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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 here. Under Email Lists, select 00 - All Provider Emails to receive: 1) a weekly Last Week in Review 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

Affordable Care Act Update

The United States Supreme Court announced its 7-2 decision in California v. Texas to uphold the Affordable Care Act (ACA) which impacts Medicaid expansion along with 200,000 others who have purchased plans through our state based exchange, Connect for Health Colorado.

Provider Revalidation Update

The Department understands provider focus has been on member care throughout the Public Health Emergency. Providers are encouraged to submit revalidation applications according to their scheduled due date if they are able. However, until further notice, claims will not be denied or suspended if revalidation has not been completed by the posted revalidation due date.

Applications for new enrollments and changes to existing applications have been given priority, so revalidation application processing times may be delayed for the next several months. Only one update can be processed at a time. If providers need to make an additional update while a revalidation application is in process, contact the Provider Services Call Center.

New Utilization Management Vendor Starts May 1, 2021

Effective May 1, 2021, Keystone Peer Review Organization (Kepro) will be the new Utilization Management (UM) partner for Health First Colorado (Colorado’s Medicaid Program).
Kepro will begin accepting Prior Authorization Requests (PARs) for the following select outpatient services and benefits as of May 1, 2021:

  • Outpatient Speech, Physical and Occupational Therapy
  • Pediatric Behavioral Therapy
  • Select Surgical Procedures
  • Durable Medical Equipment (DME)
  • Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Exceptions
  • Transplants
  • Out of State Inpatient Admissions
  • Personal Care
  • Molecular Testing
  • Diagnostic Imaging
  • Audiology
  • Synagis

Providers are encouraged to attend scheduled live trainings (recommended) or view posted recorded trainings prior to Kepro starting on May 1, 2021. Visit the ColoradoPAR Program web page and click the green “eQ to Kepro Transition Information” button to register for training and to read about the training curriculum. For more information on the UM Vendor transition, refer to the April 2021 Special Provider Bulletin (B2100462) or the March 25, 2021, email Keystone Peer Review Organization (Kepro) Transition and Survey Results.

Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835

Effective May 27, 2021, Explanation of Benefit (EOB) codes 0101 and 1010 post Claims Adjustment Reason Code (CARC) OA 18 “Exact duplicate claim/service.” and the following Remittance Advice Remark Codes (RARC) on the ERA X12 835:

  • EOB 0101 – RARC N20 – “Service not payable with other service rendered on the same date.”
  • EOB 1010 – RARC M86 – “Service denied because payment already made for same/similar procedure within set time frame.”

Previously, EOB code 1010 posted CARC PI 16, and neither EOB code posted an RARC code. This proposed change only affects the ERA X12 835 report, not the remittance advice. Providers who do not utilize the 835 or submit electronic data interchange (EDI) transactions will not be affected.

Extension of Public Health Emergency (PHE)

The Department of Health and Human Services 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 21, 2021, and would end, unless extended again, on July 20, 2021. Updates will be published via the Public Health Emergency Planning web page.

Refer to the Provider News & Resources Newsletter - Issue 22 for more information.

Colorado interChange Update - COVID-19 Vaccine Procedure Codes

The Colorado interChange has been updated with the COVID-19 vaccine procedure codes. Providers may visit the Provider Rates & Fee Schedule web page and select Immunization Rates under the Immunization Rate Schedule drop-down section for updated rate information.

Refer to the January 8, 2021, and January 11, 2021, emails for more information and resources regarding the COVID-19 vaccine.

COVID-19 Vaccines Coverage and Billing
  • COVID-19 vaccines are a covered benefit for Health First Colorado (Colorado's Medicaid Program) members. Refer to the December 16, 2020 email for more information and resources regarding the COVID-19 vaccine.
  • The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted on May 12, 2021, to approve the use of the Pfizer COVID-19 vaccine for 12- to 15- year-olds. Refer to the May 14, 2021 email for more information.

 

 

Newsletters

2021
  • Provider News & Resources - Issue 26  06-07-2021 - This newsletter contains information on Did You Know? Verify Member Eligibility; Updated: Fee Schedules; Home and Community-Based Services (HCBS): COVID-19 Rate; Reminder: Timely Filing Policy for Delayed Member Notification; Featured Quick Guide: Administrative Password Reset Process; Recently Published Billing Manuals.
  • Provider News & Resources -  Issue 25  06-01-2021 - This newsletter contains information on Provider Revalidation Update; Electronic Submission of Claims with Attachments; Claims Adjustment Reason Code (CARC) and Remittance Advice Remark Codes (RARC) Change for ERA X12 835; Featured Quick Guide: Updating Disclosure Names; Reminder: Sign Up for Provider Email Communications; Known Issues: Partially Resolved 5/26/21 - Claims Denying for Explanation of Benefits (EOB) 4000 - "The Member Has Other Insurance"; Resolved Issues: Resolved 5/21/21 - Mid-Month Appendix X Update Not Completed Due to Transmission Issue; Resolved 5/14/21 - Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/6/21 - Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims.
  • Provider News & Resources - Issue 24 5-13-2021 - This newsletter contains information on Provider Web Portal Maintenance - Sunday, May 16; Vaccination Toolkit for Providers; New Division of Insurance (DOI) Brochures on Mental Health and Preventive Benefits; Telehealth Survey - Share Experiences Using Telehealth to Drive Statewide Innovation; Electronic Funds Transfer (EFT) Update in Provider Web Portal; Anticipated Resolution 5/14/21: Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 23 5-10-2021 - This newsletter contains information on Provider Responsibility to Review Delegate Provider Web Portal Accounts; Reminder - License Update Requirement; The Top Five Reasons Enrollment Applications are Returned to Providers; Featured Resources: Internal Control Number (ICN) & Region Codes Guides; Recently Published Billing Manuals; Resolved 5/6/21: Overpayment of Acute Home Health, Long-Term Home Health and Private Duty Nursing (PDN) Claims; Resolved 5/4/21: Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211
  • Provider News & Resources - Issue 22 5-3-2021 - This newsletter contains information on Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Reconsiderations and Appeals; Reminder: New Utilization Management (UM) Vendor Starts May 1, 2021; Claim Information: Explanation of Benefits (EOB) 3110 - Claims Will Not Deny for Individual Not Being Linked to the Group; Featured Quick Guide: Verifying Member Eligibility and Co-Pay; Provider Revalidation Update; Extension: Public Health Emergency (PHE); Recently Published Billing Manuals; Hospital Claims Not Included in Managed Care Organization (MCO) Interim Solution Denying for Explanation of Benefits (EOBs) 2029, 2030, 2031 and 2580; Supply Claims for E2361 Billed with KR, RR or RB Modifiers Denying for Explanation of Benefits (EOB) 1381 or 4211; and Resolved 4/21/21: Supply Claims for B4149 Billed with Modifier BO Denying for Explanation of Benefits (EOB) 7802
  • COVID-19 Vaccine Special Issue Provider News & Resources - Issue III  04-23-2021 - This newsletter contains information on Health Resources and Services Administration (HRSA) COVID-19 Care and Vaccine Access Fact Sheets; Updated Information: COVID-19 Monoclonal Antibody Infusion Bamlanivimab; Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Resources to Support Vulnerable Populations; Resolved Issues: Resolved 4/20/21 - COVID-19 Monoclonal Antibody Codes Q0245 and M0245 a Covered Benefit for Dialysis Centers; Impacted Provider Types: Clinic-Practitioner (Physicians Services-Clinic), Federally Qualified Health Center (FQHC), Dialysis Centers, Rural Health Clinic (RHC), Indian Health Services (IHS) - Resolved 4/13/21: Claims for COVID-19 Vaccine Codes Billed with Place of Service 50 and 72 Denying for Explanation of Benefits (EOB) 0182 or 1030.
  • Provider News & Resources - Issue 21  04-12-2021 - This newsletter contains information on New Funding Opportunity Aims to Support Equitable Vaccine Access in Colorado; Updated: Fee Schedule; Provider Services Call Center Menu Update: Enter the MCD ID or National Provider Identifier (NPI); Load Letter Process; Colorado COVID-19 Vaccine Phase 2; Provider Responsibility to Review Delegate Provider Web Portal Accounts; Recently Published Billing Manuals; Resolved Issues: Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802; Resolved 4/1/21 - Hospital Emergency Department Claims Denying for Explanation of Benefits (EOB) 2029.
  • Provider News & Resources - Issue 20 04-02-2021 - This newsletter contains information on Reminder: Timely Filing Guidelines; Reminder: Verify Eligibility without ID Card; Did You Know?; Recently Published Billing Manuals; New Utilization Management (UM) Vendor Starts May 1, 2021; Featured Quick Guide: Billing from the Correct Account; Pharmacy Providers - Reminder: Update Fax Numbers; Resolved Issues: Resolved 3/24/21 - Home & Community Based Services (HCBS) Waiver Claims for A0120, A0130, H2023, S5100, S5102, S5105, T2003, T2019 & T2021 Not Paying at COVID-19 Enhanced Rate; Resolved 3/27/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with UA & TU Modifiers Denying for EOB 1010 and 0101; Resolved 3/31/21 - Transportation Claims for A0427 & A0429 with 77 Modifier Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 19 03-16-2021 - This newsletter contains information on Provider Revalidation Update; Announcing "Together We Protect": Colorado's COVID-19 Vaccine Equity Fund; Incorrect Member Billing; Featured Quick Guide: Benefit Plan & Program Aid Code Acronyms; Reminder - Sign Up for Provider Email Communications; ClaimsXten™ Known Issue: Anesthesia Claims for 01968 Denying for Explanation of Benefits (EOB) 7800.
  • Provider News & Resources - Issue 18  03-08-2021 - This newsletter contains information on Training Information - New Utilization Management (UM) Vendor for Prior Authorizations; Recently Published Billing Manuals; COVID-19 Vaccine Codes and Updated Fee Schedules; Featured Quick Guide - Verifying Member Eligibility and Co-Pay; Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211; Resolved Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101; Resolved 3/1/21 - Home & Community-Based Services (HCBS) Providers - Claims for Procedure Code H0038 with the U1 or UC Modifier and the Denver Minimum Wage Reimbursement; Resolved 3/2/21 - Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460.
  • Provider News & Resources - Issue 17 02-26-2021 -This newsletter contains information on Provider Services Call Center Hours of Operation, Did You Know? Medicare Replacement Plan Billing, Featured Quick Guide Prior Authorizations (PAs), 2021 Fee Schedule Updates, Incorrect Member Billing for COVID-19 Tests and Co-Pay Amounts, Emergency Medical Service (EMS) Benefit Plan, New Utilization Management (UM) Vendor for Prior Authorizations, Known Issues: Evaluation & Management (E&M) Services Claims Billed with 24 Modifier Denying for Explanation of Benefits (EOB) 1460, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved Issues: Resolved 2/25/21 - Durable Medical Equipment (DME) Supply Claims Billed with RB Modifier Denying for Explanation of Benefits (EOB) 4211, Anticipated Resolution Date 3/1/21 - Home & Community Based Services (HCBS) Waiver Claims for T2031 with TU Modifier Denying for EOB 1010 and 0101.
  • Provider News & Resources - Issue 16 02-22-2021 - This newsletter contains information on Did You Know? TPL Updates, Outpatient Hospital Enhanced Ambulatory Patient Grouper (EAPG) Claims Reprocessed for 1% Rate Decrease, Resolved Known Resolved 2/17/21 - All Providers Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Resolved ClaimsXten™ Known Issue: Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817.
  • Provider News & Resources - Issue 15 02-15-2021 - This newsletter contains information on Enrollment Processing Timeline, Recently Published Billing Manuals, Temporary COVID-19 Enhanced Payments for Certain Home & Community-Based Services (HCBS) Providers, ClaimsXten™ Resolved Issues: Resolved 2/3/21 - Durable Medical Equipment (DME) Providers -DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 14 02-08-2021 - This newsletter contains information onCOVID-19 Vaccine Rate Update, Provider Services Call Center Updated Schedule, Colorado Exchange Re-opening Enrollment, Did You Know? Timely Filing, Recently Published Billing Manuals, Hospital Services Rendered Via Telemedicine, COVID-19 Home & Community-Based Services (HCBS) Rate Increase for Alternative Care Facilities (ACFs), Supportive Living Program (SLP) and Group Residential Services and Supports (GRSS), Reminder - Sign Up for Provider Email Communications, ClaimsXten™ Known and Resolved Issues: Vision Providers Claims for Vision Code 92310 with Modifier 55 Denying for Explanation of Benefits (EOB) 7817, Resolved 2/3/21 - Nurse Home Visitor Program (NHVP) Claims Billed with HD & TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved 2/3/21 - Professional Claims with LT Modifier Denying for Explanation of Benefits (EOB) 7813, Resolved 2/3/21 - Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: Resolved 2/6/21 - New Medicare Part A and Part B 2021 Deductible Amounts.
  • Provider News & Resources - Issue 13 - 01-25-2021- This newsletter contains information onCOVID-19 New Diagnosis Codes, Healthcare Common Procedure Coding System (HCPCS) Updates for 2021, HCBS Providers Extension of Senate Bill (SB) 19-238 Reporting Tool, HCBS Providers Denver Minimum Wage Claim Processing Information, Recently Published Billing Manuals, Known Issues: Nurse Home Visitor Program (NHVP) Claims Billed with HD or TD Modifiers Denying for Explanation of Benefits (EOB) 7802, Resolved Issues: 1/13/21 DME Supply Claims Billed with TW Modifier Denying for Explanation of Benefits (EOB) 7802, 1/13/21 DME Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with RB or RA Modifiers Denying for Explanation of Benefits (EOB) 7802, 1/13/21 Durable Medical Equipment (DME) Supply Claims Billed with NU Modifiers Denying for Explanation of Benefits (EOB) 7802.
  • Provider News & Resources - Issue 12 - 01-18- 2021 - This newsletter contains information on Colorado interChange Update - COVID-19 Vaccination Procedure Codes, COVID-19 Vaccine Colorado Locations, Extension of Public Health Emergency (PHE), Martin Luther King, Jr. Holiday Schedule, 2021 Provider Enrollment Application Fee, Recently Published Billing Manuals, Home & Community-Based Services (HCBS) Providers: Updated Information Denver Minimum Wage Reimbursement Rates Effective January 1, 2021, Primary Care Medical Provider (PCMP) Substance Use Disorder (SUD)Updated Benefit, Known Issues: All Providers- Claims Suspending for HCPCS 2021 Quarterly Update Procedure Codes for Explanation of Benefits (EOB) 0000 - "This Claim/Service Is Pending for Program Review", Durable Medical Equipment (DME) Providers DME Claims Billed with RR Modifier Denying for Explanation of Benefits (EOB) 7802: Resolved Issues:DME Resolved Issue 9/30/20 - Geographic Rates Updated for Durable Medical Equipment (DME) Codes Subject to Medicare Upper Payment Limit (UPL), Resolved 12/9/20 Professional Claims Denying for Unbundling Explanation of Benefits (EOB) 7804, Resolved 12/12/20 - Behavioral Health Claims Billed by Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) or Indian Health Services (IHS) - FQHC Denying for Explanation of Benefits (EOB) 2029, Resolved 1/6/21 - Non-Emergent Medical Transportation (NEMT) Claims Billed with Modifier 77 Denying for Explanation of Benefits (EOB) 7802, Resolved 1/13/21 - Physical Therapy Claims for Procedure Codes 20560 & 20561 Billed with GP, 96 or 97 Modifiers Denying for Explanation of Benefits (EOB) 7802.

 

2020

 

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

 

Emails to Providers

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

 

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

Provider Association Newsletter

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2020
2019