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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.
Providers are reminded that the requirement for Prior Authorization Requests (PARs) is currently suspended for Pediatric Long-Term Home Health and Private Duty Nursing as of July 1, 2020. The Department of Health Care Policy & Financing (the Department) had previously provided guidance that the PAR requirement would not be restarted before September 30, 2020. The date for PAR requirement has been extended to at least November 30, 2020. A phased-in implementation will be completed and the Department will send further communications about when PARs will be required and how the requirement will be implemented.
Note: PARs do not need to be submitted to the Department’s prior authorization vendor, eQHealth Solutions, for dates of service beginning July 1, 2020. Any updates will be communicated via future Provider Bulletins, the ColoradoPAR website, and the Private Duty Nursing and Pediatric Long-Term Home Health Services Pre-Approval Project web page. This web page contains information about action steps, communication and training.
For more information, refer to the latest email communication sent out to affected providers on October 20, 2020, titled: Reminder - Prior Authorization Requests for Long-Term Home Health and Private Duty Nursing Providers.
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.
Effective October 1, 2020, the 3M™ EAPG solution within the Colorado interChange was updated to increase the accuracy of outpatient hospital claims (Type of Bill (TOB) 13X) review and adjudication based on State and Federal policies. Previously, multiple EAPG return codes were mapped to a single edit and Explanation of Benefits (EOB) code. With the update, each EAPG return code was mapped to a single edit and EOB code.
Appendix R, available on the Billing Manuals web page, was updated with the new EAPG outpatient hospital claim EOB codes and descriptions. Contact the Provider Services Call Center at 1-844-235-2387 with any questions related to the outpatient hospital EAPG claims editing solution.
This change impacts outpatient claims for provider types 01 (Hospital – General) and 86 - Community Clinics/Community Clinic Emergency Center (CC/CCEC).
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.
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.
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.
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