Accountable Care Collaborative Phase II - Provider and Stakeholder Resource Center

On July 1, 2018, the next iteration of the Accountable Care Collaborative (ACC) launched. The ACC seeks to leverage the proven successes of Colorado Medicaid’s programs to enhance the Health First Colorado (Colorado’s Medicaid Program) member and provider experience. For more information go to CO.gov/HCPF/ACCPhase2.

The Department has published and will regularly update information on this Provider & Stakeholder Resource Center. This resource center includes fact sheets, FAQs webinars and other resources for providers and stakeholders about Phase II.

Choose a resource below:

Key Concepts

Provider Resources

Attribution

Behavioral Health Services

Performance Measurement including Key Performance Indicators & Behavioral Health Incentive Program

Resources for Counties

ACC Phase II Frequently Asked Questions for Counties (Updated July 10, 2018)

Implementation Updates: Known System, Policy & Other Issues

The purpose of this section is to provide Implementation Updates to keep providers and other interested parties up to date on issues related to the launch of ACC Phase II. This page is not intended to be an all-inclusive list of ACC Phase II topics but will reflect known system, policy and other issues that have been identified; as well as solutions or workarounds that have been developed where applicable.

Date Added

Category

What Providers and/or Members may be Experiencing

What we know

Action Needed

Status

8/1/2018

System Assignment

Providers are unable to see the RAE region number in the Provider Web Portal

N/A

N/A

Resolved: When verifying eligibility in the Provider Web Portal, the RAE name and region number will now display.

8/1/2018

 Contracting

Some PCMPs did not receive member attributions effective July 1, 2018.

Upon further research it was determined that often these providers had not contracted with the RAE in their area.

Provider Action: We encourage providers that wish to serve as a PCMP to contact with the RAE in their area to establish a relationship. See the Primary Care Medical Provider Contracting Guidance Fact Sheet.

 

Resolved

8/1/2018

Contracting

Some PCMPs did not receive member attributions effective July 1, 2018 or believe their list of attributed members is incorrect.

It was discovered that some PCMPs have not been billing under their unique ID number primary care provider will contract with the RAE based on their brick and mortar location, which is identified by the unique billing ID created during provider revalidation/enrollment.

 

Provider Action: Group practices with multiple locations should contract with all RAEs in which their practices are located. Member assignment to the RAE will be based on the member’s attribution to a PCMP brick and mortar location. Therefore, it is imperative that providers bill by practice site location to receive attributions. See the Multiple Service Locations fact sheet.

Resolved

8/1/2018

Panel Limits

If a PCMP chooses to have a panel limit/cap and reaches this limit, the PCMP will not receive any additional attributions, including claims history, geographic attributions or member choice.

PCMPs have the ability to set their own panel limit/cap on the number of Health First Colorado members that can be attributed to them, but are not required do so. Some providers were not aware of their set panel limit/cap or how to change it.

Provider Action: PCMPs must contact their RAE for their panel limit/cap, if one has been established; PCMPs cannot view their panel limit/cap through the Provider Web Portal. See the recent stakeholder message on panel limit/caps.

Resolved

8/1/2018

System Assignment

Members not attributed to the primary care provider they have utilization history with.

Some members were attributed to the primary care provider the head of household for their case had utilization history with. The system did not look at an individual member’s utilization history when attributing the member to a primary care provider.

Member Action: Members can change their primary care provider at any time. For more information, see our frequently asked questions.

In Progress: Working DXC on this identified system defect and have prioritized a system fix.

8/1/2018

System Assignment

Some members continue to be attributed to a managed care plan, Denver health Medicaid Choice or Rocky Mountain Health Plans Prime, even if the member has opted-out.  

DXC system logic is not excluding members who have opted out of a managed care plan when the member has failed to choose a primary care provider at the time of managed care plan opt-out.

Member Action: Members should contact Health First Colorado Enrollment to choose a primary care provider and can change their primary care provider at any time. For more information, see our frequently asked questions.  

In Progress: DXC has fixed the system error and disenrolled impacted members from Denver Health Medicaid Choice or Rocky Mountain Health Plans Prime as of 8/31/2018.

8/1/2018

System Assignment

Some members have duplicate enrollments.

When verifying Health First Colorado member eligibility in the Provider Web Portal, multiple member enrollments in a RAE, managed care plan and/or to a primary care provider are displaying.

 

Provider Action: As a reminder, physical health services are reimbursed fee-for-service. Member assignment to a primary care provider does not affect fee-for-service payments. Providers who experience members with multiple RAE or primary care provider enrollments should contact their RAE.

Short-term: Department is manually correcting inaccurate enrollments.

Long-Term: DXC is working on system improvements.

8/1/2018

System Assignment

Some member enrollments in the Provider Web Portal are missing either a RAE, managed care plan or primary care provider assignment.

When verifying Health First Colorado member eligibility in the Provider Web Portal, the member’s RAE, managed care plan and/or primary care provider enrollment is not displaying.

Provider Action: As a reminder, physical health services are reimbursed fee-for-service. Member assignment to a primary care provider does not affect fee-for-service payments. Providers who experience members with missing RAE or primary care provider enrollments should contact their RAE.

Short-term: Department is manually correcting inaccurate enrollments.

Long-Term: DXC is working on system improvements.

9/12/2018 System Assignment Some eligible newborns were not appropriately enrolled in Denver Health Medicaid Choice. Some eligible newborns were attributed to a primary care provider and RAE instead of Denver Health Medicaid Choice. Member Action: Parents or guardians of eligible newborns can contact Health First Colorado Enrollment to enroll their newborn in Denver Health Medicaid Choice. Resolved: DXC has fixed the system error and corrected enrollments for impacted newborns. 
9/12/2018 System Assignment Some members have been attributed to primary care providers far from their home.  Some members who did not have claims history with a primary care provider and were geographically assigned to a primary care provider, were assigned to providers extremely far from their address we have in our records. Member Action: Members should contact Health First Colorado Enrollment to choose a primary care provider and can change their primary care provider at any time. For more information, see our frequently asked questions.

Short-term: DXC fixed one system error and re-attributed impacted members.

Long-Term: DXC is working on additional system improvements.

Other Resources

Submitting Questions: Interested parties can submit their questions to the Department using this form. The Department will not be able to respond directly to all inquiries but will use the questions submitted to tailor upcoming communications and resources.

Sign Up for Updates: The Department shares regular updates via email on the ACC Phase II. Sign up for our updates here and see our past updates to stakeholders and providers here.

Member Messaging Resource Center: The Department has developed this Member Messaging Resource Center and includes sample letters, talking points, frequently asked questions, and more.