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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.
Effective July 31, 2019, the Provider Web Portal has been updated so providers can remove claim details when adjusting a previously paid claim. A “Remove” link has been added to the Submit Dental Claim, Submit Institutional Claim and Submit Professional Claim screens in the “Service Details” section under the “Action” column. Providers can use the link to remove the applicable claim detail lines before resubmitting the claim.
Refer to Step 3 in the Submitting an Institutional Claim and Submitting a Professional Claim Provider Web Portal Quick Guides located on the Quick Guides and Webinars web page for more information.
Health First Colorado (Colorado’s Medicaid Program) provider rate increases were approved during the 2019-2020 legislative session and are effective for dates of service beginning July 1, 2019. The fee schedules located on the Provider Rates & Fee Schedule web page have been updated to reflect the approved 1.0% across-the-board (ATB) rate increase and targeted rate increases and decreases. The updated rates were implemented in the Colorado interChange on 7/24/19.
Claims were reprocessed by DXC on 7/26/19.
In response to provider suggestions, the Department and DXC have updated provider enrollment letters. Effective July 4, 2019, provider enrollment letters will now include the Health First Colorado ID. The National Provider Identifier (NPI) will also continue to be included in provider enrollment letters.
If the Department of Health Care Policy & Financing (the Department) implements rate increases, claims that were already billed with and paid at a rate lower than the new rate cannot be adjusted for the higher rate by DXC Technology (DXC). The Department will always use the “lower of” pricing logic. Providers are advised to bill their usual and customary charges.
Beginning April 1, 2019, the Outpatient Speech Therapy benefit requires a Prior Authorization Request (PAR). If a PAR is denied for “no Medicaid benefit,” providers should contact eQHealth Solutions for specific details on why that particular member does not qualify for the benefit.
Adults (members ages 21 and over) must have Alternative Benefit Plan (ABP) coverage to receive habilitative speech therapy. Providers should verify member eligibility in the Provider Web Portal for ABP coverage prior to rendering habilitative services. For detailed, step-by-step instructions on verifying member eligibility in the Provider Web Portal, refer to the Verifying Member Eligibility and Co-Pay Provider Web Portal Quick Guide, available on the Quick Guides and Webinars web page.
There is one allowable exception: adults who do not have ABP coverage may receive services billed under CPT 92609 for habilitative reasons. Refer to the Speech Therapy Billing Manual, available under the CMS 1500 drop-down section of the Billing Manuals web page, for further details.
Visit the Outpatient Speech Therapy Benefit web page for more information and links to helpful resources.
Effective 5/22/19, a new weekly automated system process will reduce turnaround time on the processing of TPL information entered in the Provider Web Portal. Additional processing will still be required if a member has multiple active policies on file.
The Effective To date will be automatically updated to 12/31/2299. If the policy is no longer active, providers should update the TPL record with a valid termination date.
Refer to the Adding and Updating Third-Party Liability (TPL) Information - Provider Web Portal Quick Guide, available on the Quick Guides and Webinars web page, for illustrated, step-by-step instructions on adding and updating TPL information via the portal.
Effective April 24, 2019, provider Taxpayer Identification Numbers (TIN) are being validated against IRS data. If a provider’s TIN does not match the IRS data, the provider will receive a letter notifying them that their contract has been put on hold until the TIN is verified. The letter will include what type of IRS documentation is required to verify the TIN and specific instructions on how to submit the required documentation.
Effective May 1, 2019, the Summary Page of the RA will be updated to include notifications when a provider has received a paper check which is now expiring or has expired.
Notifications on the status of any uncashed paper checks will be displayed on the RA under one of three categories:
Refer to the example of the RA Summary Page. For more information, refer to the Reading the Remittance Advice (RA) Dated on or after 1/9/2019 Provider Web Portal Quick Guide. Providers should contact the Provider Services Call Center at 1-844-235-2387 with any questions.
The Department of Health Care Policy & Financing (the Department) must implement an evidence-based hospital review program to ensure that the utilization of hospital services is based on a member’s need for care, according to the Senate Bill 18-266 titled Controlling Medicaid Costs. Visit the Controlling Medicaid Costs Initiatives web page for additional information.
Prior Authorization Requests (PARs) will be required for inpatient hospital services for dates of service beginning June 17, 2019.
Visit the Inpatient web page of the ColoradoPAR website for additional information and links to helpful resources.
Effective April 1, 2019, back surgery and other select surgical codes will require a PAR through the Department’s PAR vendor, eQHealth Solutions. Codes requiring a PAR will be noted in Appendix M - Procedures Requiring Prior Authorization, available on the Billing Manuals web page under the Appendices drop-down section. A PAR can be requested utilizing the online PAR portal, eQSuite®.
Visit the ColoradoPAR website for more information, including training opportunities for utilizing eQSuite®, the specific codes requiring a PAR, and other provider resources.
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