Provider Resources

Checks are in the mail!

Special Tuesday Financial Cycle - for claims that were processed (and received a status of Paid) between 3/11 and 3/14: checks will go out from the HPE Michigan print center on 3/16, and EFT deposits will begin hitting bank accounts on 3/20. Check delivery date will vary due to the Postal Service, and EFT delivery dates may vary by financial institution.

Remember – if you updated your EFT information recently, you will receive paper checks for the following two weeks.

Remittance Advice (RAs) are the new Provider Claim Reports (PCRs)

RAs will be available for download every Monday morning, by 12 p.m. MST. You can get to your RA by logging into the Provider Web Portal → Resources Tab → Report Download → choose “MMIS Reports – RA” from the Report dropdown box.

835 Availability: 835s will be available the Monday following the Friday financial cycle, almost a week earlier than previously available.

Are your Clearinghouses having trouble with your claims?

Specifically, are there files being approved but all your claims are denying? Your Clearinghouse needs to add CO_TXIX to their inbound transactions. Depending on the inbound transaction type, they may need to add this as either the:

  • Payer Identifier Information
  • Receiver Identifier
  • Information Source Primary Identifier

Please refer them to the companion guides at Colorado.gov/HCPF/EDI-Support for more details.

QMB Claims

Claims suspended for QMB clients for the EOB codes below will not be processed until an update is made to the Colorado interChange system. The Department is developing an interim solution that will allow the claims to process and will communicate additional information as it becomes available.

  • EOB 4223 - Medical Review Restriction on Procedure Code Coverage Rule.
  • EOB 4253 - Medical Review Restriction on Revenue Code Coverage Rule.

UPDATED! Claim denials due to EOB 1473 Multiple Provider Locations for Billing Provider Specialty.

In general, EOB 1473 is an indication that the system cannot determine which of your locations to look at. If you share a National Provider Identifier (NPI) with more than one (1) provider type or location address, additional steps are needed to ensure proper claims adjudication. A unique nine (9) digit zip code or taxonomy code is required to identify the correct billing provider ID.

  • There are several reasons that a provider may receive EOB 1473, including an issue that caused single claims submitted via the Provider Web Portal to incorrectly deny because the system wasn’t processing the Zip Code + 4. This particular issue has been resolved, and providers may resubmit all claims that denied for EOB 1473. Note: Rebilling these claims is not a guarantee of payment, and some claims may still hit other edits and deny.
  • There are approximately 60 providers receiving EOB 1473 because two or more of their locations have the same address and (incorrectly) have the same taxonomy codes. The fix for this particular issue is in place, and these claims will automatically be recycled for the effected providers. However, please remember that some claims may still hit other edits and deny.
  • If you are receiving EOB 1473, you should also follow these instructions to ensure your service location includes the Zip Code + 4. Note: a change (or update) of address will generate a new Application Tracking Number (ATN) for the update request. The change will take a few days to process so it will not show up immediately. Please do not submit multiple requests for the same update.

ATTENTION: Heavy call volume leading to extended wait times.

The Health First Colorado Enrollment and Revalidation Information Center (Hewlett Packard Enterprise call center, 1-844-235-2387) is experiencing heavy call volume which is resulting in extended wait times. You should anticipate longer than usual wait times, as providers have questions about the Provider Portal or revalidation and enrollment. We apologize for this inconvenience.

ATTENTION: Provider Web Portal registration errors.

Some providers are reporting an error message during registration for the new Provider Web Portal. HPE is working to resolve the issue, and has provided this work-around in the mean-time.

Provider Web Portal FAQs & Cheat Sheets

view these faqs and cheat sheets

 

Are You Ready for March 1, 2017?

Download this Go Live Guide now

 

Important Dates & Deadlines

download these important dates and deadlines

 

New Provider Web Portal Training

Click here for the new Provider Web Portal Training Schedule

 

Looking for Revalidation & Enrollment instructions?

They've moved! Find the Revalidation and Enrollment instructions on our Provider Enrollment web page.

Other links you may find helpful:

You May Also Be Interested In:

Want to know more about the new Provider Web Portal? FAQs and Cheat Sheets

What's This All About? Colorado interChange FAQs

Are You a Pharmacy? Pharmacy Benefits Management System (PBMS) Transition

 

Emails to Providers