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Provider Bulletin Index (01/21) - 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.
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100457 - 01/21) This bulletin contains information on Did You Know - Provider Enrollment Application Fee;Direct Care Collaborative Starts in January; Member Billing; Member Video Toolkit; Social Security Verification for Revalidation Applications; Prescriber Tool Project; COVID-19 Vaccines; Sign Up to Receive Updates on the Upcoming Care and Case Management System Implementation; Physician Administered Drugs (PADs) - Healthcare Common Procedure Coding System (HCPCS)/ National Drug Code (NDC) Crosswalk Update; Multiple Line Items; Children’s Habilitation Residential Program (CHRP) - Service Changes; General Updates; Hospital Transformation Program (HTP) Update; Reminder to Bill through IntelliRide; Preferred Drug List (PDL) Announcement of Preferred Products; Pharmacy and Therapeutics (P&T) Committee Meeting; Pharmacy and Therapeutics (P&T) Committee New Member Openings; Reminder to Update Fax Numbers; Quarter 1 Rate Updates 2021; COVID-19 Monoclonal Antibody Infusions; Benefit Expansion Go-Live, Residential and Inpatient SUD Provider Manual and Updates to Other Billing Manuals; Telemedicine Well-Child Check-Ups; January and February 2021 Provider Billing Webinar-Only Training Sessions
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000450 - 07/20) - This bulletin contains information on Did You Know - ConnectToCare Jobs Website for Health Care Employers; Fiscal Year 2020-2021 Provider Rate Adjustments; Help for the Uninsured During the Coronavirus (COVID-19) Pandemic; "Lower of" Pricing Logic for Rate Increases; Provider Recruitment – New Health First Colorado Providers Needed; Revalidation; Telemedicine Services; Contacting the Department’s Prior Authorization Vendor; 1% Across the Board Rate Reduction Effective July 1, 2020; Temporary Suspension of Prior Authorization Request (PAR) Requirements; General Updates; Hospital Transformation Program (HTP) Update; Inpatient Hospital Review Program (IHRP) Suspended; Replace Current Procedural Terminology (CPT) Codes With Healthcare Common Procedure Coding System (HCPCS); Transportation Broker Expansion; Nasal Atomizer Billing; Pharmacy and Therapeutics (P&T) Committee Meeting; Guidelines for Early Intervention (EI) Therapy Providers; Quarter 3 Rate Updates 2020; July and August 2020 Provider Billing Webinar-Only Training Sessions.
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2000449 - 06/20) - This bulletin contains information on Did You Know - Provider Revalidation Started; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; Guidance for COVID-19-Related Services for Recipients of Emergency Medicaid Services (EMS); Upcoming Improvements to Claims Review; Developmental Screening Changes; Pediatric Behavioral Therapy Criteria; Community Centered Boards and Single Entry Points Providing Case Management to Eligible HCBS Members; Nursing Facility National Provider Identifier (NPI); General Updates; Clinical Diagnostic Laboratory Upper Payment Limit Rates; Updates to Visit Documentation Policy; Preferred Drug List (PDL) Announcement of Preferred Products; Injectable Opioid Antagonists; Physician-Administered Drug (PAD) Billing Manual; Policies Relating to Ordering, Prescribing and Referring (OPR); June and July 2020 Provider Billing Webinar-Only Training Sessions
Special Provider Bulletin – Colorado interChange Common Questions (B1800413 - 04/18) - This bulletin contains information on Do Not Send Reconsiderations for Denied Claims; Electronic Submission of Claims with Attachments; Provider Web Portal Void Claim Option Appears Only on Eligible Claims; When to Attach Explanation of Benefits (EOB) on Third Party Liability (TPL) and Medicare Claims; Unique National Provider Identifiers (NPIs): Making Claim Submission Easier; Paper Claim Form Signature Requirements; Claims Paid with “0” Date; Suspended Claims; "Lower of" Pricing Logic for Rate Increases; Rates and Fee Schedules; Finding Information About Your Submitted Claims (What Is an ICN?); Timely Filing; Ordering, Prescribing or Referring (OPR) Application Not Required for Individual Within a Group (IWG) Providers with Prescriptive Authority; Individual Providers Enrolling with an SSN May Only Have One Medicaid ID; Department Grace Period for Updating Provider Affiliations; Retroactive Updates to Member Eligibility Files; Alternative Benefit Plan
Medicaid Program News and Updates (B1800409 - 01/18) - This bulletin contains information on Did You Know? - Void Claim Option; Fiscal Year (FY) 2017-2018 Provider Rate Increases and Adjustments; Child Health Plan Plus (CHP+) Update; Health First Colorado (Colorado’s Medicaid Program) and CHP+ Member Feedback Wanted; How Organizations Can Utilize Colorado’s Newly Approved Health IT Roadmap; Tax Year 2017 1099-MISC Forms; Transportation Benefits Collaborative Meeting; Co-Pay Policy Update; Physician-Administered Drugs Billed with Miscellaneous J Codes Require National Drug Code (NDC) Number, Healthcare Common Procedure Coding System (HCPCS) Code, and NDC Units; Physician-Administered Drug Rate Update; Drug Utilization Review (DUR) Updates; Unenrolled Prescribers: NEW Prescriptions Written by Prescribers Not Enrolled with Health First Colorado Will Deny Beginning January 1, 2018; Pharmacy Provider Updates; HCPCS 0159T No Longer Covered; Non-Emergent Medical Transportation (NEMT) Bus Ticket Modifiers; Guidance for Billing CPT 92015 for Determination of Refractive State.
Medicaid Program News and Updates (B1600381 - 04/16) - This bulletin contains information on Rendering, Referring, and Prescribing Provider’s NPI Numbers; Medicaid Provider Revalidation Update; ACC Phase II Update: Behavioral Health Reimbursement Framework & FAQs; Free Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Medicaid Providers; Person and Family Centered Approach: Creating a Culture of Collaboration with Members; National Correct Coding Initiative (NCCI) Notification of Quarterly Updates; ColoradoPAR Program Updates; Discontinued Codes; Tax Season and 1099s; Food and Drug Administration (FDA) Update on Essure: Female Sterilization Method; Inpatient Claims for Members Fewer than 29 Days Old; Preferred Drug List (PDL) Update; Hepatitis C; Morphine Equivalent Limitations Update; Drug Utilization Review (DUR) Board Update; Attention Outpatient Speech Therapists; Home and Community Based Services (HCBS) Waiver Providers; In-Home Support Services (IHSS); and April and May 2016 Provider Workshops.
04/18/2016 - Correction: The original bulletin incorrectly stated that the rendering NPI number on electronic claims should be entered in the 2420F loop. The rendering NPI number should be entered in the 2420A loop.
Medicaid Program News and Updates (B1600379 - 02/16) - This bulletin contains information on the Accountable Care Collaborative Phase II: Stakeholder Feedback and Meeting Summaries; Person and Family Centered Approach: Creating a Culture of Collaboration with Members; Regulatory Efficiency Review: 8.079 Quality Improvement; ColoradoPAR Process Resources; Tax Season and 1099s; Healthcare Common Procedure Coding System (HCPCS) Updates for 2016 – Current Dental Terminology (CDT) Changes; Billing and Program Updates from DentaQuest; Coverage for Female Condoms and Spermicides; International Classification of Diseases 10th Revision (ICD-10) and Rehabilitation Specialty Hospitals; Pharmacy Dispensing Fees for Calendar Year 2016; Morphine Equivalent Limitations Update; Hepatitis C Medication Prior Authorization Process; Hepatitis C Criteria; Drug Utilization Review Board (DUR) Meeting; Outpatient Speech Therapists; and February and March 2016 Provider Workshops.
Medicaid Program News and Updates (B1400360 - 12/14) - This bulletin contains information on the CMS 1500 Claim Form Transition; ColoradoPAR Program; International Classification of Disease Version 10 (ICD-10); NCCI Quarterly Updates; Eligibility Response Changes; Increases in Payment for Office Visits and Vaccine Administration; Screening Medicaid Members for Depression; Coding Changes to the Medicaid Fee-for-Service Primary Care Depressions Screening Benefit; Comments Sought on New Federal Provider Screening Regulations; Tax Season and 1099s; December 2014 and January 2015 Holiday Schedule; Ambulatory Surgery Center Pilot Reimbursement Program; Billing Updates for DentaQuest; Dental Service for PE Children; Dental Program Benefits Update to Rules and Regulations; CRT Supplier Enrollment; Updated DME Billing Manual; Prior Authorizations for CPAP Machines; Approved FQHC Rates; Free Standing Birth Centers; Update on Inpatient and Outpatient Rate Increase; Non-Covered Days for Inpatient Claims; Billing Vxx.xxx Diagnosis Codes; Updates to Outpatient Cost-to-Charge Ratios, PT and OT PARs; Changes to FMS for CDASS Members; ACF PARs and Payment; Prior Authorization Process for HARVONI® and New Hepatitis C Treatment; PDL Update; Prior Authorization Changes; P&T Committee Openings; and December 2014 and January 2015 Provider Workshops.
Medicaid Program News and Updates (B1400359 - 11/14) - This bulletin contains information about Payment for Office Visits and Vaccine Administration; Comments Sought on New Federal Provider Screening Regulations; CMS 1500 Claim Form Transition; Customer Survey; Tax Season and 1099s; New Medicaid Members Looking for Providers; November and December 2014 Holidays; Dental Program Benefits – Update; DentaQuest Updates; CRT Supplier Enrollment; Substance Use Disorder Providers- Enrollment with BHO’s; Air Ambulance Certification Requirements; Non-Emergent Medical Transportation (NEMT) Broker; Change to FMS for CDASS Members; TAPV Form Requirement; Hepatitis C PARs; Stimulant and Attention Deficit Hyperactivity Disorder (ADHD) Medication Changes; November and December 2014 Provider Workshops
Medicaid Program News and Updates (B1400355 - 08/14) - This bulletin contains information about Postpartum Depression Screening; New HCPF Website Coming Soon; Selecting Medicaid Health Plans and Providers Online; Medicaid Members are Looking for Providers; ColoradoPAR Program; DentaQuest Provider Portal Updates; QMB and SLMB - Adult Dental; Dental General Billing Instruction Updates; Qualified Medical Personnel; Children Ages 0-2, 3 and 4 – Dental Billing; Dental Rules and Regulations; Orthodontia Updates; Correctional Facility Populations; Outpatient PT/OT Reminder; EI PT/OT Reminder; NEMT Transition; Other Drug Coverage Updates; Proton Pump Inhibitor Reminder; Smoking Cessation Reminder; P&T Committee Update; Provider Contact Info Update; DUR Board Update; August & September Provider Workshops.
Dental Benefit Update (B1400354 - 07/14) - This bulletin contains information about the Provider Electronic Funds Transfer (EFT) Information which requires action by all dental providers; DentaQuest Claims Administration; Prior Authorization Requests (PARs) with the New Dental Vendor, July 1, 2014; Pre-Payment Review (PPR); Dental Provider Seminars and Webinars.
Medicaid Program News and Updates (B1400353 - 07/14) - This bulletin contains information about the Medicaid Fee-for-Service Provider Rate Increases effective 7/1/14; Targeted Provider Rate Increases effective 7/1/14; Colorado 835 Companion Guide Revision; Billing and Reimbursement for Office Visits During Non-Regular Office Hours; ColoradoPAR Program; Old Age Pension (OAP) Health Care Program Rate Increases; New HCPF Website Coming Soon; Financial Reporting System Transition; Independence Day Holiday; Outpatient Hospital Supplemental Medicaid Payment; Children with Life Limiting Illness (CLLI) Waiver Service Change; Pharmacy and Therapeutics (P&T) Meeting; Preferred Drug List (PDL) Update; Other Drug Coverage Updates; Obstetrical Services - Ultrasound Utilization Limit Reminder; July and August 2014 Provider Workshops; Attachment A – PAF by Provider; Attachment B - Targeted Rate Increase – Final Recommendations.
Medicaid Program News and Updates (B1400346 - 01/14) – This bulletin contains information about the Correction to Rate Increase Article Published in the November 2013 Provider Bulletin; ColoradoPAR Program CWQI Reminders; New Service Related to the Medical Orders for Scope of Treatment; FFS Depression Screenings in the Primary Care Setting/New Adult Depression Screening Benefit; ACC Reaches Milestone of 400,000 Clients – Enroll as a Provider Today; Tax Season and 1099s; January and February 2014 Holidays; 2014 Holiday Processing Schedule; Upcoming Benefits Collaborative; Update on Home Health Pediatric Assessment Tool (PAT); Outpatient Hospital Supplemental Medicaid Payment; APR-DRG Implementation; SUD Integration into BHO; PLWA Waiver Change; Web Portal Inquiries for Pediatric Hospice and Children with Autism Waivers; P&T Meeting; PDL Update; January & February 2014 Provider Workshops; and Hospitals & Adjustment Factors Attachment.
Medicaid Program News and Updates (B1300345 - 12/13) – This bulletin contains information about Medicaid Benefits for Newly Eligible; Find a Healthcare Provider; Clarification on Use of Eligibility Inquiry to Verify Dates of Service in Web Portal; PCR Opt Out; 2013 Rate Increases & Fee Schedule; 2014 HCPCS & Fee Schedule; Planning Update & Survey for ICD-10; NCCI Quarterly Update; The ColoradoPAR Program; Tax Season and 1099s; December 2013 & January 2014 Holidays; Upcoming Dental Benefits Collaborative; APR-DRG Implementation; APR-DRG Web Portal Updates; Inpatient Medicaid Base Rates Effective July 1, 2013; Updates to OP Cost-to-Charge Ratios; SBIRT Code Update; SUD Integration into BHO; CWA Service Additions; Expansion of CDASS; Psychological Testing for Individuals Seeking Services from CCB; Documenting the Purpose/Intent for All Contraception Prescriptions; P&T Board Meeting’ PDL Update; Rx Review Program; Rixubis; December 2013 & January 2014 Provider Workshops.
Medicaid Program News and Updates (B1300344 - 11/13) – This bulletin contains information about the ColoradoPAR Program; Tax Season and 1099s; Rate Increase Update; Web Portal User Assistance Resources; Updated MED-178; New Health Care Reform Resource Page for Providers; November 2013 Holidays; Billing for Hearing Aids; Upcoming Benefits Collaborative; Developmental Screening ; APR-DRG Update; Immediate Postpartum Long-Acting Reversible Contraception (LARC); Updates to Outpatient Cost-to-Charge Ratios; NHVP Procedure Codes G9006 and T1017; NMT Accounts Receivable Balances; SUD Integration into BHOs; Waiver Claim Adjustments due to Rate Increases; P&T Committee Open Positions Beginning 2014; Next DUR Board Meeting; and November & December 2013 Provider Workshops.
Medicaid Program News and Updates (B1200331 - 12/12) - This bulletin contains information about the Colorado PAR Program; the Second Phase Update of NCCI Implementation; ‘Meaningful Use’ Submissions from Health Care Providers Using EHR; the Add-A-Baby Project; CHP+ Income Eligibility Policy Changes for Pregnant Women; Tax Season and 1099s;December 2012 and January 2013 Holidays; ICD-9-CM Crosswalk Update; Billing 340B Drugs for OP Hospitals; Updates to Outpatient Cost-to-Charge Ratios; Home Health Benefit Coverage Standard; ACA Payment to PCPs Rate Increase; Prenatal Plus Program; Tobacco Cessation Counseling Benefit for Pregnant Women; Immunizations; Pharmacy P&T Board Meeting; P&T Committee Open Positions Beginning in 2013; PDL Update; COB Manager; IHS Pharmacies; Medicare Part D; 2012-2013 Synagis® Season; Enhanced Prior Authorization System (SMART PA); December 2012 & January 2013 Workshops; and the Immunization Coding Quick Reference.
Medicaid Program News and Updates (B1200310 - 01/12) - This bulletin contains information about the HIPAA 5010 Implementation Update; PAR Status via AVRS; ACC Update; Tax Season & 1099s; Updated Companion Guides; January & February 2012 Holidays; Lead Screening Diagnosis Code; Office Administered Injections & Devices; Providers Serving Pregnant Woman; Pharmacy Billing; Payer of Last Resort; Pharmacy Claim Form; Emergency 3-day Supply; Next P & T Meeting; PDL Update; Prior Authorization Criteria Update; and the January & February 2012 Workshops.