Provider News

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

What's New

Switch to Mailchimp

Email communications sent by Gainwell Technologies on behalf of the Department of Health Care Policy & Financing (the Department) have switched from Constant Contact to the email management application Mailchimp. Affected emails include the monthly bulletin, the weekly newsletter, announcements about known issues, and other general communications. No action is needed regarding this change.

Ordering, Prescribing, Referring (OPR) Claim Identifier Project - Update

Effective July 1, 2022, the Department of Health Care Policy & Financing (the Department) will begin a soft enforcement of the federal requirement 42 CFR § 455.440 that claims for certain types of services contain the National Provider Identifier (NPI) of the provider who ordered the service, and that the NPI is actively enrolled with Health First Colorado.

The OPR claim edits will initially be set to “pay and report” instead of “deny”. This will allow providers to analyze their claim Remittance Advice and identify which claims are missing the required OPR NPI number. The Department will continue to monitor claims and keep providers notified of changes.

Refer to the June 2022 Provider Bulletin (B2200479) for more information.

Extension of Public Health Emergency (PHE)

Health and Human Services Secretary Xavier Becerra has formally extended the Public Health Emergency (PHE). The PHE can be extended for up to 90 days at a time. This extension started April 16, 2022, and would end, unless extended again, on July 15, 2022.

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

Expanded Coverage under the Emergency Medical Service (EMS) COVID-19 Only Benefit Plan

Vaccine Providers:

The Colorado interChange has been updated to allow for vaccine codes to be billed.

The EMS COVID-19 Only emergency benefit for uninsured Coloradans has been updated in compliance with the American Rescue Plan Act (ARPA) to include coverage of any service for COVID-related testing, treatments, and vaccines. This update impacts all claims types with dates of service on or after March 11, 2021.

Refer to the newsletter, Provider News & Resources Issue 48 - May 13, 2022, for additional information.

COVID-19 News and Resources

 

Newsletters

2022
  • Provider News & Resources - Issue 51 06-20-2022 - This newsletter contains information on Holiday Reminder: Juneteenth Sunday, June 19, 2022 Observed Monday, June 20, 2022. Provider Enrollment Reminder; Incorrect Member Billing; Home and Community Based Provider (HCBS) Providers: Specialty Update; Durable Medical Equipment (DME) Rate Updates; Breast Pump Coverage Expansion Update; Depression Screen Billing Changes: Adding Modifiers and Allowing Other Caregivers under Child’s ID  POSTPONED until January 1, 2023; Recently Published Billing Manuals; Known Issues: Hospital Claims with Split Eligibility Interim Solution.
  • Provider News & Resources - Issue 50 06-13-2022 - This newsletter contains information on Did You Know? Enrollment Requirements; Breast Pump Coverage Expansion; Enrollment License Requirement and License Panel Updates; Family Planning Expansion; Post-Partum Coverage Extended to 12 Months for Child Health Plan Plus (CHP+) and Health First Colorado Members; Recently Published Billing Manuals; Resolved Issues - Resolved 5/26/22: Home and Community Based Services (HCBS) Procedure Codes T2025 for Explanation of Benefits (EOB) Codes 4758 and 1553. Resolved 5/25/22: Claims with TW Modifier Denying for Explanation of Benefits (EOB) 7814 and 7816.
  • Special Newsletter - Home and Community Based (HCBS) Providers - 05-20-2022 - This newsletter contains information on Former Colorado Choice Transitions (CCT) Providers for Certain Services Can Still Render Care by Adding a New Specialty; Specialty Information; Known Issues: Procedure Codes T2025 for Explanation of Benefits (EOB) Codes 4758 and 1553; Resolved Known Issues: Resolved 5/18/22: Procedure Codes T2021 and S5165 and Option Modifiers for Explanation of Benefits (EOB) Codes 4758 and 1553; Resolved 5/6/2022: Elderly, Blind, and Disabled Waiver (EBD) Claims Denying with Procedure Code S5130.
  • Provider News & Resources - Issue 48 05-13-2022 - This newsletter contains information on Did You Know? Revalidation; Telemedicine Only: New Specialty Code 878; Mailing Address for Paper Claims; Signatures on Paper Claims; Vaccine Providers: UPDATED Expanded Coverage under the Emergency Medical Service (EMS) COVID-19 Only Benefit Plan; Provider Responsibility to Review Delegate Provider Web Portal Accounts; Recently Published Billing Manuals; HCBS Known Issues: Claims Denying for EOB 4758 - Billing Provider Type/Specialty Restriction on Procedure Coverage Rule; Procedure Codes T2021 and S5165 and Option Modifiers for Explanation of Benefits (EOB) Codes 4758 and 1553; HCBS Resolved Issue: Resolved 5/6/2022: Elderly, Blind, and Disabled Waiver (EBD) Claims Denying with Procedure Code S5130; Resolved Known Issue: Resolved 4/29/2022: Inpatient Hospital Claims.
  • Provider News & Resources - Issue 47 04-22-2022 -  This newsletter contains information on Public Health Emergency (PHE) Extension; Updated Billing Manuals; Vaccine Providers: EMS COVID-19 Only Benefit Plan; Behavioral Health Providers: Provider Enrollment and Claims Submission Policy; Ophthalmology Treatment of AMD; Kepro PARs; Known Issue: DME Claims - Denying EOB 7814 or 7816; Resolved Issue: Hospital Claims with Split Eligibility.
  • Provider News & Resources - Issue 46 04-08-2022 -  This newsletter contains information on Did You Know? Claims Submitted with Medicare Advantage Primary; Reminder: Timely Filing; Dental Providers: DentaQuest Delay; Provider Enrollment: Application Fees, Fingerprinting, Site Visits; EMS COVID-19 Only Benefit; Family Planning Providers: Rate Updates for Procedure Code 99203 with Modifiers FP and FP+GT; Featured Quick Guide: Provider Maintenance - Update License; Featured: Resources Section; Pharmacy Providers Reminder: Update Fax Numbers; Recently Published Billing Manuals; Updated Fee Schedules.
  • Provider News & Resources - Issue 45 03-21-2022 -  This newsletter contains information on Delayed Member Notification of Health First Colorado Eligibility; Provider Enrollment: Fees, Fingerprinting, Site Visits; Electronic Visit Verification (EVV) Denials; Reminder: Reconsideration & Appeals; Featured Quick Guide: Delegates; Updated Billing Manuals; Resolved Issue: HCBS Claims Paid at Incorrect Rate.
  • Provider News & Resources - Issue 44 03-07-2022 - This newsletter contains information on Did You Know? Insurance and Provider Enrollment Dates; Mental Health Parity Request for Public Comment; Claims Paid with “0” Date; Provider Revalidation Reminder; Suspended Claims and Common Suspense Reasons; Featured Quick Guide: Submitting a Claim with Medicare Replacement Plan Information; Recently Published Billing Manuals.
  • Provider News & Resources - Issue 43 02-14-2022 - This newsletter contains information on Verifying Health First Colorado Enrollment for Ordering, Prescribing, and Referring (OPR) Providers; Did You Know? Timely Filing; Regional Accountable Entities (RAEs): Services Billed for Network Providers Unable to Enroll; Billing Changes for Behavioral Health Services for Gender Identity Disorders; Recently Published Billing Manuals; Reminder: Sign Up for Provider Email Communications; Resolved Issues: Resolved 2/10/22 - Claims for Healthcare Common Procedure Coding System (HCPCS) 2022 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000; Resolved 1/25/22 - Home & Community Based Services (HCBS) Alternative Care Facility/Supported Living Program (ACF/SLP) Claims for T2031 with TU Modifier Denying for Explanation of Benefits (EOB) 1010; Resolved 11/18/21 - Physician-Administered Drug (PAD) Claims Denying for Explanation of Benefits (EOB) 1381.
  • Provider News & Resources - Issue 42 1-21-2022 - This newsletter contains information on Federal Vaccine Guidance, Extension of Public Health Emergency (PHE), Pediatric Personal Care Rate Increase (Non-HCBS Providers), Pfizer Gray Cap COVID-19 Vaccine Code Updates, Respite Providers Respite Rates Billing Instructions, Psychiatric Residential Treatment Facilities (PRTF) Resources; Recently Published Billing Manuals; Known Issues - Home & Community Based Services (HCBS) Alternative Care Facility/Supported Living Program (ACF/SLP) Claims for T2031 with TU Modifier Denying for Explanation of Benefits (EOB) 1010; Resolved Issues - Resolved 11/18/21- Physician-Administered Drug (PAD) Claims Denying for Explanation of Benefits (EOB) 1381.
  • Provider News & Resources - Issue 41 1-17-2022 - This newsletter contains information on At-Home Over-The-Counter COVID-19 Test Coverage; Did You Know? Verify Insurance Coverage; COVID-19 Kepro PARs; COVID-19 Vaccine Rate Increase; Marshall Wildfire Response; Colorado interChange Updated for New Procedure Code 90677; Updated Billing Manuals; Resolved Known Issue: PAD Claims Denying EOB 0192; Resolved Known Issue: NEMT Claims Denying EOB 1512; Resolved Known Issue: EAPG Rates; Resolved Known Issue: 2022 CMS Diagnosis Code Release; Resolved Known Issue: Respite Care Claims for S5151 Paid with EOB 2391; Resolved Known Issue: HCBS IHSS T1019 Claims Paid at Incorrect Rate; Resolved Known Issue: HCBS American Rescue Plan Act (ARPA) Rates  
  • Provider News & Resources - Issue 40  01-03-2022 - This newsletter contains information on Provider Revalidation Update; 2022 Provider Enrollment Application Fee; Recently Published Billing Manuals; Known Issue: Claims for HCPCS 2022 Procedure Codes Suspending for Explanation of Benefits (EOB) 0000; Resolved Known Issue: Resolved 12/23/21 - Home & Community-Based Services (HCBS) Respite Care Providers (Specialties 675 & 676) - Respite Care Claims for S5151 Paying Incorrectly with Explanation of Benefits (EOB) 2391. Resolved Known Issue: Resolved 11/1/21 - Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates.
2021
  • Provider News & Resources - Issue 39  12-13-2021 - This newsletter contains information on New Procedure Code 90677 for Adult Pneumococcal Vaccine Colorado interChange Updated; Reminder Health First Colorado Enrollment; Reminder Non-Emergent Medical Transportation (NEMT) Intelliride Billing; Rate Adjustment Information for: Alternative Care Facility (ACF) / Supported Living Program (SLP) Providers and Singe Entry Point (SEP) Case Managers; Expanded Coverage under the Emergency Medical Service (EMS) COVID-19 Only Benefit Plan; Recently Published Billing Manuals; Known Issues: Colorado interChange Update for Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates; Resolved Issues: Resolved 12/7/21 - Home & Community-Based Services (HCBS) In Home Support Services (IHSS) Claims for T1019 Paid at Incorrect Rate.
  • Provider News & Resources - Issue 38 12-6-2021 - This newsletter contains information on Did You Know? Provider Web Portal Password Reset; Reminder: Update Address for Internal Revenue Service (IRS) Form 1099 in Provider Web Portal; New Procedure Code 90677 for Adult Pneumococcal Vaccine; Pharmacy Providers - Reminder: Update Fax Numbers; Recently Published Billing Manuals; Home & Community-Based Services (HCBS) In Home Support Services (IHSS) Claims for T1019 Paid at Incorrect Rate; Resolved 11/18/21: Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381; Resolved 11/16/21: Home & Community-Based Services (HCBS) Residential Habilitation Claims for T2016 Paid at Incorrect Rate; Resolved 10/20/21: 2022 CMS Diagnosis Code Release - M5450 and R053 Diagnosis-Related Claim Denials
  • Provider News & Resources - Issue 37 11-22-2021 - This newsletter contains information on Health First Colorado Enrollment; Recently Published Billing Manuals; Upcoming Holidays; Resolved Issues: Resolved 11/18/21- Physician-Administered Drug (PAD) Claims for Multiple Procedure Codes Denying for Explanation of Benefits (EOB) 1381; Resolved 11/16/21 - Home & Community-Based Services (HCBS) Residential Habilitation Claims for T2016 Paid at Incorrect Rate; Resolved 11/10/21 - Upcoming Colorado interChange Update to Add Multiple Procedures Codes to Free-Standing Birth Centers (FSBC) Billing; Resolved 10/20/21 - 2022 CMS Diagnosis Code Release - M5450 and R053 Diagnosis-Related Claim Denials; COVID-19: News and Updates: CMS Issues Emergency Regulation Requiring COVID-19 Vaccine for Health Care Workers; COVID-19 Response for Prior Authorization Requests (PARs) submitted to Keystone Peer Review Organization (Kepro); Colorado interChange Update for Home and Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates; Home & Community-Based Services (HCBS) American Rescue Plan Act (ARPA) Rates & Billing for Alternative Care Facility (ACF) and Supportive Living Program (SLP) Providers; Monoclonal Antibodies; Colorado interChange Update for New Pediatric COVID Vaccine Procedure Codes.
  • Provider News & Resources - Issue 36 11-5-2021 - This newsletter contains information on Children COVID-19 Vaccine; Upcoming Diabetes Webinar; Extension of Public Health Emergency (PHE); Recently Published Billing Manuals; Known Issues: Home & Community-Based Services (HCBS) Providers - Colorado interChange Update for HCBS American Rescue Plan Act (ARPA) Rates; 2022 CMS Diagnosis Code Release & Diagnosis-Related Claim Denials; Resolved Issues: Resolved 10/27/21 Physicians Services/Clinics, Women’s Health, Non-Physician Practitioners Women’s Health Claims for Procedure Code S4993 Denying for Explanation of Benefits (EOB) 0101.
  • Provider News & Resources - Issue 35 10-25-2021 - This newsletter contains information on Submission Methods for Claim Adjustments, Refunds, Voids and Attachments; Extension of Public Health Emergency (PHE); Did You Know? Diagnosis Codes; Reconsiderations and Appeal; Child Health Plan Plus (CHP+) Specialty Drug Guidance; Qualified Residential Treatment Program (QRTP) or Residential Child Care Facility (RCCF) Providers: Becoming an Instate Qualified Residential Treatment Program (QRTP); Home Health Providers: Prior Authorization Request (PAR) Requirement Re-start Information; Home and Community-Based Services (HCBS) Providers: Rate Increase; Physician-Administered Drugs (PADs) Providers: Prior Authorization Update; Featured Quick Guide: Administrative Password Reset Process; Recently Published Billing Manuals; Known Issue: 2022 CMS Diagnosis Code Release & Diagnosis-Related Claim Denials.
  • Provider News & Resources - Issue 34 10-4-2021 - This newsletter contains information on Holiday Reminder Frances Xavier Cabrini Day Monday, October 4; Holiday Reminder Frances Xavier Cabrini Day Monday, October 4; Provider Relief Fund Phase 4; Reminder: Enrollment Backdate Request; Therapy Providers: Reminder: Usage of Correct Modifiers; Home Health Providers: Prior Authorization Request (PAR) Requirement Re-start Information; Durable Medical Equipment (DME) Providers: Reminder: Orthotics Prior Authorization (PA); Home and Community-Based Services (HCBS) Providers Reminder: Enrollment Specialty; Recently Published Billing Manuals; Known Issues: Physicians Services/Clinics, Women’s Health, Non-Physician Practitioners Women’s Health Claims for Procedure Code S4993 Denying for Explanation of Benefits (EOB) 0101.
  • Provider News & Resources - Issue 33 09-13-2021 - This newsletter contains information on Recently Published Electronic Data Interchange (EDI) Companion Guides; Recently Published Billing Manuals; Durable Medical Equipment (DME) Providers: Procedure Code S1040 Cranial Remolding Orthosis; Submitting a Claim with Medicare Replacement Plan Information; Recoupments of Third-Party Liability (TPL) Claims by the Recovery Audit Contractor (RAC); Hospital Providers - Upcoming Enhanced Ambulatory Patient Groups (EAPG) Update to Drug Pricing and Reimbursement; Home & Community-Based Services (HCBS) Waiver Providers - Program Approved Service Agency (PASA); Reminder: Sign Up for Provider Email Communications; Resolved 9/1/21: Durable Medical Equipment (DME) Backup Wheelchair Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7814.
  • Provider News & Resources - Issue 32 08-26-2021 - This newsletter contains information on Upcoming Suspension: Professional and Outpatient Claims Due to a System Migration; COVID-19 Third Dose Vaccine; Food and Drug Administration (FDA) Gives Pfizer COVID-19 Vaccine Full Approval; Administrative Account Versus the Delegate Account in Provider Web Portal; Featured Quick Guide - Administrative Password Reset Process; Pharmacy & Therapeutics (P&T) Committee Open Positions; Recently Published Billing Manuals; Home & Community-Based Services (HCBS) Providers: Resolved 8/12/21 - Colorado interChange Updated with Rate Increase for Procedure Code H2021 with U8 Modifier.
  • Provider News & Resources - Issue 31 08-16-2021 - This newsletter contains information on Member Eligibility Determination for Monthly Child Tax Credit Payments; Member Eligibility Determination for Emergency Services; Upcoming Telehealth Changes Postponed: Home and Community-Based Services (HCBS) Waivers; Guidance for Resubmitting Denied Claims; COVID-19 Vaccine Update; Featured Quick Guide: Web Portal Registration; Recently Published Billing Manuals; Resolved Issues:  Home & Community-Based Services (HCBS) Providers - Resolved 8/12/21 Colorado interChange Updated with Rate Increase for Procedure Code H2021 with U8 Modifier; Resolved 8/12/21 Personal Care Claims for Procedure Code T1019 and Denver County Reimbursement; Resolved 8/10/21 Home and Community-Based Services (HCBS) Procedure Codes and the Denver Minimum Wage; Resolved 7/15/21 Telehealth Outpatient Crossover Claims for Procedure Code G2025 Denying for Explanation of Benefits (EOB) 5807.
  • Provider News & Resources - Issue 30 08-02-2021 -  This newsletter contains information on Coming Soon! Provider Enrollment Portal Updates; Colorado Indigent Care Program (CICP) Applications Extension; Remittance Advice (RA) Comma-Separated Values (CSV) File Update; What's New? Prescriber Tool; Skilled Nursing Facility Claims Reprocessing July 2021; Recently Published Billing Manuals;  Featured Quick Guide: Provider Enrollment Web Portal Quick Guide - Change of Ownership (CHOW);  Featured Quick Guide: Provider Web Portal Quick Guide - Disenrollment; Pharmacy Providers - Reminder: Update Fax Numbers; Known Issues: Durable Medical Equipment (DME) Backup Wheelchair Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7814.
  • Provider News & Resources - Issue 29  07-19-2021 - The newsletter contains information on Reminder: Timely Filing Guidelines; Reminder: Timely Filing Guidelines; Featured Quick Guide: Provider Maintenance; Resolved Issues: Resolved 7/16/21 - Colorado interChange Update for Practitioner Claims for Listed Physician Administered Drug (PAD) Codes; Resolved 7/15/21 - Telehealth Outpatient Crossover Claims for Procedure Code G2025 Denying for Explanation of Benefits (EOB) 5807; Resolved 7/7/21 - Supply Claims for E2359 Billed with Modifier RB Denying for Explanation of Benefits (EOB) 4211; Partially Resolved 5/14/21 - Hospital Claims with Split Eligibility Interim Solution.
  • Provider News & Resources - Issue 28 07-12-2021 - This newsletter contains information on Did You Know? CO Offered Programs; Child Health Plan Plus (CHP+) State Managed Care Network (SMCN) Transition: How to Bill for CHP+ Services after July 1, 2021; Recently Published Billing Manuals; Featured Quick Guide: Verifying Member Eligibility (Including Managed Care Assignment Details and Benefit Plan Information) and Co-Pay; Reminder: Sign Up for Provider Email Communications; Reminder: Member Eligibility Inquiries; Resolved Issues:  Resolved 7/7/21 - Supply Claims for Procedure Code A4421 Denying for Explanation of Benefits (EOB) 7827; Resolved 7/7/21 - Transportation Claims for Procedure Codes A0425 and A0429 with Modifier 76 Denying for Explanation of Benefits (EOB) 7817; Resolved 6/30/2021 - Vision Claims for Procedure Code 92071 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817; Resolved 6/30/21 - Professional Claims with Modifier 50 Denying for Explanation of Benefits (EOB) 7823 when Ambulatory Surgery Center (ASC) Claim Billed.
  • Provider News & Resources - Issue 27 06-28-2021 - This newsletter contains information on Prior Authorization Request (PAR) Inquiries for Home and Community-Based Service (HCBS) Providers; COVID-19 Vaccine Administration; Affordable Care Act (ACA) Update; First Notice: Home Dialysis Claims Reprocessing Retroactive to July 1, 2020; Child Health Plan Plus (CHP+) State Managed Care Network (SMCN) Transition; Recently Published Billing Manuals; Reminder: Featured Quick Guide - Administrative Password Reset Process; Known Issues: Vision Claims for Procedure Code 92071 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817; Professional Claims with Modifier 50 Denying for Explanation of Benefits (EOB) 7823 when Ambulatory Surgery Center (ASC) Claim Billed; Resolved Known Issues: Resolved 4/15/21 - Claims Reprocessed Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 26  06-07-2021 - This newsletter contains information on Did You Know? Verify Member Eligibility; Updated: Fee Schedules; Home and Community-Based Services (HCBS): COVID-19 Rate; Reminder: Timely Filing Policy for Delayed Member Notification; Featured Quick Guide: Administrative Password Reset Process; Recently Published Billing Manuals.
  • Provider News & Resources -  Issue 25  06-01-2021 - This newsletter contains information on Provider Revalidation Update; Electronic Submission of Claims with Attachments; Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835; Featured Quick Guide: Updating Disclosure Names; Reminder: Sign Up for Provider Email Communications; Known Issues: Partially Resolved 5/26/21 - Claims Denying for Explanation of Benefits (EOB) 4000 - "The Member Has Other Insurance"; Resolved Issues: Resolved 5/21/21 - Mid-Month Appendix X Update Not Completed Due to Transmission Issue; Resolved 5/14/21 - Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/6/21 - Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims.
  • Provider News & Resources - Issue 24 5-13-2021 - This newsletter contains information on Provider Web Portal Maintenance - Sunday, May 16; Vaccination Toolkit for Providers; New Division of Insurance (DOI) Brochures on Mental Health and Preventive Benefits; Telehealth Survey - Share Experiences Using Telehealth to Drive Statewide Innovation; Electronic Funds Transfer (EFT) Update in Provider Web Portal; Anticipated Resolution 5/14/21: Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 23 5-10-2021 - This newsletter contains information on Provider Responsibility to Review Delegate Provider Web Portal Accounts; Reminder - License Update Requirement; The Top Five Reasons Enrollment Applications are Returned to Providers; Featured Resources: Internal Control Number (ICN) & Region Codes Guides; Recently Published Billing Manuals; Resolved 5/6/21: Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 22 5-3-2021 - This newsletter contains information on Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Reconsiderations and Appeals; Reminder: New Utilization Management (UM) Vendor Starts May 1, 2021; Claim Information: Explanation of Benefits (EOB) 3110 - Claims Will Not Deny for Individual Not Being Linked to the Group; Featured Quick Guide: Verifying Member Eligibility and Co-Pay; Provider Revalidation Update; Extension: Public Health Emergency (PHE); Recently Published Billing Manuals; Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211; and Resolved 4/21/21: Supply Claims for B4149 Billed with Modifier BO Denying for Explanation of Benefits (EOB) 7802
  • COVID-19 Vaccine Special Issue Provider News & Resources - Issue III  04-23-2021 - This newsletter contains information on Health Resources and Services Administration (HRSA) COVID-19 Care and Vaccine Access Fact Sheets; Updated Information: COVID-19 Monoclonal Antibody Infusion Bamlanivimab; Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Resources to Support Vulnerable Populations; Resolved Issues: Resolved 4/20/21 - COVID-19 Monoclonal Antibody Codes Q0245 and M0245 a Covered Benefit for Dialysis Centers; Impacted Provider Types: Clinic-Practitioner (Physicians Services-Clinic), Federally Qualified Health Center (FQHC), Dialysis Centers, Rural Health Clinic (RHC), Indian Health Services (IHS) - Resolved 4/13/21: Claims for COVID-19 Vaccine Codes Billed with Place of Service 50 and 72 Denying for Explanation of Benefits (EOB) 0182 or 1030.
  • Provider News & Resources - Issue 21  04-12-2021 - This newsletter contains information on New Funding Opportunity Aims to Support Equitable Vaccine Access in Colorado; Updated: Fee Schedule; Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Load Letter Process; Colorado COVID-19 Vaccine Phase 2; Provider Responsibility to Review Delegate Provider Web Portal Accounts; Recently Published Billing Manuals; Resolved Issues: Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802; Resolved 4/1/21 - Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 20 04-02-2021 - This newsletter contains information on Reminder: Timely Filing Guidelines; Reminder: Verify Eligibility without ID Card; Did You Know?; Recently Published Billing Manuals; New Utilization Management (UM) Vendor Starts May 1, 2021; Featured Quick Guide: Billing from the Correct Account; Pharmacy Providers - Reminder: Update Fax Numbers; Resolved Issues: Resolved 3/24/21 - Home & Community Based Services (HCBS) Waiver Claims for A0120, A0130, H2023, S5100, S5102, S5105, T2003, T2019 & T2021 Not Paying at COVID-19 Enhanced Rate; Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 19 03-16-2021 - This newsletter contains information on Provider Revalidation Update; Announcing "Together We Protect": Colorado's COVID-19 Vaccine Equity Fund; Incorrect Member Billing; Featured Quick Guide: Benefit Plan & Program Aid Code Acronyms; Reminder - Sign Up for Provider Email Communications; ClaimsXten™ Known Issue: Anesthesia Claims for 01968 Denying for Explanation of Benefits (EOB) 7800.
  • Provider News & Resources - Issue 18  03-08-2021 - This newsletter contains information on Training Information - New Utilization Management (UM) Vendor for Prior Authorizations; Recently Published Billing Manuals; COVID-19 Vaccine Codes and Updated Fee Schedules; Featured Quick Guide - Verifying Member Eligibility and Co-Pay; Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211; Resolved Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101; Resolved 3/1/21 - Home & Community-Based Services (HCBS) Providers - Claims for Procedure Code H0038 with the U1 or UC Modifier and the Denver Minimum Wage Reimbursement; Resolved 3/2/21 - Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460.
  • Provider News & Resources - Issue 17 02-26-2021 -This newsletter contains information on Provider Services Call Center Hours of Operation, Did You Know? Medicare Replacement Plan Billing, Featured Quick Guide Prior Authorizations (PAs), 2021 Fee Schedule Updates, Incorrect Member Billing for COVID-19 Tests and Co-Pay Amounts, Emergency Medical Service (EMS) Benefit Plan, New Utilization Management (UM) Vendor for Prior Authorizations, Known Issues: Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211, Anticipated Resolution Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101.
  • Provider News & Resources - Issue 16 02-22-2021 - This newsletter contains information on Did You Know? TPL Updates, Outpatient Hospital Enhanced Ambulatory Patient Grouper (EAPG) Claims Reprocessed for 1% Rate Decrease, Resolved Known Resolved 2/17/21 - All Providers Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Resolved ClaimsXten™ Known Issue: Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817.
  • Provider News & Resources - Issue 15 02-15-2021 - This newsletter contains information on Enrollment Processing Timeline, Recently Published Billing Manuals, Temporary COVID-19 Enhanced Payments for Certain Home & Community-Based Services (HCBS) Providers, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Durable Medical Equipment (DME) Providers -DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 14 02-08-2021 - This newsletter contains information onCOVID-19 Vaccine Rate Update, Provider Services Call Center Updated Schedule, Colorado Exchange Re-opening Enrollment, Did You Know? Timely Filing, Recently Published Billing Manuals, Hospital Services Rendered Via Telemedicine, COVID-19 Home & Community-Based Services (HCBS) Rate Increase for Alternative Care Facilities (ACFs), Supportive Living Program (SLP) and Group Residential Services and Supports (GRSS), Reminder - Sign Up for Provider Email Communications, ClaimsXten™ Known and Resolved Issues: Vision Providers Claims for Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817, Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved 2/3/21 - Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 13 - 01-25-2021- This newsletter contains information onCOVID-19 New Diagnosis Codes, Healthcare Common Procedure Coding System (HCPCS) Updates for 2021, HCBS Providers Extension of Senate Bill (SB) 19-238 Reporting Tool, HCBS Providers Denver Minimum Wage Claim Processing Information, Recently Published Billing Manuals, Known Issues: Nurse Home Visitor Program (NHVP) Claims Billed with HD or TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: 1/13/21 DME Supply Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7802, 1/13/21 DME Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with NU Modifiers Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 12 - 01-18- 2021 - This newsletter contains information on Colorado interChange Update - COVID-19 Vaccination Procedure Codes, COVID-19 Vaccine Colorado Locations, Extension of Public Health Emergency (PHE), Martin Luther King, Jr. Holiday Schedule, 2021 Provider Enrollment Application Fee, Recently Published Billing Manuals, Home & Community-Based Services (HCBS) Providers: Updated Information Denver Minimum Wage Reimbursement Rates Effective January 1, 2021, Primary Care Medical Provider (PCMP) Substance Use Disorder (SUD)Updated Benefit, Known Issues: All Providers- Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802: Resolved Issues:DME Resolved Issue 9/30/20 - Geographic Rates Updated for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL), Resolved 12/9/20 Professional Claims Denying for Unbundling Explanation of Benefits (EOB) 7804, Resolved 12/12/20 - Behavioral Health Claims Billed by Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) or Indian Health Services (IHS) - FQHC Denying for Explanation of Benefits (EOB) 2029, Resolved 1/6/21 - Non-Emergent Medical Transportation (NEMT) Claims Billed with Modifier 77 Denying for Explanation of Benefits (EOB) 7802, Resolved 1/13/21 - Physical Therapy Claims for Procedure Codes 20560 & 20561 Billed with GP, 96 or 97 Modifiers Denying for Explanation of Benefits (EOB) 7802.

Emails to Providers

All Provider Types
Ambulatory Surgery Center (ASC)
Anesthesia
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Audiologist
Behavioral Health Organization
Birthing Center
Case Manager
Certified Registered Nurse Anesthetist (CRNA)
 
Community Clinic and Community Clinic with Emergency Center (CC/CCEC)
Community Mental Health Center
Dental
Developmental Evaluation Clinic

 

Dialysis Center
Durable Medical Equipment (DME)/Supply
Federally Qualified Health Center (FQHC)
Health Maintenance Organization (HMO)
Home & Community Based Services (HCBS)
Home Health
Hospice
Hospital - General
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Pharmacy
Physical Therapist
Physician Services/Clinics
Podiatrist

 

Primary Care Medical Provider (PCMP)
Psychiatric Residential Treatment Facilities
Psychologist
Public Health
 
Qualified Residential Treatment Program
Rehabilitation Agency
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Rural Health Clinic
School Health Services
Speech Therapy
Substance Use Disorder
Transportation
Vision Services
Women's Health
X-Ray Facility