Bulletins

Provider Bulletin Index

Provider Bulletin Index (01/20) - 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 the Provider Services Call Center 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.

2020: B2000441 - Current

Special Provider Bulletin – Laboratories (B2000443 - 01/20) - This bulletin contains information on the Genetic Testing Prior Authorization Requirement and Clinical Diagnostic Laboratory Upper Payment Limit Rates

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000442 - 01/20) - This bulletin contains information on Did You Know - Current Licensure Requirement; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Payment Error Rate Measurement (PERM) Audit; Prior Authorization Vendor Training; Changes to Billing Method for Home Accessibility Adaptations Benefit; Changes to Supported Living Program (SLP) Rate Methodology; Targeted Rate Increases Effective January 1, 2020; General Updates; Hospital Transformation Program (HTP); Inpatient Hospital Review Program (IHRP) Materials; Inpatient Hospital Review Program (IHRP) Admission Date; Immediate Post-Partum Long-Acting Reversible Contraception (IPP-LARC) “Carve-Out” From All Patient Refined-Diagnosis Related Group (APR-DRG) Payment Methodology; Genetic Testing Prior Authorization Requirement; Rx Review Program; Preferred Drug List (PDL) Announcement of Preferred Products; Eligibility Criteria for Enbrel, Humira, Cosentyx or Xeljanz IR; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy & Therapeutics (P&T) Committee Open Positions; Quarter 1 Rate Updates 2020; January and February 2020 Provider Billing Training Sessions

Special Provider Bulletin – Healthcare Common Procedure Coding System (HCPCS) Updates for 2020 (B2000441 - 01/20) - This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2020; Discontinued Codes; New Procedure Codes; Procedure Codes with Description Changes.

2019: B1900425 - B1900440

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900440 - 12/19) - This bulletin contains information on Did You Know - Provider-Member Billing Reminder; Deficit Reduction Act of 2005 Provider Requirements; eQSuite® Trainings; Load Letters; Prior Authorization Requests (PARs) Determination Letter Change Reminder; Update on Known Issue for Claims Paying at Zero Incorrectly; Changes to Room and Board and Personal Needs Amounts; General Updates; Hospital Back Up (HBU) Rate Corrections - December 2019; Hospital Transformation Program (HTP); Inpatient Hospital Review Program (IHRP); Inpatient Medicare Part B-Only and Medicare Part A Exhaust Claims Pricing; Brand Name Medication Favored Over Equivalent Generic; Preferred Drug List (PDL) Announcement of Preferred Products; Vivitrol Administration Enhanced Reimbursement; Dry Needling 97799 Update; Rates Updates for Non-Clinical Diagnostic Laboratory Upper Payment Limit (CDL-UPL); December 2019 and January 2020 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900439 - 11/19) - This bulletin contains information on Did You Know - Unlocking or Resetting a Provider Web Portal Password; Colorado National Provider Identifier (NPI) Law Implementation; Fingerprint – Federal Criminal Background Check; Payment Error Rate Measurement (PERM) Audit; eQSuite® User Administrators; Pre-Admission Screening and Resident Review (PASRR); General Updates; Inpatient Hospital Review Program (IHRP) Updates; New Skin Substitute Rates; Quarter 4 Rate Updates 2019; Reallocation Change Form Templates; Brand Name Medication Favored Over Equivalent Generic; October and November 2019 Provider Billing Training Sessions

Special Provider Bulletin – Synagis® & Seasonal Influenza Vaccines (B1900438 - 10/19) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine Benefit; Reimbursement of Synagis®; Prior Authorization Requests (PARs) Submission Methods; Prior Authorization Requests (PARs) Criteria and Guidelines; Billing Instructions; Synagis® and Home Health Agencies; Seasonal Influenza Vaccine is a Benefit for Children and Adults; Children/Adolescents and Adults; and Billing Information for Seasonal Influenza Vaccine

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900437 - 10/19) - This bulletin contains information on Did You Know - Process for Refunding Payments; Enrollment Application Date of Birth (DOB) Requirement Reminder; Updated Process for Member Date of Death Verification; Non-Covered Modalities Under the Occupational Therapy Benefit; Child Health Plan Plus (CHP+) Prenatal Dental Benefit; Unit Limit Update for Procedure Code T2003; Electronic Visit Verification (EVV) Training Announcement; Hospice Facility Fiscal Year 2019-2020 Rate Updates; General Updates; Hospital Transformation Program (HTP) Program Updates; Medicare Crossover Claim Billing and Payment Updates for State Funded Mental Health Institutes (MHIs); Urinalysis Test Policy Clarification; Drug Utilization Review Update to Pharmacy Prior Authorization Form for Medications Administered in a Member’s Home or in a LTCF by a Healthcare Professional; Preferred Drug List (PDL) Announcement of Preferred Products; Total Annual Prescription Volume (TAPV) Survey; Tobacco Cessation Reminder; PAD Billing Guidance; Quarter 4 Rate Updates 2019; Abortion Services Update; October and November 2019 Provider Billing Training Sessions

Special Provider Bulletin – Reporting Service Units for Outpatient Physical, Occupational and Speech Therapy Benefits (B1900436 - 10/19) - This bulletin contains information on the Reporting of Service Units for the Outpatient Physical, Occupational and Speech Therapy Benefits

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900435 - 09/19) - This bulletin contains information on Did You Know - Prior Authorization Request (PAR) Must Be Approved When Claim is Submitted; Annual ICD-10 Coding Updates Effective October 1, 2019; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; National Provider Identifier (NPI) Regulations; Payment Error Rate Measurement (PERM) Audit; Provider Web Portal Update to Add “Remove” Link to Service Details Section; Claims Must Match Documentation; Federal Upper Payment Limit (UPL) Requirement; Peristeen – Pricing, Data Analysis & Coding (PDAC)-Appropriate Coding; General Updates; Hospital Transformation Program (HTP) - Program Updates; Quarter 3 Rate Updates 2019; Drug Utilization Review Updates; September and October 2019 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900434 - 08/19) - This bulletin contains information on Did You Know - Medicare Replacement Plan; Billing Education-Only Telemedicine Services; Reminder to Update Contact Information for Member Search; Billing Guidelines for Bus Passes; In-Home Support Services (IHSS) Provider Updates; New Services for the Home & Community-Based Services – Children's Habilitation Residential Program (HCBS-CHRP) Waiver; Personal Care & Homemaker Provider Meetings; General Updates; Hospital Transformation Program (HTP); Billing Modifiers for Bilateral Radiology Procedures; Drug Utilization Review Updates; Medications Administered in a Member’s Home or in a Long Term Care Facility (LTCF) by a Health Care Professional; Dispense-As-Written (DAW) Reminders; Preventive Services Billing; Quarter 3 Rate Updates 2019; New Non-Emergent Medical Transportation (NEMT) Broker; August and September 2019 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900433 - 07/19) - This bulletin contains information on Did You Know - Electronic Claim Submission Requirement; Clinical Trial Coverage; "Lower of" Pricing Logic for Rate Increases; Payment Error Rate Measurement (PERM) Audit; Updates to Eligibility Verification; PAR Determination Letter Change; General Updates; Hospital Transformation Program (HTP) Update; Inpatient Medicare Part B-Only and Medicare Part A Exhaust Interim Solution Update; End-Stage Renal Disease (ESRD) Vascular Access Procedures for Recipients of Emergency Medicaid Services; New Grant Opportunity; Medication Administration; Quarter 3 Rate Updates 2019; July and August 2019 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900432 - 06/19) - This bulletin contains information on Did You Know - TPL Updates via Provider Web Portal; Fiscal Year 2019-2020 Provider Rate Increases and Adjustments; "Lower of" Pricing Logic for Rate Increases; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Delta Dental Switch to DentaQuest; General Updates; Hospital Transformation Program (HTP) Community and Health Neighborhood Engagement (CHNE); Inpatient Hospital Review Program (IHRP) Update; Newborn Hearing Screening; Newborn Metabolic Screening; Laboratory Rate Rebalancing Effective July 1, 2019; Genetic Testing Prior Authorizations and Rates Information; 340B Drug Pricing Program ; Stiripentol (Diacomit); Brand Name Medication Favored Over Equivalent Generic; Drug Utilization Review Updates; Pharmacy and Therapeutics (P&T) Committee Meeting; Preferred Drug List (PDL) Announcement of Preferred Products; Instructions for Claims Submission with Procedure Code 38439; Supervision Requirements for Reimbursable Services; June & July 2019 Provider Billing Training Sessions

Health First Colorado (Colorado’s Medicaid Program) Special Bulletin – Newborn Screenings (B1900431 – 05/19) - This bulletin contains information on Newborn Hearing Screening and Newborn Metabolic Screening

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900430 - 05/19) - This bulletin contains information on Did You Know - Timely Filing for Claim Resubmissions; "Lower of" Pricing Logic for Rate Increases;Regulatory Efficiency Review Public Notice – 30-Day Comment Period; Duplicate Billing of Services Rendered by a Certified Registered Nurse Anesthetist (CRNA) Supervised by an Anesthesiologist; Medicare Crossover Claim Reimbursement; Colorado Choice Transitions (CCT) Program Extension; New Services Available; Under the HCBS-CHRP Waiver; New Sustainability Services Available Under Certain HCBS Waivers; New Targeted Case Management – Transition Coordination Benefit for Colorado Choice Transitions Transition Coordination Agency (CCT-TCA) Providers; Training for In-Home Support Services Now Available; Billing Guidelines for Bus Passes; Self-Audit for Active Certifications and Licenses; General Updates; Hospital Transformation Program (HTP) Overview & Resources; Inpatient & Outpatient CHASE Supplemental Payment Percentage Adjustment Factors; Code Updates; 340B Drug Pricing Program; Brand and Generic Equivalent Changes for Non-Preferred Medications; Quarter 2 Rate Updates 2019

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900429 - 04/19) - This bulletin contains information on Did You Know - Member Eligibility Verification Availability; Fingerprint Criminal Background Check (FCBC); Verifying Member Eligibility and Appealing Claim Denials for Eligibility; Claims Must Match Documentation; Geographical Reimbursement Rates; Modifiers; Updated Prior Authorization Request (PAR) Requirements for Prosthetics & Orthotics, Effective April 1, 2019; House Bill (HB) 18-1407 Implementation; Billing Guidance for End-Stage Renal Disease as an Emergency Medical Condition; Inpatient Hospital Review Program (IHRP) Implementation Notification; General Updates; 340B Drug Pricing Program; Pharmacy Acquisition Cost Survey; April Preferred Drug List (PDL) Announcement; Drug Utilization Review Updates; Changes to Sleep Study and Pulmonary Testing Procedure Codes; Place of Service (POS) 19 and 22 for Hospital-Based Clinics; Policy Update Requiring a Prior Authorization Request (PAR) for Back Surgery and Other Select Surgical Codes; Unlisted Surgical Code Pricing and Billing Bilateral Procedures; Prior Authorization Required for Outpatient Speech Therapy; April and May 2019 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900428 - 03/19) - This bulletin contains information on Did You Know - Service Limits, Prior Authorizations and the EPSDT Benefit; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Requesting a Backdated Enrollment Effective Date; Reminder to Verify Member Eligibility Prior to Rendering Services; Peristeen® Expanding to Adults; Policy Clarification Requiring Provider IDs for FQHCs; CCT Reauthorization; Urinalysis Tests Information; General Updates; Dispense as Written (DAW) Override Code Reminder; Brand Name Medications in Generic Mandate-Exempt Classes on the Preferred Drug List (PDL); Drug Utilization Review Updates; Quarter 1 Rate Updates 2019; Policy Update Requiring a Prior Authorization Request (PAR) for Back Surgery and Other Select Surgical Codes; Policy Update Requiring Prior Authorization (PA) for Speech Therapy; Non-Emergent Medical Transportation (NEMT) Process Change; March and April 2019 Provider Billing Training Sessions

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900427 - 02/19) - This bulletin contains information on Did You Know - National Provider Identifier (NPIs) and Multiple Locations; Remittance Advices (RAs) and ERA X12 835 Reports Schedule Change; Remittance Advice (RA) Reports Must Be Obtained Through the Provider Web Portal; Remittance Advice (RA) Update to Help Providers Reconcile Payments; How to Bill for Short-Term Behavioral Health Services in the Primary Care Setting; Quarter 1 Rate Updates 2019 for Physician-Administered Drugs; Policy Clarification for Health First Colorado Benefit on Wipes; General Updates; End-Stage Renal Disease to be Considered an Emergency Medical Condition; Vivitrol® Injections and Pharmacist Immunizations; February & March 2019 Provider Billing Training Sessions

Health First Colorado (Colorado’s Medicaid Program) Special Bulletin – HCPCS Updates 2019 (B1900426 – 01/19) - This bulletin contains information on the Healthcare Common Procedure Coding System (HCPCS) Updates for 2019; Discontinued Codes; New Procedure Codes; and Procedure Codes with Description Changes

Health First Colorado (Colorado's Medicaid Program) News and Updates (B1900425 - 01/19) - This bulletin contains information on Did You Know - Suspended Claims and Timely Filing; Healthcare Common Procedure Coding System (HCPCS) Updates for 2019; New Fraud, Waste and Abuse Web Page; Provider Enrollment Change Regarding a Backdated Enrollment Effective Date; Colorado Choice Transitions (CCT) Program Ending; Federal Upper Payment Limit (UPL) Requirement; Targeted Rate Increase; Colorado Adult Protective Services (CAPS) Data System; Non-Medical Transportation Services Targeted Rate Increase Approved; General Updates; End-Stage Renal Disease to be Considered an Emergency Medical Condition; Update to Outpatient Speech Therapy Prior Authorization Requirement; New Immunization Codes Added for Shingrix and Heplisav; Hospital Back-Up (HBU) Reimbursement Methodology Update; Post-Eligibility Treatment of Income (PETI) Prior Authorization Request (PAR) Approver for Nursing Facilities; Preferred Drug List (PDL) Announcement; Drug Utilization Review Updates; Vivitrol Injections and Pharmacist Immunizations; January & February 2019 Provider Billing Training Sessions

2018: B1800409 - B1800424

Medicaid Program News and Updates (B1800424 - 12/18) - This bulletin contains information on Did You Know - Current Processing Times for Provider Enrollment; Delayed Notification of Member Eligibility; Healthy Communities Program; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Revenue Codes Under the Capitated Behavioral Health Benefit; Service, Mailing and Billing Addresses; Enrollment Required for CC and CCEC Providers; Peristeen Expanding to Adults; Cost-of-Living Adjustment (Increases); General Updates; Upcoming Policy Stakeholder Meeting Regarding Emergency Dialysis Policy and Hospital Readmission; New Billing Manual for IHS Providers; Preferred Drug List (PDL) Announcement; Drug Utilization Review (DUR) Updates; 340B Drug Pricing Program; 340B Policy and Procedures Manual; Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations; and December 2018 and January 2019 Provider Billing Training Sessions

Medicaid Program News and Updates (B1800423 - 11/18) - This bulletin contains information on Did You Know - Known Issues Web Page; Fingerprint – Federal Criminal Background Check (FCBC); Backdate Enrollment Form; Upcoming Improvements to Remittance Advice (RA) Financial Transactions Page; General Updates; Telligen Selected for Long-Term Care Utilization Management Contract; Outpatient PT/OT Policy Updates; Pharmacy & Therapeutics (P&T) Committee Open Positions; Drug Utilization Review Updates; 340B Drug Pricing Program; 340B Policy and Procedures Manual; Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations; Pricing for Unlisted Surgery CPT Codes; Upcoming Changes to Outpatient Speech Therapy Prior Authorizations Requirements; and November and December 2018 Provider Billing Training Sessions

Special Provider Bulletin – Synagis® & Seasonal Influenza Vaccines (B1800422 - 10/18) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine Benefit; Reimbursement of Synagis®; Prior Authorization Requests (PARs) Submission Methods; Prior Authorization Requests (PARs) Criteria and Guidelines; Billing Instructions; Synagis® and Home Health Agencies; Seasonal Influenza Vaccine is a Benefit for Children and Adults; Children/Adolescents and Adults; and Billing Information for Seasonal Influenza Vaccine

Medicaid Program News and Updates (B1800421 - 10/18) - This bulletin contains information on Quick Guides and Webinars Web Page; Load Letters; Member Contact Center Hours Changing; ColoradoPar Training with eQHealth Solutions Inc^®; Health First Colorado (Colorado's Medicaid Program) Recovery Audit Contractor (RAC) Begins Work; Provider Enrollment Type Changes; Reminder: Request for Reconsideration is Not Necessary for Denied Claims; Ear Mold Coverage Policy; HCBS Waiver Program Post Payment Review Contract; Final Notice: Vision Therapy Services for Children and Youth Enrolled in the Children’s Extensive Services (CES) Waiver Are Now Provided Under State Plan; Hospice Legislative Rate Increases Effective October 1, 2018; Hospital General Updates; 340B Drug Pricing Program; 340B Policy and Procedures Manual; Pharmacist Enrollment: Over-the-Counter (OTC) Drugs and Immunizations; Total Annual Prescription Volume (TAPV) Survey; Drug Utilization Review Updates; October Preferred Drug List (PDL) Announcement; Q4 Rate Updates; Multiple Surgery Billing Procedures; Billing Bilateral Procedures; and October and November 2018 Provider Billing Training Sessions.

Medicaid Program News and Updates (B1800420 - 09/18) - This bulletin contains information on Checking Member Usage for PT/OT Services on Provider Web Portal; NCCI Notification of Quarterly Updates; Billing Gender-Specific Procedures for Transgender Members; Upcoming Improvements to Remittance Advice (RA) Financial Transactions Page; New Medicare Cards; Prosthetics & Orthotics PAR Announcement; ACF Targeted Rate Increase Approved; Environmental Survey on Current Technology Usage of HCBS Providers; General Updates; Enrollment Now Open for CC and CCEC Providers; Circumcision PAR Requirements; 340B Drug Pricing Program; New 340B Policy and Procedures Manual; Rx Review Program Update; October Preferred Drug List (PDL) Announcement; Colorado MAPIR Accepting Health First Colorado-EPs and EHs Attestations; and September and October 2018 Provider Billing Training Sessions.

Medicaid Program News and Updates (B1800419 - 08/18) - This bulletin contains information on Member Contact Center Phone Number; Using a Previous Internal Control Number (ICN); Accountable Care Collaborative (ACC) Phase II—What Providers Need to Know; Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Services and Requests; Uniform Service Coding Standards Manual July 2018; Continuation of Benefits During a Member Appeal; Hospital - General Updates; Update to Imaging and Radiology Billing and Policy Manual; 340B Drug Pricing Program Provider Notice; Drug Utilization Review Announcements; Physician-Administered Drugs; Rendering Provider Number Requirement; and Physician-Administered Drug Acquisition Cost Surveys.

Medicaid Program News and Updates (B1800418 - 07/18) - This bulletin contains information on Change of Ownership; Accountable Care Collaborative (ACC) Phase II Launches July 1, 2018; eQSuite® User Administrators for Colorado PAR Portal; Fiscal Year 2018-2019 Provider Rate Increases and Adjustments; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Behavioral Health Provider Type Changes; Physician-Administered Drug (PAD) Acquisition Cost Surveys; Children with Autism (CWA) Waiver Has Ended; Hospital General Updates; Inpatient & Outpatient Colorado Healthcare Affordability & Sustainability (CHASE) Supplemental Health First Colorado Payment Percentage Adjustment Factors; Nursing Facility Fiscal Year 2018-2019 Rate Updates; July 2018 Physical and Occupational Therapy (PT/OT) and Speech Therapy Updates; Pharmacy Updates; Colorado Medical Assistance Provider Incentive Repository (MAPIR) Accepting Health First Colorado-Eligible Professionals (EPs) and Eligible Hospitals (EHs) Attestations

Medicaid Program News and Updates (B1800417 - 06/18) - This bulletin contains information on Do Not Submit Paper Claims for Dates of Service Over 365 days; Reminder: Reference the Special Provider Bulletin for Colorado interChange Common Questions; Timely Filing Period Extended to 365 Days – Effective June 1, 2018; Fiscal Year (FY) 2018-2019 Provider Rate Increases and Adjustments; Co-Pay Collection; Managed Care Organization (MCO) Laboratory Policy; Fingerprint Criminal Background Check; Children with Autism Waiver Ending June 30, 2018; Rate Updates; Hospital Meetings; Technical and Professional Component Modifiers on Outpatient Hospital Claims; Preferred Drug List (PDL) Announcement; Technical and Professional Component Modifiers on Professional Claims; Non-Emergent Medical Transportation (NEMT) Non-Covered Services; Supplemental Payment for University of Colorado School of Medicine

Anesthesia Provider Bulletin (B1800416 - 05/18) - This bulletin contains information on Anesthesia Payment Policy Changes.

Medicaid Program News and Updates (B1800415 - 05/18) - This bulletin contains information on Keep Your Provider Profile Information Up to Date; Fingerprint Criminal Background Check (FCBC); Accountable Care Collaborative (ACC) Phase II: Important Information about Provider Contracting; Prior Authorization Requests (PARs) Through eQHealth Solutions Guidance; Federal Upper Payment Limit (UPL) Requirement; Manual Pricing Billing Process Change – By Invoice; Reminder to Providers: Claims Must Match Documentation; General Updates; PAR Not Needed for Emergencies; Kyleena: New HCPCS Code and Other Long-Acting Reversible Contraceptive (LARC) Information; Preventive Services Billing; PAD - Drugs and Biologicals Discarded/Not Administered to Any Member (JW Modifier); Opioid Treatment Naïve Policy; Drug Utilization Review (DUR) Announcements

Special Provider Bulletin – Accountable Care Collaborative: Important Information for Primary Care & Behavioral Health Providers (B1800414 - 04/18) - This bulletin contains information on Provider Contracting; Resources Available on the ACC Phase II Web Page; Contacting Your RAE; Stay Informed

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 (B1800412 - 04/18) - This bulletin contains information on Did You Know? - "Lower of" Pricing Logic for Rate Increases; Fingerprint – Federal Criminal Background Check (FCBC); Reminder: Health First Colorado (Colorado’s Medicaid Program) Members Cannot Be Billed for Services; Accountable Care Collaborative (ACC): New Resources for Providers; Health First Colorado Recovery Audit Contractor (RAC) Begins Work; Updates to CMS 1500 Specialty Manual and Appendix T Billing Guidance; Federal Upper Payment Limit (UPL) Requirement; Manual Pricing; DMEPOS Billing Manual Update; Reminder to Providers: Claims Must Match Documentation; State Requirements to Receive the Medicare Low Volume Payment (LVP) Adjustment in Hospital’s Medicare Base Rate; Monthly Enhanced Ambulatory Patient Groups (EAPG) Meetings; Mass Adjustment of Xerox EAPG Claims Update; Specialty Hospital Meetings; Hospital Engagements Meetings; Rule Changes for In-Home Support Services (IHSS); April Preferred Drug List (PDL) Announcement; Upcoming Changes for Sedative Hypnotic Medications; Requiring Indications for Growth Hormone Agents; Drug Utilization Review (DUR) Announcements; Date of Service (DOS) Reminder; Pharmacy Cost of Dispensing Survey; Pricing for Unlisted Surgical Procedure Codes; Physician-Administered Drug Rates; Diabetes Self-Management Education (DSME) Coverage; Speech Therapy Coverage Determination Notice; Hospital Discharge Process

Medicaid Program News and Updates (B1800411 - 03/18) - This bulletin contains information on Sign Up for Provider Email Communications; Fingerprint – Federal Criminal Background Check; Healthcare Common Procedure Coding System (HCPCS) Updates for 2018; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Pediatric Behavioral Therapies (PBT) Fiscal Year (FY) 2017-2018 Rate Updates; Revised Psychological/Neuropsychological Billing Policy; Brand/Generic Changes; April Preferred Drug List (PDL) Announcement; Federal Upper Payment Limit (UPL) Requirement; Manual Pricing; Reminder to Providers: Claims Must Match Documentation; Addressing Reimbursable Claims that Pay Zero; General Updates; March 2018 PT/OT/ST Billing Manual Update; Pharmacy Updates; New Circumcision Rates Effective March 1, 2018; Hospital Discharge Transportation Billing Update; Updated Billing Manuals; Supplemental Payment for University of Colorado School of Medicine

Medicaid Program News and Updates (B1800410 - 02/18) - This bulletin contains information on Did You Know? - Verifying member eligibility; Child Health Plan Plus (CHP+) Update; Fingerprint Criminal Background Checks; 2018 Health Care Procedural Coding System (HCPCS) Codes Annual Update; Effective March 1, 2018 - Checks for Refund Payment Must Be Made Out to “Colorado Department of Health Care Policy and Financing”; CMS 1500 and UB-04 Paper Claim Form Reminder; Spinal Cord Injury Pilot Waiver Annual Report Published; Community Mental Health Supports (CMHS)
Fiscal Year (FY) 2017-18 Rates Updates Approved; Long-Term Home Health (LTHH) Services Prior Authorization Requests (PARs); Hospital General Updates; Emergency Supply While Waiting for Prior Authorization (PA) Determination; Drug Utilization Review (DUR) Updates; Provider Type Restrictions; New Provider Types; Drug Recall and Safety Alert: Clopidogrel 75 mg tablets; Pharmacy Cost of Dispensing Survey; Date of Service Reminders; Unenrolled Prescribers: NEW Prescriptions Written by Prescribers Not Enrolled with Health First Colorado Began Denying on January 1, 2018.

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.

2017: B1700391 - B1700408

Special Provider Bulletin – Co-payment Policy Updates (B1700408 - 12/17) - This bulletin contains information on Co-payment Policy Updates; Co-payment Increase for Health First Colorado Members Effective January 1, 2018; Co-payment Limit for Health First Colorado Members; and Resources on the Department’s interChange Resource Web Page.

Medicaid Program News and Updates (B1700407 - 12/17) - This bulletin contains information on Did You Know? - How to Read Claims: Information on the ICN (Claim Number); Timely Filing Frequently Asked Questions (FAQs); Important Information for Child Health Plan Plus (CHP+) Providers; ColoradoPAR Updates; Co-Pay Limit for Health First Colorado Members; Colorado Health IT Roadmap Approved, OeHI Seeks Public Comment on Key Roadmap Initiative; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; CMS 1500 and UB-04 Paper Claim Form Reminder; Co-Pay Policy Update; Specialty Code Update – Community Transition Services (CCT); General Updates; Community Clinics with Emergency Centers; Important NF/SNF/ICF Provider Updates; Update to Billing Manual; Drug Utilization Review (DUR) Updates; Pharmacy Provider Updates; No Cost Sharing for Tobacco Cessation Medications; Colorado Medical Assistance Provider Incentive Repository (MAPIR) Accepting Medicaid Eligible Professionals (EPs) and Eligible Hospitals (EHs) Attestations; Supplemental Payment for University of Colorado School of Medicine; and Billing Guidance for Medically Necessary Eyeglass Frames for Members Under 21 Years Old

Medicaid Program News and Updates (B1700406 - 11/17) - This bulletin contains information on Did You Know? - Reconsiderations not Required on Claim Denials; ColoradoPAR Provider Educational Resources; Co-Pay Limit for Health First Colorado Members; Child Health Plan Plus Update; Claim Submission Method for Claims with Attachments; Videos Now Available for Download; Coding Update: Miscellaneous Disposable Supplies – T5999; Reminder: Face-to-Face (F2F) Requirement; General Updates; Delay in Immediate Post-Partum Long-Acting Reversible Contraception (IPP-LARC) “Carve-Out” from APR-DRG Payment Methodology; Billing for Global Obstetrical (OB) Care; Legal Abortion Claim Documentation Requirements and Use of the Department’s Form(s) (Abortion Certification Statement) Required; Sterilization Consent Forms and Partial or Unilateral Reproductive Tissue Surgical Procedure Claim Requirements; Exceeding 48 Units; Bowel Preparation Agents: Monthly Quantity Limit; Total Annual Prescription Volume (TAPV) Survey; Drug Utilization Review (DUR) Updates

Special Provider Bulletin – Synagis® & Seasonal Influenza Vaccines (B1700405 - 10/17) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine Benefit; Seasonal Influenza Vaccine; Colorado Pharmacy Medicaid Synagis® Information Sheet; Colorado Medicaid Synagis® Pharmacy Benefit PA Form.

Medicaid Program News and Updates (B1700404 - 10/17) - This bulletin contains information on Did You Know? - The Provider Web Portal is down for regularly scheduled maintenance every Wednesday night; Temporary Filing Extension Update; Colorado PAR Information; Child Health Plan Plus Update; Revised Behavioral Health Laboratory Policy; Drug Utilization Review (DUR) Announcements; Coding Update: Miscellaneous Disposable Supplies – T5999; Secretary of State (SOS): DME Supplier License; Rate Increases; Inpatient Base Rate & Outpatient Hospital Supplemental Medicaid Payment Interim Percentage Adjustment Factors for Federal Fiscal Year (FFY) 2017-18; Hospital Updates; Hospital Discharge Transportation; Inter-Facility Transportation; Outpatient Therapy Coding; Outpatient Therapy Manuals Updated; Long Term Care (LTC) Pharmacy Partial Fills for CII Prescriptions; Drug Classes and Preferred Agents; Total Annual Prescription Volume (TAPV) Survey; Colorado Medical Assistance Provider Incentive Repository (MAPIR) Accepting Medicaid Eligible Professionals (EPs) and Eligible Hospitals (EHs) Attestations; Temporary Change in Transportation Claiming for Fiscal Year (FY) 2016-17 Cost Report; New Vision and Eyewear Rule Implemented Effective September 30, 2017.

Medicaid Program News and Updates (B1700403 - 09/17) - This bulletin contains information on Did You Know? - Claim Denials for (EOB) 2580 Appear for a Medical or Mental Health Service; NPI Numbers; Claim Submission Method for Claims with Attachments; Load Letter Information Update; NCCI Notification of Quarterly Updates; ColoradoPAR (eQHealth) Information and Updates; Urinalysis Tests Information Update; Hospital Updates; Circumcision Coverage; Behavioral Health Lab Policy; Important NF/SNF/ICF Provider Updates; Increase in Reimbursable Maternal Depression Screenings; Outpatient Therapy Coding; Coding Changes; DUR Announcements; Pharmacy Provider PAR Approval and Denial Letters; Pharmacy Member PAR Approval Letters; TAPV Survey; SBIRT Approved Screening Tools; Supplemental Payment for University of Colorado School of Medicine.

2017 Hospital Provider Special Bulletin (B1700402 - 08/17) - This bulletin contains information on the Stakeholder Meeting for CMS-Certified Community Clinics and Community Clinics with Emergency Centers.

Medicaid Program News and Updates (B1700401 - 08/17) - This bulletin contains information on Did You Know? - Claims Paid with Paid Date of 0; Accountable Care Collaborative (ACC): Access KP Program Ends, Members Enrolled in Colorado Access; ColoradoPAR Information; Supply, Pharmacy with Durable Medical Equipment (DME); Hospital Transportation Policy Information; Inpatient & Outpatient Hospital Supplemental Medicaid Payment Percentage Adjustment Factors; Newly Issued FY 2017-18 Outpatient Enhanced Ambulatory Patient Grouping (EAPG) Base Rates, New System Mass-Adjustment Coordination and Hospital Engagement Meetings; Opioid Policy Updates; Physician-Administered Drugs; Drug Utilization Review (DUR) Board Meeting; Update on Vision Claims Denied Incorrectly for Prior Authorization Requirements.

Medicaid Program News and Updates (B1700400 - 07/17) - This bulletin contains information on Did You Know? - EOB Code 3110 on Claim Affiliation Edit Only Informational; New Provider Rates, Legislative Increases and General Information; SB 16-120 Member Explanation of Benefits (EOB) Implementation Delay; DMEPOS Billing Updates; Medicare Billing Enforced; Re-Issued FY2017-18 Inpatient Base Rates, New System Mass-Adjustment Coordination and Hospital Engagement Meetings; Important Information for 340B Providers; Partial Fills for Long Term Care (LTC) Members, DAW 9 and DAW 8, Magellan Contacts, Brand - Generic Changes; Evaluation Codes; Use of Evaluation and Management Procedure Codes for Integrated Services; Physician-Administered Drugs Require both National Drug Code (NDC) Number and HCPCS Code; Changes in End of Life Counseling Benefit, Including Medical Orders for Scope of Treatment (MOST); Clinical Laboratory Improvement Amendments (CLIA) Billing; New Code for Kyleena: A New Long-Acting Reversible Intrauterine Contraceptive (LARC); Immediate Post-Partum Long-Acting Reversible Contraception (IPP-LARC) “Carve-out” from All Patient Refined-Diagnosis Related Group (APR-DRG) Payment Methodology; and New HCPCS Codes for 17-Alpha-Hydroxyprogesterone Caproate (17P) Injections.

Medicaid Program News and Updates (B1700399 - 06/17) - This bulletin contains information on Did You Know? - Provider Guide for Reading Remittance Advice; Visit the Known Issues Web Page; Monitoring Prior Authorization Request (PAR) Submissions through eQSuite; Accountable Care Collaborative (ACC) Request for Proposals (RFP) Now Available; Paper Claim Form Requirement Change; Fingerprint – Federal Criminal Background Check; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Face-to-Face Encounter Requirements for Home Health Services Initiated on or after July 1, 2017; Inpatient Hospital Base Rates FY2017-18, New System Mass-Adjustment Coordination and Hospital Engagement Meetings; Important Information for 340B Providers; Brand and Generic Changes; Drug Classes and Preferred Agents.

Medicaid Program News and Updates (B1700398 - 05/17) - This bulletin contains information on Did You Know? - Suspended Claims Only Show Once on RA; Name Change for HPE; Extended Provider Service Call Center Hours; Temporary Timely Filing Extension; News and Updates for Known Issues; Fingerprint - Federal Criminal Background Check; Claims Denied or Suspended Due to Multiple Rendering Enrollment Profiles; Remittance Advices (RAs) and 835s; Updates Impacting Secondary Claims; Load Letters; CMS 1500 Paper Claim Form Requirement Change; Fall Screening & Risk Reduction Webinars; Hospital Engagement Meetings 2017; Drug Utilization Review (DUR) Board; and Over-the-Counter (OTC) Products

Medicaid Program News and Updates (B1700397 - 04/17) - This bulletin contains information on Did You Know? - Transition Special Bulletin; CMS 1500 Paper Claim Form Requirement Change; Timely Filing Reminder and Changes to Late Bill Override Dates (LBOD) in Colorado iC; Provider Web Portal Enrollment, Resources, and FAQs; eQHealth Prior Authorization Request (PAR) Revisions; Changes for Pharmacy Claims and Prior Authorization Processing; Important Information for 340B Providers; and April Preferred Drug List (PDL) Announcement.

Go-Live Transition Special Bulletin (B1700396 - 03/17) - This bulletin contains information on Hewlett Packard Enterprise (HPE) is now Live with the New interChange System; CMS 1500 Paper Claim Form Requirement Change; What Does 'Suspended' Mean?; Are you Getting One of the Following Claim Messages?; Obtaining or Correcting an NPI on the Provider Web Portal; Home Health and Nursing Facility Billing Changes; Enrollment; Payment Reminders; and Provider References.

Medicaid Program News and Updates (B1700394 - 03/17) - This bulletin contains information on Did You Know? - Reminder to Retrieve Reports Prior to 3/11/17; Health First Colorado Now Live with the New interChange and Provider Web Portal; Resources for Health First Colorado and Child Health Plan Plus Providers; Fingerprint – Federal Criminal Background Check; Accountable Care Collaborative Phase II Update – Draft Request Comments; Influenza Immunization Code Changes for 2017; National Correct Coding Initiative Notification of Quarterly Updates; Children with Autism Modifier Code Change; Durable Medical Equipment, Prosthetics, Orthotics and Supplies; Information for 340B Providers; Vision Billing Manual and Fee Schedule Changes; Additional Hospital Billing Changes; Hospital Engagement Meetings 2017; Resubmitting Denied Claims Containing ICD-10 New Diagnosis Codes; Outpatient Hospital Crossover Medicare and Medicaid Claims; and Pharmacy Prior Authorization Request Notification.

2017 Hospital Provider Special Bulletin (B1700395 - 02/17) - The bulletin contains important information on acceptable hospital billing practices.

Medicaid Program News and Updates (B1700392 - 02/17) - This bulletin contains information on the Did You Know? - HCPCS Special Bulletin; Deadline for Electronic Medical Claims Submissions; Timely Filing Reminder and Changes to Late Bill Override Dates (LBOD) in the New System; Are You Ready for March 1, 2017; Co-Payment Policy Changes Effective March 1, 2017; Updates to 2016-17 ICD-10 New Diagnosis Codes and Upcoming Hospital Engagement Meetings; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Updates; Colorado PAR Documentation; Person- and Family-Centered Approach to Creating a Culture of Collaboration with Clients; Telemedicine Stakeholder Meeting; Community Clinic with Emergency Center Enrollment; Tax Season and 1099s; Keeping Your Information Up to Date; February 2016 Holidays; 2016-17 Inpatient Hospital Rates Updates; Important Actions for Nursing Facility Providers; Epinephrine Dosing and Drug Utilization Review Board (DUR) Meeting; and Pharmacy Dispensing Fees for Calendar Year 2017.

2017 Practitioner HCPCS Special Bulletin (B1700393 - 01/17) - This bulletin contains information on 2017 Practitioner HCPCS, including Updates for 2017; Discontinued Codes; Code Description Changes; and New Procedure Codes.

Medicaid Program News and Updates (B1700391 - 01/17) - This bulletin contains information on Did You Know? - Provider Revalidation Deadline; Frequently Asked Questions About Medicaid Expansion; 2017 HCPCS Annual Updates; Clarification of Breast Cancer Susceptibility Gene (BRCA) Testing for Men; Timely Filing Reminder and Changes to Late Bill Override Dates in the New System; Accountable Care Collaborative Phase II Update – Draft Request for Proposals (RFP); Tax Season and 1099s; Keeping Provider Info Up to Date; January and February 2016 Holidays; Billing and Program Updates from DentaQuest; HCPCS Updates for 2017 – Current Dental Terminology (CDT) Changes; Changes to Orthodontia Process: Effective January 1, 2017; Interim Therapeutic Restorations (ITR) Added to Registered Dental Hygienist (RDH) Scope of Practice: Effective January 1, 2017; Discontinuation of Home Health Type of Bill 33X: Effective March 1, 2017; and the Xerox Transition to Conduent.

2016: B1600377 - B1600390

Medicaid Program News and Updates (B1600390 - 12/16) - This bulletin contains information on the Revised Go Live Date for the New Colorado interChange, Provider Web Portal, and Pharmacy Benefits Management System; New Call Center for Revalidation and Enrollment Assistance; Reminder About New Ordering, Prescribing, or Referring (OPR) Provider Regulations; Revalidation/Enrollment Application Fee – Increase Effective January 1, 2017; Accountable Care Collaborative (ACC) Phase II Update; National Provider Identifier (NPI) Number Needed for Rendering and Referring Providers on Professional Claims; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS); Recovery Audit Contractor (RAC); National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Tax Season and 1099s; Please Keep Your Information Up-to-Date; Holiday Schedule 2016-17; Rx Review Program – Update; January Preferred Drug List (PDL) Announcement; Pharmacy and Therapeutics Committee Meeting; and New Plan Information.

Medicaid Program News and Updates (B1600389 - 11/16) - This bulletin contains information on the Revised Go Live Date for the New Colorado interChange, Provider Web Portal, and Pharmacy Benefits Management System; New Call Center for Revalidation and Enrollment Assistance; Reminder About New Ordering, Prescribing, and Referring (OPR) Regulations; ACC Phase II Update: Request for Proposals and Stakeholder Engagement Opportunities; Telemedicine Policy Updates; eQHealth New Provider Reference Guides; Tax Season and 1099s; Attention Providers: Please Keep Information Up to Date; November 2016 Holidays; Behavioral Health Services at a Federally Qualified Healthcare Centers (FQHC); Notice of Skilled Nursing Facility (SNF) Change of Ownership – Cottonwood Care Center; Impact of interChange Launch Postponement on Enhanced Ambulatory Patient Grouping System (EAPGS) Implementation for Outpatient Hospital Services; and Immunization Rate Schedule – Effective July 1, 2016.

Synagis and Seasonal Influenza Vaccines Special Bulletin (B1600388 - 10/16) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine; Reimbursement and Prior Authorization (PAR) of Synagis®; Pharmacy PAR Requests; Medical PAR Requests; Synagis® and Home Health Agencies; Seasonal Influenza Vaccine is a Benefit for Children and Adults; Children/Adolescents and Adults; and Billing Information as of October 1, 2016.

Medicaid Program News and Updates (B1600387 - 10/16) - This bulletin contains information on the Health First Colorado Provider Enrollment and Revalidation; ColoradoPAR; Colorado’s New Medicare-Medicaid Advocate; Accepting Applications for the Member Experience In-Person and Virtual Advisory Council; PainNet Access; Recovery Audit Contractor (RAC); Columbus Day Holiday; Discontinuation of Home Health Type of Bill 33X: Effective October 1, 2016; Notice of SNF Change of Ownership – Autumn Heights Health Care Center; Notice of SNF Change of Ownership – Mesa Vista of Boulder; and Inpatient Base Rate & Outpatient Hospital Supplemental Medicaid Payment.

10/12/2016 - Correction: A previous version of the bulletin misstated the date of discontinuation for Home Health Type of Bill 33X. The discontinuation date is October 31, 2016.

Medicaid Program News and Updates (Special Revalidation and Enrollment Guide - 09/16) - This bulletin contains information on Provider Revalidation and Enrollment; Upcoming Deadlines to Submit Claims and PARs; Delays in Payment; Trading Partners in interChange for Batch Claim Submitters; Training on the New Systems; and the Provider Resources Web Page.

Medicaid Program News and Updates (B1600386 - 09/16) - This bulletin contains information on the Accountable Care Collaborative Phase II Update: Request for Proposals and Federal Waiver Authority; Colorado’s New Medicare-Medicaid Advocate; Big Changes to the Provider Portal & Pharmacy Benefits Management System (PBMS); Facilitated Provider Testing of the New Provider Web Portal; Cross-Agency Effort to Improve Member Eligibility Correspondence; ColoradoPAR Program Updates; Coding Changes to the Health First Colorado Fee-for-Service Primary Care Depression Screening Benefit Reminder; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Obtaining or Replacing Health First Colorado (Colorado’s Medicaid Program) Cards; Record Retention; September 2016 Holiday; Unit Limit and Prior Authorization Review; Billing Manual Updates; Liletta Intrauterine Device – Product Change Notification for NDC; Inpatient Rates and All Patient Refined Diagnosis Related Group (APR-DRG) Recalibration Update; Attention Imaging and Radiology Providers; Preferred Drug List (PDL) Update; Hepatitis C Medication Prior Authorization Process; Pharmacy and Therapeutics Committee Meeting; and the Transition of Pharmacy Benefit Management Services to Magellan Rx Management.

Medicaid Program News and Updates (B1600385 - 08/16) - This bulletin contains information on Health First Colorado Provider Revalidation Updates; Provider Enrollment Process; New Videos for Health First Colorado (Colorado’s Medicaid Program) Members; Practitioner Claims Submitted Via Web Portal; Big Changes to the Provider Portal, MMIS, and PBMS; ColoradoPAR Program Updates; ACC: Access KP Payment Reform Initiative; New Recovery Audit Contractor; Update Provider Contact Information Maintained in the Medicaid Management Information System (MMIS); Hospice Room and Board Rates Update; Updates to Outpatient Cost-to-Charge Ratios and Enhanced Ambulatory Patient Grouping System (EAPGS) Implementation; Inpatient Claims for Members Fewer Than 29 Days Old; Attention Imaging and Radiology Providers; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Unit Limit and Prior Authorization Review; Total Transit Has a New Name; and August 2016 Provider Workshops.

Medicaid Program News and Updates (B1600384 - 07/16) - This bulletin contains information on Colorado Medicaid Now Called Health First Colorado; New Recovery Audit Contractor; Big Changes to the Provider Portal, Medicaid Management Information System, and Pharmacy Benefits Management System; Health First Colorado Provider Revalidation Important Update; Regulatory Efficiency Review; Electronic Funds Transfer (EFT) Setup for New Provider Enrollments; Provider Address Reminder; ColoradoPAR Program Updates; Rate Changes for Evaluation and Management (E&M) and Vaccine Administration Services; Health First Colorado Nurse Advice Line; 2016 Payment Error Rate Measurement (PERM) Audit; July 2016 Holiday; Inpatient Base Rate & Outpatient Hospital Supplemental Medicaid Payment; New Web Hub for Immunization Information; Maternity Services – Revision of Billing for Delivery of Multiple Gestations; Attention Outpatient Radiology and Imaging Providers; New Vendor for Setting Average Acquisition Costs (AAC) Rates; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Unit Limit and Prior Authorization Review; Billing Manual Updates; Preferred Drug List (PDL) Update; Pharmacy and Therapeutics Committee Meeting; Drug Utilization Review (DUR) Board Update; Attention Outpatient Physical and Occupational Therapists; and Provider Workshops.

Medicaid Program News and Updates (B1600383 - 06/16) - This bulletin contains information on Big Changes to the Provider Portal, Medicaid Management Information System (MMIS), and Pharmacy Benefit Management System (PBMS); Long Bill Has Been Signed: Outlines Funding for Fiscal Year 2017; Medicaid Provider Revalidation Update; Electronic Fund Transfer (EFT) Setup for New Provider Enrollments; ACC: Access KP Payment Reform Initiative; 2016 Payment Error Rate Measurement (PERM) Audit; ColoradoPAR Program Updates; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Free Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Medicaid Providers; Accredited Diabetes Self-Management Education (DSME) Providers and Program Staff: We Want to Hear from You!; July 2016 Holiday; Billing and Program Updates from DentaQuest; “Take 5” Pay for Performance Program Update; All Patient Refined Diagnosis Related Group (APR-DRG) Version Update; Attention Outpatient Physical and Occupational Therapists; Preferred Drug List (PDL) Update; Pharmacy and Therapeutics Committee Meeting; Drug Utilization Review (DUR) Board Update; Inhaled Corticosteroid Combinations; New Vendor for Setting Average Acquisition Cost (AAC) Rates; Rx Review Program Upcoming Cycle; Attention speech-Language Pathology Providers; Home and Community Based Services (HCBS) Providers Post-Payment Review Audit Announcement; and June and July Provider Workshops.

Medicaid Program News and Updates (B1600382 - 05/16) - This bulletin contains information on the Medicaid Provider Revalidation Update; Provider Address Reminder; ACC Phase II Update: New Stakeholder Resources; Access Monitoring Review Plan (AMRP); What is Payment Error Rate Measurement?; Rendering, Referring, and Prescribing Providers NPI Numbers; ColoradoPAR Program Updates; Free Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Medicaid Providers; Discontinued Codes; May 2016 Holiday; Ambulatory Surgery Center Rates Update; Behavioral Therapy Updates; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Billing Manual Updates; Reminder to Providers: PARs for Additional Units; Attention Speech-Language Pathology Providers; Total Transit Has revised Non-Emergency Medical Transportation (NEMT) Forms; and May and June 2016 Provider Workshops.

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 (B1600380 - 03/16) - This bulletin contains information on ACC Phase II Updates: Procurement Timeline & Behavioral Health Services Reimbursement; New Look Medicaid Cards Coming in March; Discontinued Codes; Tax Season and 1099s; New Medicaid Members are Looking for Providers: Please Update Provider Contact Information Maintained in MMIS; DentaQuest Office Reference Manual (ORM) Update; Billing and Program Update from DentaQuest; Cost Report forms and Instructions for Freestanding FQHCs; Federally Qualified Health Center Managed Care Accuracy Audit Report Forms and Instructions; Imaging Services at Federally Qualified Health Centers; Preferred Drug List (PDL) Update; Morphine Equivalent Limitations Update; Rural Health Center (RHC) Encounter Rate “Carve-Out” – Long-Acting Reversible Contraceptive (LARC) Device Provision; Attention Outpatient Speech Therapists; Speech Therapy National Correct Coding Initiative Webinar; Community Transition Services (CTS) Rate Increase; Home and Community Based Services (HCBS) Waiver Providers; and March and April 2016 Provider Workshops.

03/08/2016 - Correction: The original bulletin listed two incorrect fee-for-service rates for HCPCS codes J7300 and J7301. The updated bulletin now reflects the correct rates.

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.

2016 Practitioner HCPCS Special Bulletin (B1600378 - 01/16) - This bulletin contains information on 2016 Practitioner HCPCS, including Updates for 2016; Discontinued Codes; Code Description Changes; and New Procedure Codes.

Medicaid Program News and Updates (B1600377 - 01/16) - This bulletin contains information on the Federal Tax Document IRS Form 1095-B Coming in January; Physician Office Data Collection Study; Fiscal Year 2015 Fee-for-Service Depression Screening Summary; 2016 Health Care Procedural Coding System Codes Annual Update; ColoradoPAR; ACC Phase II January 2016; New Desk Aid for Eligibility Notice of Action; Continuous Eligibility FAQ Now Available; Coming in January: Enhancements to PEAKHealth Mobile App; Tax Season and 1099s; January and February 2016 Holidays; Long Acting Reversible Intrauterine Contraceptive Methods: Newly Assigned Healthcare Common Procedure Coding System Codes; Reimbursement for Group Services at FQHCs; New and Updated Immunization Current Procedural Terminology Codes; Medicaid Hospice Reimbursement Effective January 1, 2016; All Patient Refined-Diagnosis Related Group and Immediate Post-Partum Long-Acting Reversible Contraception Update; Durable Medical Equipment, Prosthetics, Orthotics and Supplies; Morphine Equivalent Limitations Update; January Preferred Drug List Announcement; Omega-3-Acid Ethyl Esters for Cardiovascular Protection; Hepatitis C Medication Prior Authorization Process; Prior Authorization Reminder; Psychiatric Consultation for Children; Outpatient Speech Therapists; and Community Transition Services Rate Increase.

02/10/2016 - Correction: The original bulletin listed an incorrect Code Description and Rate in the "Community Transition Services (CTS) Rate Increase" article. The updated bulletin now reflects the correct code and rate.

2015: B1500362 - B1500376

Medicaid Program News and Updates (B1500376 - 12/15) - This bulletin contains information on the Accountable Care Collaborative Phase II – Upcoming Feedback Opportunities & Concept Paper; Colorado Medicaid 2015 Diabetes Self-Management Education (DSME); 2016 Health Care Procedural Coding System (HCPCS) Codes Annual Update; Medicaid Billing Provider ID on CMS 1500 Paper Claim Forms; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Tax Season and 1099s; Christmas Day Holiday; New Year’s Day Holiday; Martin Luther King, Jr. Day Holiday; “Take 5” Pay for Performance Program – Update; Qualified Medical Personnel – Billing Procedures Guidance; Family Planning Services Legislative Rate Increases Effective September 26, 2015; Inpatient and Outpatient Rate Increase Update; Effective January 1, 2016, All Hospital Cost-to-Charge Ratios will be Updated; Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Billing Manual Update; New Healthcare Common Procedure Coding System (HCPCS) for 2016; Morphine Equivalent Limitations Update; Rx Review Program – Update; Pharmacy and Therapeutics Committee; January Preferred Drug List (PDL) Announcement; Prior Authorization (PA) Reminder; Psychiatric Consultation for Children; Home and Community Based Services (HCBS) Home Modification Billing and Stakeholder Meeting Update; December Home Modification Stakeholder Workgroup; Colorado Choice Transitions (CCT); Targeted Case Management Legislative Rate Increases Effective September 1, 2015; and December and January 2015-16 Provider Workshops.

ColoradoPAR Program Special Bulletin (B1500377 - 11/15) - This bulletin contains information on the ColoradoPAR Program; Military Providers; eQSuite® Changing to Allow Ordering or Referring Provider Offices to Submit PARs on Behalf of the Provider Performing the Service; Retroactive PAR Policy Extension; Change of Provider; Suspended PARs; PAR Revisions; System Administrator Refresher; Accessing the User Administration Module; Upcoming eQSuite® Trainings; and Durable Medical Equipment Code Selection Updates.

Medicaid Program News and Updates (B1500375 - 11/15) - This bulletin contains information on the Top 5 Reasons Your Revalidation/Enrollment Application will be Sent Back for Correction; Department Releases ACC Phase II Concept Paper; Tax Season and 1099s; Reminder: Medicaid Billing Provider ID on CMS 1500 Paper Claim Forms; Veterans Day; Thanksgiving Day; “Take 5” Pay for Performance Programs – Update; Billing Guidance Reminder for Registered Dental Hygienists; Manually Priced Paper Claims; Billing Manual Updates; Questionnaires; Pharmacy Billing Numbers; Physical Therapy and Occupational Therapy Billing; Prior Authorization Update to Proton Treatment Delivery Current Procedural Terminology Codes; Rx Review Program – Update; Morphine Equivalent Limitations – Update; Drug Utilization Review Board Meeting; Psychiatric Consultation for Children; Pharmacy and Therapeutics Committee Open Positions; and November and December Provider Workshops.

Synagis and Seasonal Influenza Vaccines Special Bulletin (B1500374 - 10/15) - This bulletin contains information on the Synagis® (Palivizumab) Vaccine; Reimbursement and Prior Authorization (PAR) of Synagis®; Pharmacy PAR Requests; Medical PAR Requests; Synagis® and Home Health Agencies; Seasonal Influenza Vaccines; Seasonal Influenza is a Benefit for Children and Adults; Billing Information as of October 1, 2015; The Colorado Pharmacy Medicaid Synagis® Information Sheet; and The Colorado Medicaid Synagis® Pharmacy Benefit* Prior Authorization Request Form.

Medicaid Program News and Updates (B1500373 - 10/15) - This bulletin contains information on the International Classification of Diseases, 10th Revision (ICD-10) going Live; ColoradoPAR New Vendor Information; Medicaid Billing Provider ID on CMS 1500 Paper Claim Forms; Medicaid Provider Rate Increase Updates; Medicaid Cessation Resource Group; Columbus Day Holiday; “Take 5” Pay for Performance Program – Update; Billing for Assistant Surgeon Services; Morphine Equivalent Limitations Update; Psychiatric Consultation for Children; Total Annual Prescription Volume Survey; Non-Emergent and Emergent Medical Transportation (NEMT, EMT) ICD-10 Change; and Home and Community Based Service Providers ICD-10 Change.

Pediatric Personal Care Benefit Special Bulletin (B1500372 - 09/15) - This bulletin contains information on the New Pediatric Personal Care Benefit; Eligible Members; Eligible Providers and Provider Requirements; Personal Care and Skilled Care Under the Home Health Benefit; Personal Care and Home and Community Based Services (HCBS) Waivers; Programs Excluded for the Personal Care Benefit; Enrolling Members into Pediatric Personal Care Benefit Services; The Personal Care Assessment Tool (PCAT); The 485 Home Health Certification and Plan of Care; Prior Authorization Request (PAR) Instructions; Billing and Reimbursement; Agency Coordination; Training Schedule and Information; and Claim Submission.

10/01/2015 - Correction: Member eligibility requirements have been clarified.

Medicaid Program News and Updates (B1500371 - 09/15) - This bulletin contains information on the ColoradoPAR New Vendor; Colorado Medicaid and CHP+ Provider Revalidation and Enrollment beginning September 15, 2015; Medicaid Billing Provider ID on CMS 1500 Paper Claim Forms; International Classification of Diseases, 10th Revision (ICD-10) Update; Medicaid Provider Rate Increase Update; Obtaining or Replacing Medicaid ID Cards; Building Better Health Conference; Record Retention; Labor Day Holiday; “Take 5” Pay for Performance Program – New Details; DME Billing Manual Updates; Questionnaire #10 – Oral and Enteral Nutrition Formula; Newborn Hearing Screening: Provision and Reimbursements; Morphine Equivalent Limitations Update; Preferred Drug List (PDL) Update; and September and October 2015 Provider Workshops.

ColoradoPAR New Vendor Special Bulletin (B1500370 - 08/15) - This bulletin contains information on the ColoradoPAR New Vendor Notification; Future ColoradoPAR Provider Portal eQSuite®; eQSuite® Webinars; Important Prior Authorization Request Dates; and ColoradoPAR Program Vendor Transition Frequently Asked Questions.

Medicaid Program News and Updates (B1500369 - 08/15) - This bulletin contains information on the Medicaid Provider Relations Team Expanding; Targeted Rate Increases; ColoradoPAR Vendor Notification; Current ColoradoPAR Provider Portal: CareWebQI; Future ColoradoPAR Provider Portal: eQSuite®; eQSuite® Webinars; Colorado Medicaid and CHP+ Provider Revalidation & Enrollment Begins September 15, 2015; New Medicaid Members are Looking for Providers: Please Update Provider Contact Information Maintained in the MMIS; Labor Day Holiday; Dental Program – Benefits and Administrative Updates; Dental Program – Rate Increase; “Take 5” Pay for Performance Program – Details Coming Soon!; Free Standing Birth Center Provider Enrollment; Inpatient Base Rate & Outpatient Hospital Supplemental Medicaid Payment; Maternity Services – Billing for Delivery of Multiple Infants; Public Comment Meeting on Rule 8.800; Pharmacy Cost of Dispensing Survey; Durable Medical Equipment (DME) Form Update; Reminder: Tobacco Cessation; Morphine Equivalent Limitations; Nasal Atomizer Kits for Naloxone and Midazolam; Drug Utilization Review (DUR) Board Meeting; Pharmacy and Therapeutics Committee Open Positions; and the August and September 2015 Provider Workshop Schedule.

Medicaid Program News and Updates (B1500368 - 07/15) - This bulletin contains information on Medicaid Provider Rate Increase Updates; International Statistical Classification of Diseases and Related Health Problems (ICD-10) Updates; Parking Placards for Persons with a Disability; Colorado Medicaid Name Change; Provider Conflict of Interest: Interpreter Services; Vaccine Administration Rate Increase Updates; Non-Invasive Prenatal Testing for Fetal Aneuploidy; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Diabetes Self-Management Education (DSME) Coverage; ColoradoPAR New Vendor Notification; Colorado Medicaid and CHP+ Provider Revalidation and Enrollment Begins September 15, 2015; 2015-2016 Provider Revalidation and Enrollment Wave Schedule; New Medicaid ID Cards Coming; Independence Day Holiday; Newborn Hearing Screening Reimbursement Policy; Dental Program – Benefits and Administrative Updates; “Take5” Pay for Performance Program – Details Coming Soon; Dental Program – Rate Increases Coming July 1, 2015; Durable Medical Equipment Policy Changes and Updates; Family Planning – Medical Record Documentation for Intent of Service; Liletta – New Long-Acting Reversible Intrauterine Contraceptive Method; All Patient Refined Diagnosis Related Group (APR-DRG) Version Update; Preventative Lung Cancer Screening is a Covered Benefit; Current Procedural Terminology (CPT) Code 80300-80377 Update; Approved Non-Emergent Medical Transportation (NEMT) Rates; Pharmacy Cost of Dispensing Survey; Preferred Drug List (PDL) Update; Drug Utilization Review (DUR) Board Open Position; Reminder: Tobacco Cessation; Morphine Equivalent Limitations; Children with Autism Waiver Billing Changes; and July and August 2015 Provider Workshops.

Medicaid Program News and Updates (B1500367 - 06/15) - This bulletin contains information on the Medicaid Provider Rate Increases Effective July 1,2015; Provider Revalidation and Enrollment; New Medicaid ID Cards Coming; Anesthesiologist Assistant Participation and Billing in Colorado Medicaid; ColoradoPAR Program Retroactive Prior Authorization Request (PAR) Process Per Category; ColoradoPAR New Vendor Notification; PeakHealth Mobile App for Medicaid & CHP+ Clients; Independence Day Holiday; Dental Program – 2015 Legislative Sessions Updates; Dental program – Rate Increases Coming July 1, 2015; Durable Medical Equipment (DME), Prosthetics, Orthotics, and Supplies (DMEPOS) Billing Manual Updates; Non-Emergent Medical Transportation: Hospital to Inpatient Facility Transfers; Transportation Billing Manual Updates; Pharmacy Audits; Tobacco Cessation; New Global Prior Authorization Form; July Preferred Drug List (PDL) Announcement; Pharmacy and Therapeutics (P&T) Meeting; and June and July 2015 Provider Workshops.

Medicaid Program News and Updates (B1500366 - 05/15) - This bulletin contains information on the New Colorado interChange; Provider Revalidation and Enrollment; Add-a-Baby Project; ColoradoPAR Program; Memorial Day 2015; Dental Program – Revised Adult Dental Policies Update; Dental Administration Services Organization (ASO) Updates from DentaQuest; Provider Retraction/Clarification – Durable Medical Equipment Prior Authorization Requests (PARs); Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Pharmacy Audits; Drug Utilization Review Board (DUR) Meeting; and May and June 2015 Provider Workshops.

05/04/2015 - Correction: The ColoradoPAR Program does not process out-of-state transportation Prior Authorization Requests (PARs) as was previously stated.

Medicaid Program News and Updates (B1500365 - 04/15) - This bulletin contains information on the Colorado PAR Program; New Medicaid Members Looking for Providers (Update Contact Information); National Correct Coding Initiative Notification of Quarterly Updates; Modifier ‘59’ and New Modifiers; Billing the Member for Colorado Medical Assistance Program Services; Medicaid and Child Health Plan Plus 2015 Income Guidelines; Screening, Brief Intervention, and Referral to Treatment (SBIRT); Memorial Day Holiday; General Dental Program Billing Instruction Updates; Dental Services for Medicaid-Eligible Refugees and Qualified Disabled Widows; Dental Program – Adult Dental Rule Update; Dental Administration Services Organization (ASO) Updates from DentaQuest; Durable Medical Equipment (DME) and Supply Billing Manual Updates; Complex Rehabilitation Technology (CRT) Provider List; Manually Priced Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); Prior Authorization Request (PAR) Process for Home and Community-Based Services Waiver for Spinal Cord Injury (HCBS-SCI); Hospice Legislative Rate Increases Effective October 1, 2014; Abortion Services Update; Residential Child Care Facilities Update; Preferred Drug List (PDL) Update of Preferred Products; Genotropin Update; and April and May 2015 Provider Workshops.

05/18/2015 - Correction: The original bulletin listed an incorrect "Colorado Revised Statutes" citation. The current citation is 25.5-4-301. The hyperlink in the bulletin has also been updated to reflect this change.

Medicaid Program News and Updates (B1500364 - 03/15) - This bulletin contains information on Medicare-Medicaid Enrollees; Record Retention; Submitting Diagnostic Imaging PARs; Group Home Resident PARs; Physical and Occupational Therapy PARs; Durable Medical Equipment PARs; CWQI Access; Intent to Submit an Application to Extend Colorado’s Title XXI Section 1115 Demonstration Project; DentaQuest Office Reference Manual Update; Qualified Medical Personnel Billing Procedure Guidance; Non-citizen Emergency Dental Service; Adult Dental Rule Update; Billing and Program Updates from DentaQuest; Durable Medical Equipment Supplier License; Update on FQHC/RHC Submissions with Multiple Lines; Pharmacy Audits; Hepatitis C Medication Update; Genotropin Update; and the Preferred Drug List Update.

Medicaid Program News and Updates (B1500363 - 02/15) -This bulletin contains information on the 2015 Healthcare Effectiveness Data and Information Set Data Collection Study; Pain Management ECHO Project; Continuous Positive Airway Pressure Prior Authorization Request; Lack of Information Denials; New CWQI Fields; PeakHealth; ICD-10; 2015 HCPCS Update; Tax Season and 1099s; February 2015 Holiday; Dental Program Benefits – Rules and Regulations Update; Current Dental Terminology Changes; Bill and Program Updates from DentaQuest; Durable Medical Equipment Supplier Licenses; Approved Home Health Rates; Pharmacy PAR Letters; and Prior Authorization Process for Hepatitis C Treatment: Addressing Harvoni and Viekira.

Medicaid Program News and Updates (B1500361 - 01/15) - This bulletin contains information on the CMS 1500 Claim Form Transition; Payment Collection from Medicaid Members; Influenza and Pneumonia Vaccine Code Update; 2015 HCPCS; The Colorado PAR Program; Eligibility Response Changes; PeakHealth Mobile App; CHP+ Logo Update; Benefits Collaborative Meeting Schedule Update; Tax Season and 1099s; January and February 2015 Holidays; Dental Provider Rate Increase; Adult Dental Program Benefit – Rule and Regulations Date Change; Billing and Program Updates from DentaQuest; DME and Supplies Billing Manual Update; FQHC and RHC Accommodation for Submission with Multiple Lines; Nursing Facility & Intermediate Care Facility for Individuals with Intellectual Disabilities PAR Provider Instructions for Xerox State Healthcare Transition; PAR Process for the CCT Program; Notice to Case Managers on Changes to the Alternative Care Facility; ACF PAR Process Reminder; Addendum to the December 2014 Provider Bulletin Prior Authorization/Changes: Hepatitis C Medications.

2015 Practitioner HCPCS Codes (B1500362 - 01/15) - This bulletin contains listings of discontinued procedure codes, codes with description changes, and new procedure codes. All codes and changes are effective 01/01/2015. This bulletin replaces bulletin B1400348 (05/13).

2014: B1400346 - B1400360

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

Synagis® and Influenza Vaccines (B1400358 - 10/14) - This bulletin contains updated information about Synagis® and Influenza Vaccine benefits and reimbursement for children and adults for the 2014-2015 season.

Medicaid Program News and Updates (B1400357 - 10/14) - This bulletin contains information about CMS 1500 Claim Form Transition; Financial System Schedule; Additional Payments for PCMPs; October and November Holidays; DentaQuest Transition Updates; Non-Citizen Emergency Services; Member Eligibility Verification Dental Rules and Regulations; Dialysis Treatment Centers; CRT Suppliers; Billing Reminder – LT & RT Modifiers; DIDD TCM Services; DIDD Homemaker Services; Operations Processing Schedule; Nursing Facility Providers; Requested Nursing Facility Information; ATA Assessments; Substance Use Disorder Providers; Enrollment in BHO’s; NEMT Broker Transition; Usage Reduction for procedure codes PAR Requests; 430B Drug Pricing Program; Prescription Drug List Update; Hydrocodone Combo Rescheduling; P&T Meeting; Oct & Nov Provider Training Workshops.

Medicaid Program News and Updates (B1400356 - 09/14) - This bulletin contains information about Clients with Reinstated Benefits; July 1, 2014 Rate Increases; NCCI Notification of Quarterly Updates; ACC Program Auto-Enrollment Process; Child Welfare Eligibility Verification; Labor Day Holiday; ACA - Provider Screenings; Coverage to Care Resources; Protect Yourself by Understanding Healthcare Fraud; ColoradoPAR Program; Prior Authorization

(PAR) Revisions; Private Duty Nursing (PDN) Hours; Colorado Medicaid Nurse Advice Line; DentaQuest Office Reference Manual (ORM) Status Update; Rate Increase Update; QMB/SLMB Beneficiaries; Children’s Dental Benefit; Assistive Technology Assessments; Short-Acting Opioids; Butalbital-Containing Product Policy; Take Back Initiative; Preferred Drug List (PDL) Update; Pharmacy and Therapeutics meeting; September and October 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 (B1400352 - 06/14) - This bulletin contains information about Medicaid Fee-for-Service Provider Rate Increases 07/01/14; Targeted Provider Rate Increases 07/01/14; ColoradoPAR Program; Financial Reporting System Transition; Changes to BHOs; New HCPF Website Coming Soon; New Provider Training for Implementing Tobacco Cessation Guidelines in Clinical Practice; NCCI Notification of Quarterly Updates; ICD-10 Update;Independence Day Holiday; ASC Procedure Code Updates; DentaQuest; ICD-10 and Dental Claims; Reminders for FQHCs; Rate Increases for FQHCs; Medicaid Hospital Coverage for Correctional Facility Populations; SBHC required to bill with POS Code 03; CLLI Waiver Service Change; Pharmacy Global Prior Authorization Form & Criteria; Osphena, Copaxone, & Sovaldi; Oral Allergen Extracts; Preferred Drug List (PDL) Update; Clinical Pearl: Long-Acting Insulin Conversions; June & July 2014 Provider Workshops; and Attachment A - Targeted Rate Increases.
06/02/2014 - Corrected CPT code 96110 to T1026 under Pediatric Developmental Assessments.
06/09/2014 - Replaced 92506 with 92521, 92522, 92523, 92524 (All for Speech/Hearing Evaluations) on Attachment A.

Medicaid Program News and Updates (B1400351 - 05/14) - This bulletin contains information about the ICD-10 delay; Financial Reporting System Transition; NCCI Edits & Global Surgery Modifiers; Client Eligibility Verification Reminder; Client Billing Permitted; Memorial Day Holiday; Dental Updates; Oxygen Claim Edits; Rate Increases for FQHCs; Hospice Legislative Rate Increases Effective October 1, 2013; NCCI changes for RCCFs; Billing for Psychotherapy for Crisis; DUR Board Meeting; PDL Update; and May & June 2014 Provider Workshops.

Medicaid Program News and Updates (B1400350 - 04/14) - This bulletin contains information about ColoradoPAR; Important Changes to Certain SSA Services; 1099s Returned to the Department; the Memorial Day Holiday; ASC & Dialysis Center Rates Effective July 1, 2013; Hearing Aids Rates Adjustments; Softband Hearing Aids for Children; Adult Dental Program Policy & Billing; OAP Dental Benefit; Secondary/Back-Up Wheelchairs & NCCI - PTP Edits; Disposable Oxygen Probes; DME - Oxygen Claim Edits; IP Hospital Billing for Children Age 1 or Under; OP Hospital Billing Edits for ‘Other Diagnosis Not Covered’; OP Hospital Rate Increases Effective July 1, 2013; ACF Providers; Hepatitis C Treatment; P&T Board Meeting; PDL Update; April & May 2014 Provider Workshops; and Adult Dental Benefit Procedure Code Table.

Medicaid Program News and Updates (B1400349 - 03/14) - This bulletin contains information about Postpartum Depression Screenings & Payment in the Pediatric Primary Care Office; Persons with Disabilities Parking Application Changes; New Medicaid Clients Are Looking for Providers; 2014 HCPCS; NCCI Notification of Quarterly Updates; How Will ICD-10 Change a Provider’s Practice?; ColoradoPAR Program; Web Portal Internet Explorer 11 Compatibility View Update; Medicare-Medicaid Enrollees; Record Retention; Help Improve the Department’s Website; 1099s Returned to the Department; Rate increases for FQHCs, OP Hospital Services, & RHCs; Adult Dental Benefit; Secondary/Back-Up Wheelchairs & NCCI PTP Edits; Inpatient Hospital Billing for Newborns; NHVP Billing Manual Update; Waiver PAR Over Utilization Review – Revision; Copay Exemption for Aspirin & Vitamin D; Hepatitis C Treatment; Medicaid Coverage of Injections for Prevention of Preterm Birth; P&T Meeting; PDL Update; March & April 2014 Provider Workshops; and Persons with Disabilities Parking Privileges Application.

03/04/2014 - Updated Hepatitis C Treatment article and added Attachment B.

2014 Practitioner HCPCS Codes (B1400348 - 02/14) - This bulletin contains listings of discontinued procedure codes, codes with description changes, and new procedure codes. All codes and changes are effective 01/01/2014. This bulletin replaces bulletin B1300337 (05/13).

Medicaid Program News and Updates (B1400347 - 02/14) – This bulletin contains information about Preventive & Wellness Services Procedure Codes; ColoradoPAR; Claims for Prior Authorized Services and PAR Inquiries; 1099s Returned to the Department; February 2014 Holiday; Abortion Services Update; Upcoming Dental Benefits Collaborative; State Fiscal Year 2013-2014: Rate Increase for Medicaid Family Planning Services; NCCI Impacts on Immunization and Evaluation & Management (E&M) Codes; Billing Change for Mental Health Clients with Retroactive Eligibility; PT, OT, ST Alternative Benefits Plan (ABP); Radiology Billing Manual; PLWA Waiver Change; DUR Board Meeting; Copay Exemption for Aspirin and Vitamin D; February and March 2014 Provider Workshops; and USPSTF & ACIP 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.

2013: B1300332 - B1300345

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.

Synagis® and Influenza Vaccines (B1300343 - 10/13) - This bulletin contains updated information about Synagis® and Influenza Vaccine benefits and reimbursement for children and adults for the 2013-2014 season.

Medicaid Program News and Updates (B1300342 - 10/13) – This bulletin contains information about NCCI Modifiers 24, 25, and 57 Guidelines; NCCI Quarterly Update; ColoradoPAR Program; Updated MED-178; New ACA Consumer Site; ACA HIPAA Operating Rule Changes Improve Colorado Medical Assistance Program Web Portal Eligibility Response Information; October and November 2013 Holidays; Dental Benefit Update; DME NCCI Edits; DME Wheelchair Billing Requirements; AACD Benefit Coverage Standard; Increase to Hospice Provider Rates; Immediate Postpartum Long-Acting Reversible Contraception (LARC); Waiver Prior Authorization Request Over Utilization Review; Distribution of Cost of Dispensing and Total Annual Prescription Volume Surveys; PDL Update; P&T Committee Open Positions Beginning 2014; P&T Committee Meeting; October and November 2013 Provider Workshops.

Medicaid Program News and Updates (B1300341 - 09/13) – This bulletin contains information about Medicare Disallowance Update; Medicare-Medicaid Enrollees; NCCI Impacts on Vaccine/Immunization/Depression/Vision Services; Medicaid PCP Supplemental Payment Program Update; Additions to Billing Physician Administered Drugs HCPCS/NDC Crosswalk; Record Retention; Updated Provider Enrollment Applications; September & October 2013 Holidays; Dental Benefit Update; DME NCCI Edits; DME Wheelchair Billing Requirements; AACD Benefit Coverage Standard; EPSDT Services; Skyla Contraceptive Method; Hospice Rate Update; Changed Billing Requirements for Selected Pathology Codes; Billing Errors for NMT Services; Radiology PARs; Update for Implementation of New Waiver Rates; Preferred Drug List (PDL) Update; 2014 P&T Committee Open Positions; P&T Committee Meeting; AAC Rate Update Date Shift; and September & October 2013 Provider Workshops.

Medicaid Program News and Updates (B1300340 - 08/13) – This bulletin contains information about the Labor Day Holiday; Implementation of New Provider Rates; The Online ACC Contract; ACC Payments; Expansion of Colorado Access into an Additional County; PARs for Dental Services; APR-DRGs Implementation; SBIRT Benefit Updates; New Online Training for SBIRT; Speech-Language Pathology Practice Act; Changes to HCPCS Code S3005; HCBS for Developmentally Disabled Program Payment Errors; August & September 2013 Provider Workshops; and Client Appeals Rights.

Medicaid Program News and Updates (B1300339 - 07/13) – This bulletin contains information about the ACC Contract Online; Well Child Key Performance Indicator; Implementation of New Provider Rates; ColoradoPAR; Updated Provider Enrollment Applications; Nurse Advice Line; Independence Day Holiday; ASC Billing Reminder; DME, Prosthetics, Orthotics, and Supply (DMEPOS) and Medicare Crossover Claims; DME Billing Manual Updates; Clarification on Qualifying Sleep Studies for CPAP/BiPAP Requests; FQHC/RHC Billing Changes; NCCI Impacts on Immunization & Adolescent Depression Screening; Depression Screening; Medicaid PRTF/RCCF Provider Rate Increases Effective July 1, 2013; NCCI Impacts on Vision; P&T Committee Meeting; Other Drug Coverage Updates; PDL; and July & August 2013 Provider Workshops.

Medicaid Program News and Updates (B1300338 - 06/13) – This bulletin contains information about the Medicaid Provider Rate Increases Effective July 1, 2013; Children’s Medical Home Reimbursement and the ACC Program; 2013 HCPCS; NCCI Quarterly Update; Billing Reminders for NCCI; NCCI Requirements & Billing Endoscopy Procedures; ColoradoPAR; Planning for ICD-10; Provider Communication Survey Reminder; Independence Day Holiday; CPAP/BiPAP; DME Reimbursement Rates and Manually Priced Items; DME NCCI Edits; Depo Shot, Skyla – New Long-Acting Reversible Contraceptive Method; Acceptable Application Documents for FQHC; Colorado Access Transition; HCBS NMT Providers; Inpatient Hospital ICD-9-CM Crosswalk Update; NCCI Impact to Vaccine Administration & Procedure Codes and 99211; Pharmacy P&T Meeting & PDL Update; and June & July 2013 Provider Workshops.

02/07/2014 - Updated to remove Hospice service from rate increases.

2013 Practitioner HCPCS Codes (B1300337 - 05/13) - This bulletin contains listings of discontinued procedure codes, codes with description changes, and new procedure codes. All codes and changes are effective 01/01/2013. This bulletin replaces bulletin B1200316 (02/12).

Medicaid Program News and Updates (B1300336 - 05/13) – This bulletin contains information about the Memorial Day Holiday; the ColoradoPAR Program; Long-Acting Reversible Contraceptive Rate Increase; Revised Rates for HCBS NMT providers; Home Health PAR Form Changes; Home Health Telehealth; Appendix T Update; Prenatal Plus Program Billing Manual; Abilify, Risperidone and Zyprexa; Pharmacy COBManager; Updates to Pharmacy Web Pages and the May & June 2013 Provider Workshops.

Medicaid Program News and Updates (B1300335 - 04/13) – This bulletin contains information about the Provider Communication Survey; Third Party Bank Accounts; the Department’s Web site Changes; Client’s Who Need Assistance; Fee-for-Service Providers & ACC Members; NCCI Requirements and Billing Colonoscopies; ColoradoPAR; 2013 HCPCS and Fee Schedule; Physician Supplemental Payments; DME/Supply Providers & NCCI; Waiver Providers & Colorado Choice Transitions; IHS Pharmacies Billing Updates; Seroquel; Updates to Appendix P and the April & May 2013 Provider Workshops.

05/28/2013 - Updated description for code E0600.

Medicaid Program News and Updates (B1300334 - 03/13) – This bulletin contains information about Medicare-Medicaid Enrollees; Medicare/Medicaid Crossover Claims; Record Retention; Planning for ICD-10; the Second Phase NCCI; Billing Reminders; Colorado Medical Assistance Program Web Portal; PERM; Physician Supplemental Payments; ColoradoPAR; Expansion of Colorado Access into Two Additional Counties; CCT Waiver Program Launch; Renamed Waivers: PHW & MI; Waiver PAR Form Changes; Pharmacy P&T Meeting; PDL Update; Atypical Antipsychotic Update; IHS Pharmacies Billing Updates; Updated Pharmacy Reimbursement Methodology; PDL Update; Billing Update for Avonex; Updates to Appendix P; and March & April 2013 Provider Workshops.

Medicaid Program News and Updates (B1300333 - 02/13) – This bulletin contains information about Medicaid Expansion in 2014; OAP Provider Rate Increase; EHR Incentive Program; Healthy Living Initiatives; 2013 HCPCS & Fee Schedules; Presidents’ Day Holiday; The ASC Project; Billing Shared Liquid Oxygen Systems at Nursing Facilities; HH Pediatric Assessment Tool Implementation; HH Rule Update & Benefit Coverage Standard Effective as of January 1, 2013; Pediatric Home Health PAR Certification Period; Home Health Agency Change of Provider Letter; Next Home Care Information Exchange Meeting; CCT Program Launch; IHS Pharmacies Billing Updates; Updated Pharmacy Reimbursement Methodology; DUR Board Meeting; PDL Update; and February & March 2013 Provider Workshops.

Medicaid Program News and Updates (B1300332 - 01/13) – This bulletin contains information about some Web Portal Upgrades; Clarification of Blood Lead Testing for Medicaid-Eligible Children; 2013 HCPCS Codes Update; Primary Care Provider Supplemental Payments; Tax Season and 1099s; January and February 2013 Holidays; Dental PAR Processing; Appendix N Update for Home Health Providers; Outpatient Hospital Supplemental Medicaid Payment with Percentage Adjustment Factors Attachment; Office Administered Drugs, Lupron Depot; IHS Pharmacies Billing Updates; Benefit Updates for Benzodiazepines and Barbiturates; Updated Pharmacy Reimbursement Methodology; Total Prescription Volume Surveys; and January and February 2013 Provider Workshops.

2012: B1200310 - B1200331

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 (B1200330 - 11/12) - This bulletin contains information about PAR Submission to the ColoradoPAR Program; ICD-10 Changes to Billing Practices; NCCI Second Phase Implementation in Early 2013; Breast Reconstruction PAR Submission Changes; Tax Season and 1099s; the Add-A-Baby Project; Medicaid & CHP+ Income Eligibility Policy Changes for Pregnant Women; Web Portal User Assistance Resources; Healthy Living Initiatives; A New Location of Colorado Medical Assistance Program Forms; Removal of the “Little Billing Book” from Web site; November 2012 Holidays; Audiology & Vision PAR Requirements; Colorado Choice Transitions (CCT) Update; Dental and Orthodontic PAR Submission Update; Updates to Outpatient Cost-to-Charge Ratios; Inpatient Hospital (DRG) Rates; Inpatient Hospital ICD-9-CM Crosswalk Update; Changes to Transportation PAR Requirements; Targeted Case Management (TCM) and Early Intervention (EI) Change; Pharmacy: DUR Board Meeting; IHS Pharmacies; Medicare Part D; 2012-2013 Synagis® Season; Enhanced Prior Authorization System (SMART PA); Brand/Generic Coverage Updates; P&T Committee Meeting; P&T Committee Open Positions Beginning 2013; and the November & December 2012 Workshops.

Synagis® and Influenza Vaccines (B1200329 - 10/12) - This bulletin contains updated information about Synagis® and Influenza Vaccine benefits and reimbursement for children and adults for the 2012-2013 season.

Medicaid Program News and Updates (B1200328 - 10/12) - This bulletin contains information about Program Integrity Fraud Reporting; Changes to PAR Requirements for Breast Reconstruction; Updated Client Appeals Rights; ColoradoPAR PAR Submission; Audiology and Vision PAR Requirements; DME/Supply Special PAR Requirements; Home Health PAR Submission; Name Change for MI Waiver Providers; Outpatient PT and OT 48 Unit Limit Postponed; Add-a-Baby Process; 2012-2013 Synagis® Season; Changes to Transportation PAR Requirement; Pharmacy: Appendix P, Medicare Part D Updates, Proton Pump Inhibitors, Updates to Pharmacy Rules, PDL Update, P&T Committee Meeting, P&T Committee Open Positions in 2913; October & November Holidays; October & November 2012 Workshops; Provider Overuse, Fraud and Abuse Referral Form; and a copy of the Client Appeals Rights

Medicaid Program News and Updates (B1200327 - 09/12) - This special Outpatient Physical Therapy (PT) and Occupational Therapy (OT) bulletin addresses important information about the 48 unit limit for all Outpatient PT and OT services and Prior Authorization Requests (PARs). The changes are effective October 1, 2012. Please read the bulletin carefully and retain it for future reference.

Medicaid Program News and Updates (B1200326 - 09/12) - This bulletin contains information about the Proof of Eligibility Letter; Safeguarding Medical Identity Toolkit; Colorado Choice Transition; Medicaid Fee Schedule; PAR Submission to the ColoradoPAR Program; Client Over-Utilization Program (COUP); ACC Program Referral Requirement; ACC Payment Reform Initiative; Dual Eligibles; Record Retention; September & October Holidays; Dental and Orthodontic PAR Procedures Update; Special DME/Supply PAR Submission Requirements - including notice of revised special provider bulletin, B1200323; FQHC Provider Identification Number; HCBS Waiver Providers and PERM; Home Health PAR Submission; Inpatient Medicaid Base Rates effective July 1, 2012; ICD-9-CM Codes Crosswalk; Nursing Facility Providers and PERM; PT/OT Daily Unit Limit Changes; Next P&T Committee Meeting; Appendix P; COBManager; Medicare Part D Updates; PPI; PDL Update; September & October 2012 Workshops; and Proof of Medicaid Eligibility Sample Letter.

Medicaid Program News and Updates (B1200325 - 08/12) - This bulletin contains information about PAR Submission; Client Over-Utilization Program (COUP); ACC Program Referral Requirement; Medicaid Payment Reform; Direct Deposit Information; Labor Day Holiday; New Provider Manual Section; Dental and Orthodontic PAR Submission; DME/Supply Special PAR Submission Requirements; Home Health Providers PAR Submission; Home Health Revenue Code Change; HCBS Waiver Procedure Code Changes and Program Rates; 2012 Colorado Immunization Information System (CIIS) Participation Survey; DUR Board News; COBManager; Proton Pump Inhibitors (PPI); Open P&T Committee Positions; August and September 2012 Provider Billing Workshops; and Home and Community Based Services Rates Attachment.

Medicaid Program News and Updates (B1200324 - 07/12) - This bulletin contains information about PAR Submission; Nurse Advice Line; Implementing the SPA for TCM; Independence Day Holiday; Billing Reminder for ASCs; Dental and Orthodontic PAR Submission; Dialysis Billing Reminder; AACDs, Electrical Stimulation Devices, & Apnea Monitors Benefit Coverage Standards; Emergency & Non-Emergency Medical Transportation 1% Rate Reduction - Effective July 2012; Home Health PAR Submission; Using CPT Code 11981; School-Based Health Center (SBHC) Benefit Coverage Standard; Combined 48 Unit Limit Postponed for Therapy Providers; Coverage of Vision Therapy; Next DUR Board Meeting; Prior Authorization Updates; COBManager Process for Pharmacy Claims; PDL Update; Next P&T Committee Meeting; July and August 2012 Provider Workshops; and Transportation Rates & PAR Requirements.

Medicaid Program News and Updates (B1200323 - 06/12) - This special DME PAR bulletin addresses important information about changes in the PAR processing policy for selected codes. The codes are listed in Attachment A of this bulletin. The changes are effective July 2, 2012. Please read the bulletin carefully and retain it for future reference.

08/31/2012 - Updated list of Codes Requiring Notification

Medicaid Program News and Updates (B1200322 - 06/12) - This bulletin contains information about ColoradoPAR PAR Submission; ACC Providers; Colorado Choice Transitions (CCT) Program; Immunization Services Billing Manual; Non Payment for Provider Preventable Conditions; RAC Program Update; Provider Status Verification; Independence Day Holiday; CHP+ Copay Changes; Dental & Orthodontic PAR Submission; Revised DME & Supply Billing Manual; Home Health PARs; Prognosis Required for Hospice; PT, OT, S-L & Hearing Benefit Coverage Standards; Changes for Outpatient PT and OT Benefit; New PAR Vendor for Skilled Nursing Facility Providers; Bariatric Surgery and Intersex Surgery Benefit Coverage Standards; PDL Update; PDL News; Next P&T Meeting; and June & July 2012 Provider Billing Workshops.

Medicaid Program News and Updates (B1200321 - 05/12) - This bulletin contains information about Colorado Access Expansion; ColoradoPAR Updates; Important ACC Update; Medicaid Buy-In Program for Children with Disabilities; Colorado Web Portal Updates; Memorial Day Holiday; Children's Medical Home Providers Pay-for-Performance Reimbursement; Hospice Services Benefit Coverage Standard; Hepatitis B for Newborns; HCBS Non Medical Transportation Providers; Waiver PAR Forms; Next DUR Board Meeting; Pharmaceutical Drug Reimbursement Methodology Surveys; Prior Authorization Updates; Prescriber NPI; PDL Updates; May and June 2012 Provider Billing Workshops; BI & EBD NMT Rate Schedules; Revised Request for HCBS Prior Approval and Cost Containment for HCBS-BI; and the revised Request for Adult HCBS Prior Approval and Cost Containment form.

Medicaid Program News and Updates (B1200320 - 04/12) - This bulletin contains information about the Proof of Medicaid Eligibility Letter; Colorado Registration and Attestation System; Nurse Advice Line; ColoradoPAR Program; Memorial Day Holiday; ASCs and DTCs Policy Statements; Depression Screening; PARs for Non-Emergent CT Scans, MRIs & all PET Scans; Hippotherapy Coverage; Podiatry Policy Statement; Pharmaceutical Drug Reimbursement Methodology Surveys; NPI; Next P&T Committee Meeting; PDL Update; Prior Authorization Updates; April and May 2012 Provider Billing Workshops; and sample of the Proof of Medicaid Eligibility Letter.

Medicaid Program News and Updates (B1200319 - 03/12) - This special Home Health bulletin contains important information about PDN Providers; Extraordinary Clarification; Brief Nursing Visit; POC Requirements; Using ICD-9 V-Codes on the Plan of Care; Appropriate Utilization and Billing of Acute and LTHH Services; Home Health Advanced Beneficiary Notice; Transferring a Client’s Home Health PAR; Revised HH PAR Form; Primary Agency and the Plan of Care Reminder. The bulletin also includes a list of Reviewing Agencies; the Revised HH PAR Form; and a copy of the Plan of Care.

Medicaid Program News and Updates (B1200318 - 03/12) - This special Outpatient Radiology bulletin contains important information about new outpatient radiology policies effective April 1, 2012. It also contains the PAR web-based training schedule and lists of imaging codes requiring PARs.

Medicaid Program News and Updates (B1200317 - 03/12) - This bulletin contains information about Medicare/Medicaid Crossover Claims; Adult Buy-In Program; ACC Referral Requirement; Web Portal Training Materials and User Assistance Documents; Upcoming Benefits Collaborative Meetings; Up and Away and Out of Sight; ColoradoPAR Program; 2012 HCPCS/Procedure Codes Bulletins; Appendices & EPSDT Manual Update; Dual Eligibles; Record Retention; DME Questionnaires; Immunization Services Policy; Vaccines for Children (VFC) Program; Colorado Immunization Information System (CIIS); Policy of Setting Interim Rates for New Rural Health Centers (RHCs); New Transportation Policy Statements; Next P&T Committee Meeting; Preferred Drug List (PDL) Update; DUR Board Update; PPIs; New Generics in the PDL Classes; and March and April 2012 Provider Billing Workshops.

2012 Practitioner HCPCS Codes (B1200316 - 02/12) - This bulletin contains listings of discontinued procedure codes, codes with description changes, and new procedure codes. All codes and changes are effective 01/01/2012. This bulletin replaces bulletin B1100294 (01/11).

Immunization Benefit Update (B1200315 - 02/12) - This bulletin contains updated information on immunization benefits for children and adults. A Quick Reference is included with the bulletin. This bulletin replaces B1100293 (01/11).

Billing Instruction Update for Ambulatory Surgery Centers (ASCs) (B1200314 - 02/12) Rev. 03/20/12 - This bulletin contains a complete list of the Medicaid-approved ASC procedure codes effective January 1, 2012. The list is divided into related groups for payment. Only surgical procedure codes that are published in this bulletin are ASC Medicaid benefits. This bulletin replaces bulletin B1100295 (01/11).

03/20/2012 - Updated ASC Group 2

Medicaid Program News and Updates (B1200313 - 02/12) - This special Transportation bulletin contains important information about upcoming transportation claim adjustments and rate changes.

Medicaid Program News and Updates (B1200312 - 02/12) - This bulletin contains information about Coverage for Adults without Dependent Children (AwDC); ACC Update; Change to Provider Contact Information for the Colorado Medical Assistance Program RAC Program; Provider Outreach Page (POP) LIVE; Add-A-Baby Process Training; President’s Day Holiday; Amendments to the HCBS-DD Services; Home Health Telehealth; Pharmacy Cost of Dispensing and Acquisition Cost Surveys; P&T Committee News; PDL Update; Appropriate use of PPIs; Prior Authorization Criteria (Appendix P) Updates; DUR Board Update; February & March 2012 Workshops; and HCBS Rates, Procedure Codes, Modifiers & Service Limitations.

Medicaid Program News and Updates (B1200311 - 01/12) - This special Prior Authorization Request (PAR) bulletin contains important information about PARs that are currently processed and will be processed beginning February 1, 2012 by the ColoradoPAR Program. It also contains PAR submission clarification and PAR criteria. Please read the bulletin carefully and retain it for referencing PAR guidelines.

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.