Inpatient Subacute Care, Home Health and Transportation Options During the COVID-19 Public Health Emergency Fact Sheet

Hospice

• Recovery Audit Contractor Webinar - Hospice Providers - 11-17-2021
• Monoclonal Antibodies - 11-16-2021

Hospital - General

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Health First Colorado’s Inpatient Hospital Review Program (IHRP) 2.0 - 02-10-2023
• Health First Colorado’s Inpatient Hospital Review Program (IHRP) 2.0 Provider Survey - 01-04-2023
• Temporary Changes to Prior Authorization Request (PAR) Requirements - 12-15-2022
• Inpatient Hospital Review Program (IHRP) 2.0 Stakeholder Information - 11-09-2022
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• EAPG Version Update - 07-27-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Resolved Known Issue 4/29/22: Inpatient Hospital Claims - Update 05-13-2022
• Inpatient Hospital Claims Paying Incorrectly - 4-29-2022
• Physician-Administered Drug Prior Authorization Request Policy Clarification 4-28-2022 
• Inpatient Hospital Claims - 04-27-2022
• Hospital Claims with Split Eligibility Interim Solution - 04-21-2022
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Monoclonal Antibodies - 11-16-2021
• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• Claims Reprocessed Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029 6-18-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Update - Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835 5-28-2021
• Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835 5-24-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• Increases in Health First Colorado Reimbursement for All COVID-19 Vaccines 3-25-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together 12-9-2020
• COVID-19 Labor & Delivery and Breastfeeding Guidance 8-7-2020
• Colorado interChange Update for Inpatient Subacute Care Pricing Process during the COVID-19 Public Health Emergency in Non-Psychiatric Hospitals & Approved Alternative Care Sites (ACSs) 7-13-2020
• Inpatient Subacute Care, Home Health and Transportation Options During the COVID-19 Public Health Emergency Fact Sheet
• Resolved Issue Update - Long Term Acute Care and Maternity Claims Denials and COVID-19 Update to 3M Enhanced Ambulatory Patient Grouping (EAPG) Grouper
• COVID-19 Guidance for Prescribers 03-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020
• New COVID-19 Provider Information Web Page and Healthcare Common Procedure Coding System (HCPCS) Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests 3-13-2020k

Hospital - Mental

• Monoclonal Antibodies - 11-16-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• COVID-19 Guidance for Prescribers 03-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020

Independent Laboratory

• New COVID-19 Provider Information Web Page and Healthcare Common Procedure Coding System (HCPCS) Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests 3-13-2020

Indian Health Services

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020
• COVID-19 Guidance for Prescribers 3-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 3-19-2020

Non-Physician Practitioner - Group

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Resolved 10/03/22: Physician Services: Claims for Physician Administered Drugs (PAD) Denying on New J Codes - 10-26-2022
• Physician-Administered Drug (PAD) Codes Requiring Prior Authorization - 10-12-2022
• Electronic Visit Verification (EVV) Program Update - 09-01-2022
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• EVV Program Update: Pediatric Behavior Therapies EVV Applicable in Place of Service 99 - EVV Required - 02-17-2022
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Hospital Surge Continues/Physician Services for In-Home Care 2-7-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• Physician-Administered Drugs - Prior Authorization Implementation Date - 12-16-2021
• Resolved Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-18-2021
• Update Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-17-2021
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Claims for Procedure Code J0585 Denying for Explanation of Benefits EOB 1381 11-16-2021
• Monoclonal Antibodies - 11-16-2021
• Behavioral Therapy Webinar October 12, 2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• Increases in Health First Colorado Reimbursement for All COVID-19 Vaccines 3-25-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together 12-9-2020
• Upcoming Recoupment of Paid Claims for COVID-19 Laboratory Procedure Codes U0003 and U0004 6-12-2020
• COVID-19 Guidance for Prescribers 3-20-2020

Non-Physician Practitioner - Individual

• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Doing Our Part - 12-17-2021
• Resolved Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-18-2021
• Update Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-17-2021
• Claims for Procedure Code J0585 Denying for Explanation of Benefits EOB 1381 11-16-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021

Nursing Facility

• COVID-19 Vaccine Rate Increase 12-16-21
• Monoclonal Antibodies - 11-16-2021
• Skilled Nursing Facility Claims Reprocessing July 2021 - 07-30-2021
• Short Notice - Fireside Chat on Vaccine Safety - 1-6-2021
• DEADLINE EXTENDED - ACTION REQUIRED - Federal Vaccination Distribution Program for LTC Residents - Strongly Recommended by CDPHE 11-4-2020
• Action Required - White House Announces Vaccination Distribution Program for Long-Term Care (LTC) Residents 10-19-2020

Occupational Therapist

• Listening Sessions for Therapy, Supply and Home Health Prior Authorization Process 2-4-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Electronic Visit Verification (EVV) Telehealth Requirements Update: Outpatient Occupational Therapy, Outpatient Physical Therapy and Outpatient Speech Therapy Providers - 1-29-2021

Pediatric Behavioral Therapy

• Pediatric Behavioral Therapy Rates Discussion - 3-1-2023
• Pediatric Behavioral Therapy Rates Discussion - 12-21-2022
• Register for the Pediatric Behavioral Therapy Discussion - 11-28-2022
• Severe Behavior Training Series -10-6-2022
• Electronic Visit Verification (EVV) Program Update - 09-01-2022
• Reminder: Behavioral Health Survey - 04-06-2022
• Behavioral Health Survey 3-18-2022
• EVV Program Update: Pediatric Behavior Therapies EVV Applicable in Place of Service 99 - EVV Required - 02-17-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Behavioral Therapy Webinar October 12, 2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Electronic Visit Verification (EVV) Telehealth Requirements Update: Pediatric Behavioral Therapy Providers - 1-29-2021

Pharmacy

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Guidance for the Prescription of Paxlovid - 08-16-2022
• COVID-19 Antiviral Distribution - 03-31-2022
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Providers Unable to Contact by Fax to the Magellan Rx Management for 6-25-2021 6-29-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• COVID-19 Tests Billable by Pharmacists 6-3-2020
• Durable Medical Equipment (DME) and Oxygen Supplies During the COVID-19 State of Emergency 4-8-2020
• COVID-19 Guidance for Prescribers 03-20-2020

Physical Therapist

• Listening Sessions for Therapy, Supply and Home Health Prior Authorization Process 2-4-2022
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• Electronic Visit Verification (EVV) Telehealth Requirements Update: Outpatient Occupational Therapy, Outpatient Physical Therapy and Outpatient Speech Therapy Providers - 1-29-2021

Physician Services/Clinics

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Resolved 10/03/22: Physician Services: Claims for Physician Administered Drugs (PAD) Denying on New J Codes - 10-26-2022
• Physician-Administered Drug (PAD) Codes Requiring Prior Authorization - 10-12-2022
• Guidance for the Prescription of Paxlovid - 08-16-2022
• Family Planning Benefit Expansion - 08-08-2022
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Physician-Administered Drug Prior Authorization Request Policy Clarification 4-28-2022 
• EVV Program Update: Pediatric Behavior Therapies EVV Applicable in Place of Service 99 - EVV Required - 02-17-2022
• Hospital Surge Continues/Physician Services for In-Home Care 2-7-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• Physician-Administered Drugs - Prior Authorization Implementation Date - 12-16-2021
• Resolved Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-18-2021
• Update Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381 11-17-2021
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Claims for Procedure Code J0585 Denying for Explanation of Benefits EOB 1381 11-16-2021
• Monoclonal Antibodies - 11-16-2021
• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• Increases in Health First Colorado Reimbursement for All COVID-19 Vaccines 3-25-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together 12-9-2020
• COVID-19 Labor & Delivery and Breastfeeding Guidance 8-7-2020
• Upcoming Recoupment of Paid Claims for COVID-19 Laboratory Procedure Codes U0003 and U0004 6-12-2020
• COVID-19 Guidance for Prescribers 03-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020
• New COVID-19 Provider Information Web Page and Healthcare Common Procedure Coding System (HCPCS) Codes for 2019 Novel Coronavirus (COVID-19) Laboratory Tests 3-13-2020

Podiatrist

 

Primary Care Medical Provider (PCMP)

• Webinar for Integrated Care Grant - 02-03-2023
• Upcoming Webinar for PCMP Providers Alternative Payment Methodology 2 APM 2 - 1-26-2021
• Primary Care Medical Provider (PCMP) Substance Use Disorder (SUD) Updated Benefit - 1-15-2021
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020

Psychiatric Residential Treatment Facilities

• Residential Child Care Policy Summary 7-8-2022
• Billing Update: Becoming an Instate Qualified Residential Treatment Program (QRTP)Transitioning from a Residential Child Care Facility (RCCF) to a QRTP 12-2-2021
• Becoming a QRTP Transitioning from an RCCF 10-7-2021
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Department of Health and Human Services (HHS) Announces New Round of Provider Relief Funds 10-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020

Psychologist

• Webinar for Integrated Care Grant - 02-03-2023
• Digital Tools Investment Grant Information - 10-3-2022
• Behavioral Health Technology and Digital Tools Investment Grant - 08-18-2022
• Billing Changes for Gender Identity Disorders - 03-09-22
• EVV Program Update: Pediatric Behavior Therapies EVV Applicable in Place of Service 99 - EVV Required - 02-17-2022
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Department of Health and Human Services (HHS) Announces New Round of Provider Relief Funds 10-7-2020
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020

Public Health

 

Qualified Residential Treatment Program

• Residential Child Care Policy Summary 7-8-2022
• Billing Update: Becoming an Instate Qualified Residential Treatment Program (QRTP)Transitioning from a Residential Child Care Facility (RCCF) to a QRTP 12-2-2021
• Becoming a QRTP Transitioning from an RCCF 10-7-2021

Rehabilitation Agency

• Kepro-ColoradoPAR Provider Satisfaction Survey - 03-07-2023
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021

Residential Child Care Facility

• Residential Child Care Policy Summary 7-8-2022
• Billing Update: Becoming an Instate Qualified Residential Treatment Program (QRTP)Transitioning from a Residential Child Care Facility (RCCF) to a QRTP 12-2-2021
• Becoming a QRTP Transitioning from an RCCF 10-7-2021

Rural Health Clinic

• 2022-2023 Respiratory Syncytial Virus (RSV) Season and Synagis® Vaccine Benefit - 03-06-2023
• Monkeypox and Pediatric COVID-19 Reimbursement Rates - 08-03-2022
• Monkeypox Vaccine Reimbursement - 07-14-2022
• Physician-Administered Drug Prior Authorization Request Policy Clarification 4-28-2022 
• COVID-19 VACCINE ORDERING REMINDER Deadline at 11:59 p.m. tonight to order COVID-19 vaccine for children 6 months - 4 years 2-8-2022
• Marshall Wildfire Response - All Medication-Prescribing Providers and Pharmacies - 01-05-2022
• Doing Our Part - 12-17-2021
• COVID-19 Vaccine Rate Increase 12-16-21
• CO Prescriber Incentive APM - Provider Bulletin ListServ Survey Announcement 9-13-2021
• Coadministration of Routine Vaccines with COVID-19 Vaccines and CPT Code 90697 Now Available - 08-30-2021
• COVID-19 Third Dose Vaccine - 08-23-2021
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• State Health Officials Release COVID-19 Back-to-School Guidance from CDC - 7-23-2021
• Colorado Department of Public Health and Environment (CDPHE) Vaccine Provider Letter - 6-29-2021
• COVID-19 Vaccine Program Webinar - 6-24-2021
• CMS to host “We Can Do This” COVID-19 Vaccine Campaign Toolkit Webinars 6-14-2021
• Letter from HHS Secretary Xavier Becerra Regarding COVID-19 Vaccinations 6-10-2021
• Colorado Joint Vaccine Task Force Advises Providers to Take Every Opportunity to Vaccinate Every Eligible Person - 6-3-2021
• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Increases in Health First Colorado Reimbursement for All COVID-19 Vaccines 3-25-2021
• Update - COVID-19 Vaccines Coverage and Billing - Updated Vaccine Prioritization Plan 1-11-2021
• Update - COVID-19 Vaccines Coverage and Billing 1-8-2021
• COVID-19 Vaccines Coverage and Billing 12-16-2020
• Billing for COVID-19 Monoclonal Antibody Infusions Casirivimab and Imdevimab, Administered Together 12-9-2020
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020
• COVID-19 Guidance for Prescribers 03-20-2020
• Guidance to Delay Non-Essential Surgery due to COVID-19 03-19-2020

School Health Services

• Pfizer COVID-19 Vaccine Approved for 12-to 15-Year-Olds 5-14-2021

Speech Therapy

• Listening Sessions for Therapy, Supply and Home Health Prior Authorization Process 2-4-2022
• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Telemedicine Stakeholder Engagement Webinar August 18, 2021 - 8-5-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021
• Electronic Visit Verification (EVV) Telehealth Requirements Update: Outpatient Occupational Therapy, Outpatient Physical Therapy and Outpatient Speech Therapy Providers - 1-29-2021

Substance Use Disorder

• Webinar for Integrated Care Grant - 02-03-2023
• Mental Health Parity and Health First Colorado (Colorado’s Medicaid Program)  5-4-2021
• Primary Care Medical Provider (PCMP) Substance Use Disorder (SUD) Updated Benefit - 1-15-2021
• Guidance for Residential and Inpatient Substance Use Disorder (SUD) Treatment Providers' Transition to Health First Colorado Reimbursement on January 1, 2021 - 12-4-2020
• Department of Health and Human Services (HHS) Announces New Round of Provider Relief Funds 10-7-2020
• Special Update Concerning Coronavirus (COVID-19) and Substance Use Disorder (SUD) Benefits 4-7-2020
• Regional Accountable Entity (RAE) Behavioral Health Telemedicine Services During COVID-19 State of Emergency Fact Sheet 4-3-2020

Transportation

• Claims Reprocessed: Non-Emergent Medical Transportation (NEMT) Claims for Procedure Code A0120 Denying for Explanation of Benefits (EOB) 1512 1-13-2022
• Resolved Issue Non-Emergent Medical Transportation (NEMT) Claims for Procedure Code A0120 Denying for Explanation of Benefits (EOB) 1512 1-6-2022
• Known Issue: Non-Emergent Medical Transportation (NEMT) Claims for Procedure Code A0120 Denying for Explanation of Benefits (EOB) 1512 1-5-2022
• Non-Emergent Medical Transportation NEMT IntelliRide Billing - 12-15-2021
• Important Non-Emergent Medical Transportation Service Change 6-29-2021
• Claims Reprocessed: Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802 4-5-2021
• Resolved Issue: Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802 4-1-2021
• Known Issue - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802 3-25-21
• Claims Reprocessed - NEMT Claims Billed with Modifier 77 Denying for EOB 7802 1-8-2021
• Resolved Issue - NEMT Claims Billed with Modifier 77 Denying for EOB 7802 1-6-2021
• Known Issue - NEMT Claims Billed with Modifier 77 Denying for EOB 7802 - 1-5-2021
• Inpatient Subacute Care, Home Health and Transportation Options During the COVID-19 Public Health Emergency Fact Sheet

Vision Services

• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Resolved Issue Vision Claims Denying for EOB 7817 7-9-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021

Women's Health

• COVID-19 Labor & Delivery and Breastfeeding Guidance 8-7-2020
• COVID-19 Guidance for Prescribers 03-20-2020

X-Ray Facility

• Update: COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro) 1-5-2022
• Marshall Wildfire Response - Prior Authorization Requests PARs Submitted to Kepro - 01-05-2022
• COVID-19 Response for Prior Authorization Requests (PARs) Submitted to Keystone Peer Review Organization (Kepro) 11-16-2021
• Utilization Management (UM) Vendor Transitioning 4-28-2021
• New Utilization Management UM Vendor for Prior Authorizations - 2-22-2021