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Are your billers and claims specialists receiving Department email notifications? Oftentimes, only the credentialing specialist who originally enrolled the provider is subscribed to our mailing list. To make sure the appropriate person within your practice is getting the information they need, please invite them to sign up here. Under Email Lists, select “00 – All Provider Emails to receive: 1) a weekly Last Week in Review newsletter, which includes Hot Topics, Featured Provider Resources, and status updates on Known Issues; 2) a monthly notification when the Provider Bulletin is published; and 3) occasional general announcements relevant for all providers. Select your provider type to subscribe to communications specific to your provider type, including status updates on Known Issues. Also, make sure to keep contact information up to date in the Provider Web Portal.
The Department of Health and Human Services has formally extended the Public Health Emergency (PHE). The PHE can be extended for up to 90 days at a time. This extension starts January 21, 2021, and would end, unless extended again, on April 20, 2021. Updates will be published via the Public Health Emergency Planning web page.
Refer to the January 8, 2021, email A Message from Executive Director Kim Bimestefer for more information.
The Colorado interChange has been updated with the COVID-19 vaccine procedure codes. Providers may visit the Provider Rates & Fee Schedule web page and select Immunization Rates under the Immunization Rate Schedule drop-down section for updated rate information.
Refer to the January 8, 2021, and January 11, 2021, emails for more information and resources regarding the COVID-19 vaccine.
COVID-19 vaccines are a covered benefit for Health First Colorado (Colorado’s Medicaid Program) members. Refer to the December 16, 2020 email for more information and resources regarding the COVID-19 vaccine.
The General Assembly and Joint Budget Committee approved a rate increase effective for dates of service on or after January 1, 2021. The increase applies to services rendered to members living in the City and County of Denver for select Home and Community-Based Waiver Services.
Refer to the Home & Community-Based Services (HCBS) Providers email and HCBS Case Managers email for more information regarding the wage increase.
Effective Monday, August 3, 2020, providers of Electronic Visit Verification (EVV) services were required to utilize an EVV system to collect service visit data. On January 1, 2021, claims requiring the use of EVV will deny if not matched to a valid EVV record. Refer to the Program Manual located on the Electronic Visit Verification Resources web page for guidance if unsure why a claim did not match to a verified visit or contact the Provider Services Call Center for assistance. Contact Sandata customer service at (855) 871-8780 or email email@example.com for assistance on verifying visits or entering EVV information.
Visit the Electronic Visit Verification – Main web page for timelines, guidance, resources, and all other EVV information. Refer to the April 2020 Provider Bulletin (B2000447) and the September 2020 Provider Bulletin (B20000452) to read the EVV articles.
Currently enrolled organization health care providers (not individuals) will be required to submit claims with dates of service on or after January 1, 2021, using the unique NPI that is associated with the provider type provider type and service location. Section 8.126.3 A.2.C of 10 CCR 2505-10 8.100 (Volume 8 Rules) specifies that all health care providers must submit every claim using the unique NPI used for enrollment that identifies both the provider type and site (service location) effective for dates of service on or after January 1, 2021.
The Provider Web Portal has been updated to allow providers to add the newly obtained NPIs to the enrollment records. Visit the Provider Maintenance - Adding a National Provider Identifier (NPI) Provider Web Portal Quick Guide web page or, for Hospital providers, the Provider Maintenance - Hospital Provider Adding a National Provider Identifier (NPI) web page, for more information.
For more information, visit the Colorado NPI Law web page. Providers are also encouraged to review the Special Newsletter - National Provider Identifier (NPI) Billing Updates sent to providers on July 2, 2020, available on the Provider News page under the Newsletters > 2020 drop-down section.
Note: Home & Community-Based Services (HCBS) providers that are considered Atypical (non-medical) are not required to have an NPI. However, Atypical providers are reminded that if already using an NPI, they must be in compliance with the law referenced above.
The Colorado NPI Law also does not apply to individual practitioners (Individuals Within a Group, Billing Individuals or Ordering/Prescribing/Referring), as individuals are limited to one enrollment and one NPI per person.
Not all deletions, changes and additions for 2021 Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) are covered by Health First Colorado (Colorado’s Medicaid Program). Providers are reminded to check the Provider Rates & Fee Schedule web page before billing, to ensure the codes are a covered benefit. All codes must be reviewed for medical necessity, prior authorization coverage standards and rates before the codes are reimbursable. Communications will be sent with coverage information in the coming weeks.
Effective October 1, 2020, references to the current fiscal agent will now be Gainwell Technologies. Visit the News and Media web page of the Gainwell Technologies website to review the Press Releases.
Revalidation is underway. Child Health Plan Plus (CHP+) and Health First Colorado (Colorado’s Medicaid Program) providers must revalidate in the program every five (5) years to continue as a provider.
Providers can find their upcoming revalidation deadline by checking the new Provider Revalidation Dates spreadsheet, now available on the Revalidation web page under the Health First Colorado and CHP+ Provider Revalidation section.
Visit the Revalidation web page for additional information and links to helpful resources. Providers are also encouraged to review the Special Revalidation Newsletter and Special Revalidation Newsletter II, available on the Provider News web page under the Newsletters > 2020 drop-down section.
Effective September 26, 2020, the Colorado interChange has been updated with a claims editing solution in accordance with Senate Bill (SB) 18-266, which requires the Department to implement new initiatives intended to help control Health First Colorado’s costs and ensure appropriate claims payment. The Department and Gainwell Technologies (formerly DXC Technology) are working with Change Healthcare to implement the ClaimsXten™ tool.
Professional and Outpatient claims received in Colorado interChange will automatically process through ClaimsXten™ to apply additional editing based on State and Federal policies. This additional editing tool will help to identify inappropriate bill coding and reduce potential overpayments.
The following claims and providers services are excluded:
Refer to the Provider Claim Types Processed Through ClaimsXten™ chart for a complete list of included and excluded provider/claim types.
Providers are encouraged to visit the Provider Training web page for the latest updates and information on the ClaimsXten™ training session schedule as dates and times are subject to change.
Providers are encouraged to visit the Ensuring Appropriate Claims Payment web page for information on upcoming trainings, FAQs and other updates.
COVID-19 News and Resources
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