Special Projects

The Colorado Immunization Program (CIP) at the Colorado Department of Public Health and Environment is assisting local public health agencies (LPHA) develop the mechanisms to bill health insurance plans for services provided to health plan members.

These funds support LPHA with a new pilot program opportunity called “Reimbursement Immunization Opportunity” or RIZO.  The RIZO project involves the following:

• Funding for the development and/or improvement of LPHA infrastructure and processes that lead to successful third-party (public and/or private) billing mechanisms for the immunization of insured patients

• Ideally, third-party billing includes billing of both the vaccine administration fees as well as the vaccine cost (private stock vaccines only)

• Participation of both experienced and inexperienced third-party billers

• Participants located in both rural and metro areas of Colorado

Monthly Project RIZO calls are held on the third Tuesday of every month at 1:00 pm, unless participants are notified otherwise.  To add yourself to the distribution list for these meetings, please contact Cathleen Beaver via email.

For more information on Project RIZO, please contact:

Colorado Immunization Program

Teri Lindsey

303-692-2732

Teri.lindsey@state.co.us

In-state toll-free:1-800-886-7689 ext. 2732 (Teri)

RIZO contractors are required to report monthly for the RIZO activities completed during each month. Additional follow-up contact may be made periodically by the CIP contract monitor.

ARRA funded contractors should use the ARRA RIZO online monthly report and ACA funded contractors should use the ACA RIZO online monthly report.

RIZO projects are required to collect, track, document, and report the following data as applicable:

• Number of claims submitted to each payer

• Total monthly dollar amount of claims submitted by payer

• Total reimbursement amount received by payer

• Most frequently received denial reasons

• Status of project-specific milestones as documented on the application timeline

• Populations Served (payer source, vaccine type, etc., as requested by CIP)

Throughout the funding period, the CIP will conduct ongoing project monitoring and provide technical assistance as needed.  In the event that project performance does not meet the agency's stated goals, a follow-up work plan will be created and additional technical assistance will be provided.  In an extreme situation, and in consultation with the agency, the CIP reserves the right to reduce or withhold quarterly payments due to poor project performance.

Project RIZO: On-Site Data Collection

The RIZO Data Collection Template is a simple spreadsheet used to capture general, patient-level data about the patients you serve, the vaccinations those patients receive, and the insurance payer (public or private) for those patients.  This data is supplied to the CIP without patient identifiers and analyzed in an attempt to better quantify the billing opportunities in Colorado.  Periodically, the CIP will supply contractors with analysis of the data they submitted for their jurisdiction.  Analysis might include, but is not limited to:
 

• which payers represent the majority of patients served
• populations served by age
• most common vaccinations given
• reason most patients chose to visit your clinic

Unless notified otherwise, all RIZO contractors are required to complete a RIZO Data Collection Template form monthly and submit the form by the 5th day of the following month to Jodi Maturo via email. 

•   RIZO Data Collection Template 2011-10

Project RIZO: Off-Site Data Collection

Data Collection at off-site clinics, such as School Located Vaccination (SLV) clinics is equally important. The data you capture at your off-site clinics helps us identify the most common payer sources of students served and the vaccinations those students received.  Much like on-site data collection, these data are supplied to the CIP without patient identifiers and are used to assess the billing opportunity of an off-site clinic.  A data collection template must be completed for each off-site clinic your agency implements as part of Project RIZO. 

• Off-Site Data Collection Template 2011-10-17

Your completed template is due within 2 weeks of the clinic date and should be sent to Marget Huffman via email.

The process for Project RIZO contractors to bill the CIP varies by the source of funding, as shown below.

• ARRA Funded Projects (funding ends Dec 2011):  ARRA Invoice Form

• ACA Funded Projects (Oct 2011 – Aug 2012): ACA Invoice Form

Note: Project RIZO invoices should include charges for both on-site activity and school located vaccination clinics (SLV). Your invoice does not need to be itemized according to the location of the immunization clinic.

Have questions? Please contact Teri Lindsey at 303-692-2732 or by email for more information.

Two Medicaid care options in Colorado:

1.   Straight Medicaid (operated by Colorado Access)
2. Managed Care Organizations (MCO), made up of the following HMOs:
   • Colorado Access
   • Rocky Mountain Health
   • Denver Health
   • Colorado Choice
   • Kaiser

How do Local Public Health Agencies (LPHA) apply to be Medicaid providers?
The Department of Health Care Policy and Financing (HCPF) has developed “Provider Services” web pages designed to help you through the process.  To get started with your provider enrollment, visit the website and scroll down to the “Electronic Rendering Provider Application” link.  This page has many other helpful resources including FAQs and a “Provider Enrollment Application Workshop” that offers insights on how to complete the application process.

How does an LPHA determine whether to be a straight Medicaid provider or a MCO Medicaid provider?
The Colorado Immunization Program (CIP) advises all Local Public Health Agencies (LPHA) in Colorado to apply to be State Managed Care Network providers.  In addition, most LPHAs may also want to apply as MCO Medicaid provider for the MCOs in their area.  To determine which MCO is in your jurisdiction, please visit the website.

How do I check eligibility for a Medicaid patient?

• Medicaid Patient Eligibility Manual

How do I bill for immunizations?
Billing Medicaid for immunizations is simple.  See the attached document to view screenshots of the process.

• Medicaid Billing Process 2011-05

Two CHP+ care options:

1. State Managed Care Network (SMCN)

2. CHP+ HMO program, made up of the following HMOs:

   • Colorado Access (mostly eastern slope)
   • Rocky Mountain Health (heavily in western slope)
   • Denver Health
   • Colorado Choice (San Luis Valley)
   • Kaiser

Structure:  Colorado Access is the Administrative Service Organization (ASO) that administers the State CHP+ plan called the State Managed Care Network (SMCN).  When a child first joins CHP+, he or she will be initially covered by SMCN for approximately 1-2 months before transitioning to their HMO for the duration of their membership.  These children receive full CHP+ services through the SMCN during this “pre-HMO” period.  However, CHP+ enrolled patients who live the counties of Teller, Sedgwick, and El Paso do not have HMOs and will all be served by the SMCN network exclusively.

How does an LPHA determine whether to be an SMCN or HMO CHP+ provider?
The Colorado Immunization Program (CIP) advises all Local Public Health Agencies (LPHA) in Colorado to apply to be State Managed Care Network (SMCN) providers.  In addition, most LPHAs (aside from the jurisdictions of Teller, Sedgwick, and El Paso counties) may also want to apply as CHP+ providers for the HMO in their area.

• HMO jurisdictions

How do I begin the CHP+ provider application process?
Refer to the table to determine which CHP+ care options are available to patients in your jurisdiction. Keep in mind that some HMOs, such as Kaiser, operate closed networks and may not be able to accept your LPHA as a provider.  Once you have identified the providers in your area, you may request a provider contract in one of the following ways.  Be sure to note your interest in both SMCN and any corresponding HMOs.

• Make requests online

• Make requests via email

• Having troubles? Contact Yolanda Hall

What are the reimbursement rates for CHP+ SMCN and HMOs?
CHP+ SMCN reimburses 100% of Average Wholesale Prices (AWP).  After accessing the fee schedule, select “Fee Schedule & Reimbursements” on the left-hand side navigation bar.  Next, click the link for “Immunization Fees.”  CHP+ HMO plans are capitated plans and have their own contracted rate for vaccinations.

Already a CHP+ provider?
CHP+ has a team of region-based Provider Relations Liaisons available to answer your questions and offer training.