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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 Colorado interChange is being 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 DXC Technology (DXC) are working with Change Healthcare to implement the following tools:
The Ensuring Appropriate Claims Payment project is anticipated to begin in late Fall 2020. The project has two components:
An informational webinar will be available prior to the system change. All providers are encouraged to attend the webinar for information regarding ClaimsXten™ and the upcoming improvements to the 3M EAPG solution.
Provider training sessions will also be announced soon. These sessions will be conducted by DXC and will provide technical guidance.
Providers are encouraged to visit the Ensuring Appropriate Claims Payment web page for information on upcoming trainings, FAQs and other updates.
Contact HCPF_ClaimXten@state.co.us with questions and comments. More information will be provided in future communications.
The Provider Enrollment web page has been updated to improve the provider enrollment experience and more clearly describe each step of the enrollment process.
Visit the Provider Enrollment web page for Enrollment Instructions & Application, enrollment resources and forms, next steps after completing your application, Ordering, Prescribing, or Referring Provider Information, general Enrollment News & Updates, and more.
Health First Colorado (Colorado’s Medicaid Program) provider rate decreases were approved during the 2020-2021 legislative session and are effective for dates of service beginning July 1, 2020. All rate adjustments are subject to Centers for Medicare & Medicaid Services (CMS) approval prior to implementation. The fee schedules located on the Provider Rates & Fee Schedule web page have been updated to reflect the approved 1.0% across-the-board rate decreases. Rates will be updated in the Colorado interChange once approval is received from CMS.
Refer to the July 2020 Provider Bulletin (B2000450) for further details on services and supplies approved for across-the-board decreases and information on how this affects Home & Community-Based Services.
Inpatient claims with a To Date of Service (TDOS) of July 1, 2020, and later, will no longer require hospitals to bill a mother’s delivery and services provided to newborns during the mother’s inpatient stay under a single combined claim. For additional information on reasons for the change, review meeting materials on the Hospital Stakeholder Engagement Meeting web page.
PAR requirements are being suspended for Pediatric Long-Term Home Health and Private Duty Nursing as of July 1, 2020, until approximately September 30, 2020, if not later. PARs do not need to be submitted to eQHealth Solutions for dates of service beginning July 1, 2020.
For more information, refer to the email communication sent out to affected providers on June 20, 2020, titled: Update to Prior Authorization Requests for Long-Term Home Health and Private Duty Nursing Providers.
The Affordable Care Act requires providers to complete revalidation every five years. The next round of revalidation deadlines will begin in October 2020, based on previous provider enrollment approval dates. Providers will be contacted via email approximately six months prior to their exact revalidation deadline with further instructions.
Refer to the Revalidation Newsletter, available on the Provider News web page under "Newsletters - Last Week in Review," for the latest revalidation information. Visit the Revalidation web page for more information and links to additional resources.
Effective April 10, 2020, providers will be allowed to temporarily enroll in Health First Colorado (Colorado's Medicaid Program) to provide services during the public health emergency. Temporary enrollment will end once the public health emergency ends. Prior to any temporary enrollments being terminated, providers will be notified and given the opportunity to convert from temporary enrollment to long term enrollment by updating the application and completing the requirements.
New applicants will be required to indicate temporary enrollment due to the public health emergency or long term enrollment.
In addition to selecting a provider type and primary specialty, each applying provider will need to add one of the following specialties to their application:
This applies only to provider types for which application fees, fingerprinting and/or site visits are required, including:
For providers choosing to enroll temporarily:
COVID-19 News and Resources
Completed Additional Reprocessing for Anesthesia Providers - Fiscal Year 2019-2020 Provider Rate Increases and Adjustments 11-4-2019
Additional Reprocessing for Anesthesia Providers - Fiscal Year 2019-2020 Provider Rate Increases and Adjustments 10-25-2019
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