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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.
Effective 10/25/19, Colorado interChange will match the member DOD to the DOD in the Colorado Benefits Management System (CBMS), the eligibility system of record. This update will ensure Colorado interChange has valid and complete member information and prevent billing issues for providers.
Effective 10/2/19, the Colorado interChange has been updated to ensure that State Funded MHIs are paid correctly for Medicare crossover claims. Services that have been provided since 3/1/17 with incorrect payment or no payment will be reprocessed.
State Funded MHIs are now able to bill Medicaid for room and board and Medicare for the ancillary expenses. MHIs must manually enter the Medicare ancillary payment and the final payment should equal the Medicaid allowed amount payment (per diem x days) - Medicare payment (ancillary x days).
The Provider Web Portal has been updated to allow providers to use a new Part B only/Part A Exhausted checkbox when billing inpatient crossover claims for members that have TXIX benefits and Medicare Part A benefits during the stay.
The Affordable Care Act requires providers to complete revalidation every five years. The next round of revalidation will begin in October 2020, based on previous provider enrollment approval dates. Providers will be contacted via email approximately six months prior to their exact revalidation deadline with further instructions.
Visit the Revalidation web page for more information and links to additional resources.
Effective 9/3/19, the provider type Dentist with the specialty of Oral Surgeon is now accepting a copy of the Oral Maxillofacial Surgery (OMFS) certification and hospital privileges in lieu of a physician license. Refer to the Dentist drop-down section of the Information by Provider Type web page for a full list of requirements for this specialty.
House Bill (HB) 18-1282, the Colorado National Provider Identifier (NPI) Law, requires newly enrolling and currently enrolled Organization Health Care providers (not individuals) to obtain and use a unique NPI for each service location and provider type enrolled in the Colorado interChange. Providers are encouraged to visit the Colorado NPI Law web page for additional resources and information, including the Colorado NPI Law Webinar, Colorado NPI Law FAQs for Providers, and fact sheet.
Effective 7/1/19, the Provider Web Portal has been updated so providers can remove claim details when adjusting a previously paid claim. A “Remove” link has been added to the Submit Dental Claim, Submit Institutional Claim and Submit Professional Claim screens in the “Service Details” section under the “Action” column. Providers can use the link to remove the applicable claim detail lines before resubmitting the claim.
Refer to Step 3 in the Submitting an Institutional Claim and Submitting a Professional Claim Provider Web Portal Quick Guides located on the Quick Guides and Webinars web page for more information.
Effective 5/22/19, a new weekly automated system process will reduce turnaround time on the processing of TPL information entered in the Provider Web Portal. Additional processing will still be required if a member has multiple active policies on file.
The Effective To date will be automatically updated to 12/31/2299. If the policy is no longer active, providers should update the TPL record with a valid termination date.
Refer to the Adding and Updating Third-Party Liability (TPL) Information - Provider Web Portal Quick Guide, available on the Quick Guides and Webinars web page, for illustrated, step-by-step instructions on adding and updating TPL information via the portal.
The Department of Health Care Policy & Financing (the Department) must implement an evidence-based hospital review program to ensure that the utilization of hospital services is based on a member’s need for care, according to the Senate Bill 18-266 titled Controlling Medicaid Costs. Visit the Controlling Medicaid Costs Initiatives web page for additional information.
Prior Authorization Requests (PARs) will be required for inpatient hospital services for dates of service beginning June 17, 2019.
Visit the Inpatient web page of the ColoradoPAR website for additional information and links to helpful resources.
Completed Additional Reprocessing for Anesthesia Providers - Fiscal Year 2019-2020 Provider Rate Increases and Adjustments 11-4-2019
Additional Reprocessing for Anesthesia Providers - Fiscal Year 2019-2020 Provider Rate Increases and Adjustments 10-25-2019
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