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Provider Bulletin Index (07/18) - The Provider Bulletin Index contains a list of topics and sub-topics in current and prior year bulletins. To use the Index, simply find your topic and go to the bulletin for the date listed in the far right column. This is the bulletin in which the topic was published. If you have questions about Provider Bulletins, please contact Provider Services at 1-844-235-2387.
The Provider Bulletin is published monthly and posted to this web page. The bulletin covers topics of interest to providers and billing professionals.
Special Provider Bulletin – Colorado interChange Common Questions (B1800413 - 04/18) - This bulletin contains information on Do Not Send Reconsiderations for Denied Claims; Electronic Submission of Claims with Attachments; Provider Web Portal Void Claim Option Appears Only on Eligible Claims; When to Attach Explanation of Benefits (EOB) on Third Party Liability (TPL) and Medicare Claims; Unique National Provider Identifiers (NPIs): Making Claim Submission Easier; Paper Claim Form Signature Requirements; Claims Paid with “0” Date; Suspended Claims; "Lower of" Pricing Logic for Rate Increases; Rates and Fee Schedules; Finding Information About Your Submitted Claims (What Is an ICN?); Timely Filing; Ordering, Prescribing or Referring (OPR) Application Not Required for Individual Within a Group (IWG) Providers with Prescriptive Authority; Individual Providers Enrolling with an SSN May Only Have One Medicaid ID; Department Grace Period for Updating Provider Affiliations; Retroactive Updates to Member Eligibility Files; Alternative Benefit Plan
Medicaid Program News and Updates (B1800409 - 01/18) - This bulletin contains information on Did You Know? - Void Claim Option; Fiscal Year (FY) 2017-2018 Provider Rate Increases and Adjustments; Child Health Plan Plus (CHP+) Update; Health First Colorado (Colorado’s Medicaid Program) and CHP+ Member Feedback Wanted; How Organizations Can Utilize Colorado’s Newly Approved Health IT Roadmap; Tax Year 2017 1099-MISC Forms; Transportation Benefits Collaborative Meeting; Co-Pay Policy Update; Physician-Administered Drugs Billed with Miscellaneous J Codes Require National Drug Code (NDC) Number, Healthcare Common Procedure Coding System (HCPCS) Code, and NDC Units; Physician-Administered Drug Rate Update; Drug Utilization Review (DUR) Updates; Unenrolled Prescribers: NEW Prescriptions Written by Prescribers Not Enrolled with Health First Colorado Will Deny Beginning January 1, 2018; Pharmacy Provider Updates; HCPCS 0159T No Longer Covered; Non-Emergent Medical Transportation (NEMT) Bus Ticket Modifiers; Guidance for Billing CPT 92015 for Determination of Refractive State.
Medicaid Program News and Updates (B1600381 - 04/16) - This bulletin contains information on Rendering, Referring, and Prescribing Provider’s NPI Numbers; Medicaid Provider Revalidation Update; ACC Phase II Update: Behavioral Health Reimbursement Framework & FAQs; Free Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Medicaid Providers; Person and Family Centered Approach: Creating a Culture of Collaboration with Members; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; ColoradoPAR Program Updates; Discontinued Codes; Tax Season and 1099s; Food and Drug Administration (FDA) Update on Essure: Female Sterilization Method; Inpatient Claims for Members Fewer than 29 Days Old; Preferred Drug List (PDL) Update; Hepatitis C; Morphine Equivalent Limitations Update; Drug Utilization Review (DUR) Board Update; Attention Outpatient Speech Therapists; Home and Community Based Services (HCBS) Waiver Providers; In-Home Support Services (IHSS); and April and May 2016 Provider Workshops.
04/18/2016 - Correction: The original bulletin incorrectly stated that the rendering NPI number on electronic claims should be entered in the 2420F loop. The rendering NPI number should be entered in the 2420A loop.
Medicaid Program News and Updates (B1600379 - 02/16) - This bulletin contains information on the Accountable Care Collaborative Phase II: Stakeholder Feedback and Meeting Summaries; Person and Family Centered Approach: Creating a Culture of Collaboration with Members; Regulatory Efficiency Review: 8.079 Quality Improvement; ColoradoPAR Process Resources; Tax Season and 1099s; Healthcare Common Procedure Coding System (HCPCS) Updates for 2016 – Current Dental Terminology (CDT) Changes; Billing and Program Updates from DentaQuest; Coverage for Female Condoms and Spermicides; International Classification of Diseases 10th Revision (ICD-10) and Rehabilitation Specialty Hospitals; Pharmacy Dispensing Fees for Calendar Year 2016; Morphine Equivalent Limitations Update; Hepatitis C Medication Prior Authorization Process; Hepatitis C Criteria; Drug Utilization Review Board (DUR) Meeting; Outpatient Speech Therapists; and February and March 2016 Provider Workshops.
Medicaid Program News and Updates (B1400360 - 12/14) - This bulletin contains information on the CMS 1500 Claim Form Transition; ColoradoPAR Program; International Classification of Disease Version 10 (ICD-10); NCCI Quarterly Updates; Eligibility Response Changes; Increases in Payment for Office Visits and Vaccine Administration; Screening Medicaid Members for Depression; Coding Changes to the Medicaid Fee-for-Service Primary Care Depressions Screening Benefit; Comments Sought on New Federal Provider Screening Regulations; Tax Season and 1099s; December 2014 and January 2015 Holiday Schedule; Ambulatory Surgery Center Pilot Reimbursement Program; Billing Updates for DentaQuest; Dental Service for PE Children; Dental Program Benefits Update to Rules and Regulations; CRT Supplier Enrollment; Updated DME Billing Manual; Prior Authorizations for CPAP Machines; Approved FQHC Rates; Free Standing Birth Centers; Update on Inpatient and Outpatient Rate Increase; Non-Covered Days for Inpatient Claims; Billing Vxx.xxx Diagnosis Codes; Updates to Outpatient Cost-to-Charge Ratios, PT and OT PARs; Changes to FMS for CDASS Members; ACF PARs and Payment; Prior Authorization Process for HARVONI® and New Hepatitis C Treatment; PDL Update; Prior Authorization Changes; P&T Committee Openings; and December 2014 and January 2015 Provider Workshops.
Medicaid Program News and Updates (B1400359 - 11/14) - This bulletin contains information about Payment for Office Visits and Vaccine Administration; Comments Sought on New Federal Provider Screening Regulations; CMS 1500 Claim Form Transition; Customer Survey; Tax Season and 1099s; New Medicaid Members Looking for Providers; November and December 2014 Holidays; Dental Program Benefits – Update; DentaQuest Updates; CRT Supplier Enrollment; Substance Use Disorder Providers- Enrollment with BHO’s; Air Ambulance Certification Requirements; Non-Emergent Medical Transportation (NEMT) Broker; Change to FMS for CDASS Members; TAPV Form Requirement; Hepatitis C PARs; Stimulant and Attention Deficit Hyperactivity Disorder (ADHD) Medication Changes; November and December 2014 Provider Workshops
Medicaid Program News and Updates (B1400355 - 08/14) - This bulletin contains information about Postpartum Depression Screening; New HCPF Website Coming Soon; Selecting Medicaid Health Plans and Providers Online; Medicaid Members are Looking for Providers; ColoradoPAR Program; DentaQuest Provider Portal Updates; QMB and SLMB - Adult Dental; Dental General Billing Instruction Updates; Qualified Medical Personnel; Children Ages 0-2, 3 and 4 – Dental Billing; Dental Rules and Regulations; Orthodontia Updates; Correctional Facility Populations; Outpatient PT/OT Reminder; EI PT/OT Reminder; NEMT Transition; Other Drug Coverage Updates; Proton Pump Inhibitor Reminder; Smoking Cessation Reminder; P&T Committee Update; Provider Contact Info Update; DUR Board Update; August & September Provider Workshops.
Dental Benefit Update (B1400354 - 07/14) - This bulletin contains information about the Provider Electronic Funds Transfer (EFT) Information which requires action by all dental providers; DentaQuest Claims Administration; Prior Authorization Requests (PARs) with the New Dental Vendor, July 1, 2014; Pre-Payment Review (PPR); Dental Provider Seminars and Webinars.
Medicaid Program News and Updates (B1400353 - 07/14) - This bulletin contains information about the Medicaid Fee-for-Service Provider Rate Increases effective 7/1/14; Targeted Provider Rate Increases effective 7/1/14; Colorado 835 Companion Guide Revision; Billing and Reimbursement for Office Visits During Non-Regular Office Hours; ColoradoPAR Program; Old Age Pension (OAP) Health Care Program Rate Increases; New HCPF Website Coming Soon; Financial Reporting System Transition; Independence Day Holiday; Outpatient Hospital Supplemental Medicaid Payment; Children with Life Limiting Illness (CLLI) Waiver Service Change; Pharmacy and Therapeutics (P&T) Meeting; Preferred Drug List (PDL) Update; Other Drug Coverage Updates; Obstetrical Services - Ultrasound Utilization Limit Reminder; July and August 2014 Provider Workshops; Attachment A – PAF by Provider; Attachment B - Targeted Rate Increase – Final Recommendations.
Medicaid Program News and Updates (B1400346 - 01/14) – This bulletin contains information about the Correction to Rate Increase Article Published in the November 2013 Provider Bulletin; ColoradoPAR Program CWQI Reminders; New Service Related to the Medical Orders for Scope of Treatment; FFS Depression Screenings in the Primary Care Setting/New Adult Depression Screening Benefit; ACC Reaches Milestone of 400,000 Clients – Enroll as a Provider Today; Tax Season and 1099s; January and February 2014 Holidays; 2014 Holiday Processing Schedule; Upcoming Benefits Collaborative; Update on Home Health Pediatric Assessment Tool (PAT); Outpatient Hospital Supplemental Medicaid Payment; APR-DRG Implementation; SUD Integration into BHO; PLWA Waiver Change; Web Portal Inquiries for Pediatric Hospice and Children with Autism Waivers; P&T Meeting; PDL Update; January & February 2014 Provider Workshops; and Hospitals & Adjustment Factors Attachment.
Medicaid Program News and Updates (B1300345 - 12/13) – This bulletin contains information about Medicaid Benefits for Newly Eligible; Find a Healthcare Provider; Clarification on Use of Eligibility Inquiry to Verify Dates of Service in Web Portal; PCR Opt Out; 2013 Rate Increases & Fee Schedule; 2014 HCPCS & Fee Schedule; Planning Update & Survey for ICD-10; NCCI Quarterly Update; The ColoradoPAR Program; Tax Season and 1099s; December 2013 & January 2014 Holidays; Upcoming Dental Benefits Collaborative; APR-DRG Implementation; APR-DRG Web Portal Updates; Inpatient Medicaid Base Rates Effective July 1, 2013; Updates to OP Cost-to-Charge Ratios; SBIRT Code Update; SUD Integration into BHO; CWA Service Additions; Expansion of CDASS; Psychological Testing for Individuals Seeking Services from CCB; Documenting the Purpose/Intent for All Contraception Prescriptions; P&T Board Meeting’ PDL Update; Rx Review Program; Rixubis; December 2013 & January 2014 Provider Workshops.
Medicaid Program News and Updates (B1300344 - 11/13) – This bulletin contains information about the ColoradoPAR Program; Tax Season and 1099s; Rate Increase Update; Web Portal User Assistance Resources; Updated MED-178; New Health Care Reform Resource Page for Providers; November 2013 Holidays; Billing for Hearing Aids; Upcoming Benefits Collaborative; Developmental Screening ; APR-DRG Update; Immediate Postpartum Long-Acting Reversible Contraception (LARC); Updates to Outpatient Cost-to-Charge Ratios; NHVP Procedure Codes G9006 and T1017; NMT Accounts Receivable Balances; SUD Integration into BHOs; Waiver Claim Adjustments due to Rate Increases; P&T Committee Open Positions Beginning 2014; Next DUR Board Meeting; and November & December 2013 Provider Workshops.
Medicaid Program News and Updates (B1200331 - 12/12) - This bulletin contains information about the Colorado PAR Program; the Second Phase Update of NCCI Implementation; ‘Meaningful Use’ Submissions from Health Care Providers Using EHR; the Add-A-Baby Project; CHP+ Income Eligibility Policy Changes for Pregnant Women; Tax Season and 1099s;December 2012 and January 2013 Holidays; ICD-9-CM Crosswalk Update; Billing 340B Drugs for OP Hospitals; Updates to Outpatient Cost-to-Charge Ratios; Home Health Benefit Coverage Standard; ACA Payment to PCPs Rate Increase; Prenatal Plus Program; Tobacco Cessation Counseling Benefit for Pregnant Women; Immunizations; Pharmacy P&T Board Meeting; P&T Committee Open Positions Beginning in 2013; PDL Update; COB Manager; IHS Pharmacies; Medicare Part D; 2012-2013 Synagis® Season; Enhanced Prior Authorization System (SMART PA); December 2012 & January 2013 Workshops; and the Immunization Coding Quick Reference.
Medicaid Program News and Updates (B1200310 - 01/12) - This bulletin contains information about the HIPAA 5010 Implementation Update; PAR Status via AVRS; ACC Update; Tax Season & 1099s; Updated Companion Guides; January & February 2012 Holidays; Lead Screening Diagnosis Code; Office Administered Injections & Devices; Providers Serving Pregnant Woman; Pharmacy Billing; Payer of Last Resort; Pharmacy Claim Form; Emergency 3-day Supply; Next P & T Meeting; PDL Update; Prior Authorization Criteria Update; and the January & February 2012 Workshops.
Medicaid Program News and Updates (B1100309 - 12/11) - This bulletin contains information about HIPAA 5010 Implementation Update; Colorado Medical Assistance Program Web Portal (Web Portal) Reminders; Provider Billing Workshops Handouts; Elimination of the CHP+ Pre-HMO Period; Non-Emergent Medical Transportation (NEMT) Broker; Tax Season and 1099s; Updated Companion Guides; Healthy Living Initiatives: Prevention Efforts for Medicaid and CHP+ Clients; December 2011 & January 2012 Holidays; Home Health Face-to-Face Encounter; PASRR Level II Evaluation and Determination; NF Late Bill Override Date (LBOD); Nursing Facility Billing; Next P&T Committee Meeting; Preferred Drug List (PDL) Update; DUR Board Updates; Appropriate use of PPIs; December 2011 & January 2012Workshops; and 2012 Holiday Payment Processing Schedule.
Medicaid Program News and Updates (B1100308 - 11/11) - This bulletin contains information about ACC; Clerical Errors Can Be Costly; Updated Companion Guides; Recovery Audit Contractor (RAC) Award Made; Tax Season and 1099s; Healthy Living Initiatives; November 2011 Holidays; Correction to the October 2011 Synagis® and Influenza Vaccines Bulletin; ASC Procedure Coding; Revised Home Health, Extraordinary Home Health and Private Duty Nursing PAR Form; Updates to Outpatient Cost-to-Charge Ratios; Physician-Administered Drugs Require Both NDC Number and HCPCS Code; Potential P&T Committee Members; PDL Update; DUR Board Updates; Simvastatin and November & December 2011 Workshops.
11/03/11 - Revised with current information for ACC clients.
Medicaid Program News and Updates (B1100292 - 01/11) - This bulletin contains information about Application Assistance – Mapping Tool ; Electronic Only Notifications; Web Portal News; CLIA Certification; 2011 HCPCS; Medicaid Post-Payment Review; Oxygen Benefit for Dually Eligible Clients in Home and Community Setting; Updated Medicaid Provider Application; Tax Season and 1099s; January & February 2011 Holidays; Diagnostic Casts and Study Models; Unsupervised Dental Hygienists Medicaid Allowable Procedures Expanded; Dental Web Portal Claim Submissions; Reimbursement for Providers After FQHC or RHC Application; Services Incident to Physician’s Professional Services; ICD-9-CM Codes Crosswalk; Next P&T Committee Meeting; PDL Update; DUR Board Updates; Updates to Prior Authorization Criteria; Synagis® PAR Updates; January & February Workshops and the Email Opt-Out Form.
Medicaid Program News and Updates (B1000291 - 12/10) - This bulletin contains information about Electronic PAR Letters through FRS; Load Letter Requests; Increase Well-Care/Dental Visits Study; Laboratory Processing Changes; CMS NCCI; Updated Standard Provider Application; Tax Season and 1099s; Electronic Only Notifications; December 2010 and January 2011 Holidays; Dialysis Billing Manual Update; J7300 Reimbursement Rate Increase; Additional Code for Prior Authorization; 2011 Social Security COLA; Next P&T Committee Meeting; PDL Update; DUR Board Updates; Updates to Prior Authorization Criteria; Synagis® PAR; Additional Code for Prior Authorization; December & January Workshops; Synagis® PAR Instructions and Synagis® Diagram.
Medicaid Program News and Updates (B1000274 - 01/10) - This bulletin contains information about Dual Eligibility; Provider Co-Pay Agreement; Records Retention; Essential Community Providers; January and February 2010 Holidays; State Furlough Day; Tax Season and 1099s; ICD-9-CM Codes Crosswalk; Billing Change for Mental Health Clients with Retroactive Enrollment; Pharmacy and Therapeutics (P&T) Committee News; Preferred Drug List Update[ Azmacort; Physical Therapy and Occupational Therapy Providers Prior Authorization Requirement Reminder; Notice to All Providers Billing Physician-Administered Drugs; Botulinom Neurotoxins Administered in the Office Setting; Enjoy the Benefits of Direct Deposit; Electronic Provider Bulletin Notification and January & February 2010 Denver Provider Billing Workshops.