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What's New

Secure File Transfer Protocol (FTP) Server Migration

The Secure File Transfer Protocol (FTP) server was moved on November 9th. Refer to the Electronic Data Interchange (EDI) webpage for more information or contact the Provider Services Call Center. If you submit any batch transactions or use a vendor or a clearinghouse, please ensure they have made the change to the new location to submit the batch files.

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 October 13, 2022 and will next be evaluated by January 11, 2023. The Biden administration has indicated that they will provide a 60-days advance notice, by November 12, 2022, before any end to the PHE.

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

Family Planning Benefit Expansion

Providers are reminded that effective July 1, 2022, eligibility types were expanded to include additional populations for family planning services.

There are two different categories for this expansion.

• EMS (Emergency Medical Services) Benefit Plan

EMS benefit plan is for undocumented individuals and previously only covered emergency services. Members with EMS coverage may now receive any family planning service regardless of an emergency.

• Family Planning (FAMPL) Benefit Plan

FAMPL is a new benefit plan for individuals who are within the 133%-260% of the Federal Poverty Level (FPL) income bracket. Providers using a batch X12N 271 response to verify eligibility will receive the program aide code of "FP" (family planning) or "PF" (presumptive family planning). Providers using the provider web portal will see the benefit plan of "FAMPL". Members with FAMPL coverage may now receive any family planning or family planning related service.

Individuals must apply for services and have a valid member ID for the provider to submit claims. Providers are encouraged to check eligibility for each date of service.

Refer to the email Family Planning Benefit Expansion - 08-08-2022 for more information.

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

The Department of Health Care Policy and Financing (the Department) has heard concerns regarding the PDN PAR process. Our shared goal is to ensure Colorado has programs that provide people with access to the services they need. This is especially true for those with complex healthcare needs. We continuously evaluate how to best balance our responsibility to ensure our members have timely access to care and our federal responsibility to demonstrate services are medically necessary at the level approved.

Effective immediately, the Department is initiating a Temporary Administrative Approval Process on PDN PARs until December 31, 2022. Please note this is an Administrative Approval Process not a pause. Providers will still need to submit all necessary documentation.

Refer to the October 26, 2022 email, Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services for more information.

Deficit Reduction Act of 2005 extended to December 1, 2022

Section 6032 of the Deficit Reduction Act of 2005 (DRA) requires providers who meet the definition of entity and who make or receive annual Medicaid payments of $5 million or more to establish and disseminate certain written policies for preventing and detecting fraud, waste and abuse. The entities must also provide information to employees and contractors about the Federal False Claims Act and other applicable federal and state false claims laws, the administrative remedies for false claims and statements, and the “whistleblower” protections afforded under such laws.

For Federal Fiscal Year 2022 (FFY2022) providers who are subject to Section 6032 must submit the DRA Declaration FFY2022 form, a copy of the employee handbook or Code of Conduct containing the written polices, the rights of employees to be protected as whistleblowers and a copy of policies and procedures for detecting and preventing fraud, waste and abuse.

The completed DRA Declaration and all required documents listed above must be emailed to hcpf_draact2005@state.co.us no later than December 1, 2022.

Contact Eileen Sandoval at hcpf_draact2005@state.co.us with questions related to the DRA.

Refer to the article in the November 2022 Provider Bulletin (B2200485) for more information.

Enrollment License Requirement and License Panel Updates

Current Health First Colorado (Colorado's Medicaid program) providers that are required to maintain a license as part of their enrollment will receive a letter from the Department of Health Care Policy & Financing (the Department) when the primary license is approaching expiration or has reached its expiration date.

Providers are reminded that Health First Colorado enrollment may be inactivated if the provider’s license, certification, or accreditation has expired or is subject to conditions or restrictions.

Providers will start seeing the message "Provider license not active on date of service" on their remittance advice if the license is not current.

Provider Services Call Center Changes

A virtual agent named GABBYTM, designed to listen to the caller and respond, will soon be implemented to assist providers contacting the Provider Services Call Center. A phased implementation went into effect on Friday, November 4, 2022. Callers will begin to interact with this Provider Services Call Center virtual agent, which will be available 24 hours a day, 7 days a week.

Refer to the November 2022 Provider Bulletin (B2200485) for more information.

 

COVID-19 News and Resources

 

Newsletters

2022
  • Provider News & Resources Issue 57 11-2-2022 - This newsletter contains information on Seasonal Influenza Vaccines; A Message from the Executive Director; Home Health Providers: Temporary Administrative Approval for Prior Authorization Requests (PARs) with Private Duty Nursing (PDN) Services; Enrollment License Requirement and License Panel Updates; Provider Enrollment: Application Fees, Fingerprinting, Site Visits; Provider Services Call Center Change; Featured Resource: Provider Address Usage; Recently Published Billing Manuals and Fee Schedules; Known Issues: Durable Medical Equipment (DME) Supply Claims Paying at Incorrect Rate; Claim Processing Times for New Procedure Codes; Resolved Issues: Resolved 10/03/22: Physician Services: Claims for Physician Administered Drugs (PAD) Denying on New J Codes; Resolved 10/28/22: Physician Services: Claims for Physician Administered Drugs (PAD) Denying for Explanation of Benefits (EOBs) 0192 and 3053.
  • Provider News & Resources Issue 56 10-10-2022 - This newsletter contains information on Seasonal Influenza Vaccines; Did You Know? Provider Type Manual Spreadsheet;  Submitting a Claim with Other Insurance or Medicare Crossover Information; Keep Information Current on Administrative Accounts in the Provider Web Portal; Suspended Claims and Common Suspense Reasons; Updates to the Addresses Panel during Revalidation; Recently Published Billing Manuals.
  • Provider News & Resources - Issue 55  09-12-2022 - This newsletter contains information on Did You Know? Maintain Delegate Access to Provider Web Portal; COVID-19 Vaccine Age Range Update; COVID-19 Bivalent Booster Vaccines; Provider Services Call Center Change; Reminder: Reconsiderations & Appeals; Pharmacy Providers: Update Fax Numbers; Recently Published Billing Manuals and Fee Schedules; Resolved Known Issue: Some Claims Denying for Explanation of Benefits (EOB) 4000 - "The Member Has Other Insurance".
  • Provider & News Resources - Issue 54 08-29-2022 - This newsletter contains information on Did You Know? Provider Enrollment Applications; Vaccination Rates Update; National Provider Identifier (NPI) Reminder; Administrative Password Reset Process Change; Electronic Funds Transfer (EFT) Process Change; Deficit Reduction Act of 2005 due November 1, 2022; Family Planning Benefit Expansion; Pediatric Behavioral Therapy Providers: Electronic Visit Verification (EVV) Program Update; Recently Published Billing Manuals and Fee Schedules; Resolved Issues: Resolved 7/28/22: Institutional Claims Denying for EOB 3014 and EAPG Error Code 3102; Resolved 8/24/22: Claims Denying EOB 4000; Resolved 8/24/22: Hospital Claims with Split Eligibility.
  • Provider News & Resources - Issue 53 07-25-2022 - This newsletter contains information on Novavax COVID-19 Vaccine Codes; Public Health Emergency (PHE) Extension; Recently Published Billing Manuals; Known Issues: Claims Requiring an Ordering, Prescribing, Referring (OPR) Provider; Physician Services: Claims for Physician Administered Drugs (PAD) Denying for Explanation of Benefits (EOBs) 0192 and 3053; Updated Information: Known Issue:  Institutional Claims for Diagnosis Codes Z28310, Z28311, Z2839 Denying for Explanation of Benefits (EOB) 3014 EAPGS - “Diagnosis is either invalid for date(s) of service or requires greater specificity” and Enhanced Ambulatory Patient Grouping (EAPG) Error Code 3102 - “Secondary Diagnosis”.
  • Provider News & Resources - Issue 52  07-11-2022 - This newsletter contains information on Did You Know? Switch to Mailchimp; Revalidation Reminder; Reminder:  Verify License Status; Ordering, Prescribing, Referring (OPR) Claim Identifier Project - Update; Delayed Member Notification of Health First Colorado Eligibility; Claims Editing Bypass for Gender Restrictions; When to Attach Explanation of Benefits (EOB) on Third Party Liability (TPL) and Medicare Claims; Recently Published Billing Manuals; Known Issues: Institutional Claims for Diagnosis Codes Z28310, Z28311, Z2839 Denying for Explanation of Benefits (EOB) 3014 EAPGS - “Diagnosis is either invalid for date(s) of service or requires greater specificity” and Enhanced Ambulatory Patient Grouping (EAPG) Error Code 3102 - “Secondary Diagnosis”; Resolved Known Issues: Resolved 07/01/2022 - Ambulatory Surgical Center (ASC) Claims for Procedure Code 36561 Paying at Incorrect Rate.
  • 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
  •  
Audiologist
Behavioral Health Organization
Birthing Center
Case Manager
Certified Registered Nurse Anesthetist (CRNA)
 
Community Clinic and Community Clinic with Emergency Center (CC/CCEC)
Community Mental Health Center
Dental
Developmental Evaluation Clinic

 

Dialysis Center
Durable Medical Equipment (DME)/Supply
Federally Qualified Health Center (FQHC)
Health Maintenance Organization (HMO)
Home & Community Based Services (HCBS)
Home Health
Hospice
Hospital - General
Hospital - Mental
Independent Laboratory
Indian Health Services
Non-Physician Practitioner - Group
Non-Physician Practitioner - Individual
Nursing Facility
Occupational Therapist
Pediatric Behavioral Therapy
Pharmacy
Physical Therapist
Physician Services/Clinics
Podiatrist

 

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