Provider Web Portal

Provider Web Portal Cheat Sheets

Delegates

Updating your EFT/ERA Information

Validating a Trading Partner ID (TPID)

Provider Maintenance, including:

  • Updating contact information
  • Opt-out of Provider Directory
  • Managing Affiliations

FAQs - Jump to... 

Batch (X12), EDI, & Trading Partner Questions

Reports Questions

Training Questions

General Provider Web Portal Questions

EFT/ERA Questions

Updating Provider Information/Affiliations

Member Information/Verification Questions

Provider Web Portal Registration/Delegation

Claims Questions

PAR Questions

Eligibility Questions

Enrollment Questions

Alerts & Secure Correspondence

Online bill pay

Batch (X12), EDI, & Trading Partner Questions

Can files be transmitted both through a Clearinghouse and through the new Provider Web Portal?

Yes, batch (X12) files can be transmitted through a Clearinghouse and through the Provider Web Portal; both methods (of batch submission) require a Trading Partner ID.

If you use a Clearinghouse, the Clearinghouse needs to obtain a HPE TPID.

If you want to transmit batch through the Web Portal, you need to obtain a HPE TPID.
You do NOT need a HPE TPID, to submit single claims (not batch) through the Web Portal.

Do we have to be a TPID in order to upload 837 files?

Yes, a TPID is needed to upload 837 files.

If we use a Clearinghouse to submit our claims, but we pull our own 835 remit, do we need a TPID?

Yes, if you would like to download your own 835 you will need a TPID. You will also need to use the Manage Accounts page within the Provider Web Portal to define which TPID will submit your claims and which TPID will receive your 835.

Is the primary TPID the only one able to upload and download files or can we designate another employee that will be able to do so as well?

A Billing Agent will be able to create delegates who can then upload and download files.

What would a provider use the “file exchange” for?

Providers could use the file exchange to upload and download batch files (including X12 reports) directly through the Provider Web Portal, rather than through FTP or through a Clearinghouse.

Is it common for a Clearinghouse to serve that function for multiple providers?

Yes, it is fairly common for a Clearinghouse to act as a Trading Partner for multiple providers. Note: A Clearinghouse could use the same TPID with all of their clients (providers).

If a Trading Partner or Clearinghouse serves that function for multiple providers, will all of the providers for which they perform this service appear on the home page?

No, the Provider Web Portal will not give indication that a Trading Partner serves more than one provider.

Where can I go to get more information on batch claims and deciding whether or not to register as a trading partner?

Please visit our EDI Support webpage, or call the EDI HelpDesk at: 1 (844) 801-8482

Do I have to enroll as a Trading Partner if I am a single provider who bills his own claims (not in batches)?

No, you do not need to enroll as a Trading Partner to submit single (interactive) claims through the new Provider Web Portal.

If I send individual claims through my vendor, do I need to enroll my own name as a trading partner?

No, your vendor would need to enroll as a Trading Partner, but you would not.

If I bill every client individually, every claim is submitted separately, but I bill 50-100 clients at a time/once a week. Does it mean that I am doing batch billing?

Not necessarily. If you’re submitting your claims individually through the Provider Web Portal but typing the claim information into the portal, you are not submitting batch files. Batch is a technical term, and does not refer to “many” claims, but rather the file format.

If we want to pull our payment reports/835 or run eligibility on the portal do we need a TPID?

You do not need a TPID to:

  • download Remittance Advice (RA), formerly Provider Claims Reports (PCR)
  • verify member eligibility (one at a time)
  • You do need a TPID to:
  • download any X12 reports (such as an 835)
  • upload a 270, download a 271 (batch eligibility)

Is a Trading Partner synonymous with group enrollment?

Not necessarily, a Group is the billing provider for one or more individuals within a Group (rendering providers). Example: Salud Clinic may be a Group, and the doctors who work there may be the Individuals within a Group. Health First Colorado will report the income paid to Salud, to the IRS.

A Trading Partner is someone who submits batch claims or eligibility files on behalf of a billing provider, but may not receive the income from Health First Colorado. Example, Trizetto may submit claims for Salud Clinic, but does not receive the income from Health First Colorado. They are simply handling the file transmission to or from the fiscal agent (HPE).

If Salud submits their own batch files however, they would be the Group and the Trading Partner in that instance.

if I use a Clearinghouse to submit most of my claims but still want to send some through the Web Portal, do I need a trading partner ID?

Yes, if you are going to retrieve your own 835, you will need a Trading Partner ID.

What is a Trading Partner?

A trading partner is anyone who trades information (submits or retrieves the X12 HIPAA compliant file). If you are not submitting your own X12 files or retrieving your own X12 files, you do not need a trading partner ID.”

If I want to use a vendor to submit batch claims on my behalf, who can I use?

Health First Colorado does not make recommendations for who you should use as a Trading Partner, but a Google search for “medical claims Clearinghouse companies” should give you a good place to start. You can contact HPE to verify they are enrolled for the Health First Colorado program.

As the practice manager who will be managing the enrollment for all providers and users, where do I register? Am I a delegate?

You will want to register for the Provider Web Portal. If you are going to be the primary user of the Provider Web Portal, then you don’t need to be a delegate.

For Providers that are organizations, does the display name need to be the organization name, or the name of the individual doing the set-up?

Either will work. The display name is something you’ll only see in the Provider Web Portal, and the display name won’t affect your claims (or anything else).

How do we know what file delimiter we need to use?

That’s really a personal preference. However, if you have a billing person or Department, you may want to check and see if they have a preference. Otherwise you can just stick with the default option and change it later if you need to.

Will there be somewhere I can check to see if my billing agent has received a Trading Partner ID?

We do have a list published here, but you can also check with your billing agent. They will need to give you their TPID in order for you to “authorize” them as a Trading Partner.

Will we be able to pull up the remittance report (to show what claims have been paid) if we do not enroll as a trading partner?

Yes, the Search Payment History panel on the Provider Web Portal will provide this information for providers. You do not need to enroll as a trading partner to access remittance advice (RA), previously called provider claim reports.

If I bill for more than one company, do I have to enroll as a Trading Partner?

Not necessarily. You could submit single claims (through the Provider Web Portal) on behalf of your clients, and that would not require you to be a Trading Partner. However, it would require each of your clients to “delegate” claims access to you.

If the Provider is also the billing agent, will the Provider also need a Trading Partner ID to enter batch claims and receive the specific reports mentioned that are available through Trading Partner access?

Yes, anyone who wants to transmit batch (X12) files needs to enroll as a Trading Partner, and complete file testing for HIPAA compliance.

Can our practice be a Trading Partner as well as our Clearinghouse? In other words, can there be 2 Trading Partners?

Yes, both you and your Clearinghouse can enroll as Trading Partners and receive a Trading Partner ID. Then on the Manage Accounts page within the Provider Web Portal you will indicate which transactions each Trading Partner ID will submit/receive.

I have 16 locations, but I currently only have one Trading Partner ID. Will I be assigned one new Trading Partner ID # or 16 individual ones?

While you could enroll for 16 different Trading Partner IDs, we recommend that you only enroll for one Trading Partner ID, and “authorize” that TPID to submit for all your locations.

Is there a minimum threshold for submitting batch claims? What is a "large amount" of claims?

There is no minimum threshold for batch claims. Batch is a technical term referring to the file type and method of submission:

  • Whether one claim or 1000, claims submitted in an X12 file are considered batch.
  • Whether one claim or 1000, claims submitted by typing the claim information into the Provider Web Portal are considered single (interactive) claim submission.

How do Clearinghouses test?

Here is our Getting Started Guide, but you can also visit our EDI Support webpage, or call the EDI HelpDesk at: 1 (844) 801-8482.

I saw a spreadsheet that showed some Clearinghouses that have already "tested"; how did they do that before Go Live?

The testing process for Trading Partners is a separate process, not requiring access to the parts of the Web Portal that are not yet active.

Reports Questions

What are the different types of reports that can be downloaded from the new Provider Web Portal?

You will be able to download Remittance Advice (RA) reports, Prior Authorization (PA) reports, Prior Authorization (PA) letters and CTMS letters from the Provider Web Portal.

Will Remittance Advice (RA) reports (from the new Provider Web Portal) be available for claims processed in the legacy system?

No. We will transfer over 6 years of claims data, but not in the form of reports. Please make sure you download any reports you want before March 11, 2017. March 11, 2017 is the last day to access the legacy Web Portal, including reports and PAR letters.

What is a file delimiter?

According to dictionary.com, a file delimiter is, “a blank space, comma, or other character or symbol that indicates the beginning or end of a character string, word, or data item.”

While an excel file may look like this: 

Column 1 Column 2 Column 3

a file with a comma as the delimiter, would show you “Column 1,Column 2,Column 3”.

Can I select a different file delimiter after I register?

Yes, you can change your preferred file delimiter at any time in the “My Profile” section of the Provider Web Portal.

If we have a Trading Partner that enters our claims for us, could we get an automatic 835 report sent to them, rather than downloading it and sending it to the trading partner manually?

The new Provider Web Portal does not have the capability to automatically send reports out to different parties. However, your Trading Partner may log into their Trading Partner account and pull your 835 report at any time, so long as you have authorized their TPID to do so.

Is it a problem if you enroll as a Trading Partner even if not required?

It’s not a problem, but you’ll probably receive some emails you don’t need. If you would like to disenroll, just call the EDI HelpDesk at 1 (844) 801-8482.

Can RAs be printed from the Provider Web Portal or must they be downloaded first?

They can be opened from the portal and printed which initiates a temporary download. The file size is very small so this option really depends on preference.

How far back will the portal allow us to pull reports from?

As of right now, there is no limit. The Department will notify you if this changes.

In the current portal, providers or TPs can pull an accept/reject report or a 999. Is the accept/reject report option no longer available?

The accept/reject report will no longer be a report option; the 999 will be still be available. Please review the Guide to Go Live more information on report changes.

Training Questions

Can we retake a session for more clarification?

Yes, you can take a session as many times as you like. You can also view a recording of the sessions on or after February 6th.

Where can we find the handouts mentioned during training?

The content is PowerPoint versions of the slides demo’d in the session. You can request them by sending an email with which sessions you would like to co.trainers.mail@hpe.com

Do we need to complete Web Portal training sessions to be able to enroll?

No. Web Portal training is not a prerequisite for Enrollment, Revalidation, or Provider Web Portal registration. However, enrolment/revalidation training is highly recommended.

Will certificates be issued upon completion of these classes to show we have undergone training or what do I need to do to prove I have done training?

Certificates will not be issued; however, we do have attendance records if they are needed at a later date.

If I am a new provider, do I need to take all training sessions?

We recommend it; however, it’s not required.

General Provider Web Portal Questions

Do we need to use a specific browser to access the portal?

No. The Provider Web Portal was built to be used with any modern Web Browser. You can see the Website requirements here: https://colorado-hcp-portal.xco.dcs-usps.com/hcp/provider/Home/WebsiteRe...

Do we need to update our license and insurance information before billing for the first time?

This updated information should have been provided during your revalidation in the new system. If it has changed you can update it using Provider Maintenance in the Provider Web Portal.

After I log into the Provider Web Portal, there is a “Location ID” at the top of the page. Is this our facilities Trading partner ID or Provider ID?

This is the service location ID and is usually the same as the Provider ID.

How long before a user must change or update a password?

The user will be requested to update their password after 90 days.

Will our old website log-in info work? Or is this whole new system we need to register for?

Old Web Portal login information will not work for the new Provider Web Portal.

If an employee locks themselves out of the system, where do you go to unlock them so they can access the Web Portal again?

The provider can use the Forgot User ID and Forgot Password functionality of the Provider Web Portal to determine their User ID or Password. However, if they are locked out, they will need to call the Provider Help Desk (1-844-235-2387) to reset the lock.

EFT/ERA Questions

Can we just continue receiving paper checks?

Only the following providers are eligible for an EFT exemption:

Do I need to enroll in EFT again if I've already included that info in provider revalidation?

No, if you provided your EFT information during revalidation you do not need to provide it again.

I need to change my electronic funds deposit information ASAP. What is the best way to do so? Can I do it online?

You can change your EFT information online through the new Provider Web Portal. You will just login, and click the link that says “EFT/ERA Enrollment”. You will receive paper checks for two weeks after changing your EFT information, though, so make sure your mailing address on file is also up to date. You can find detailed instructions for changing your EFT/ERA here.

Will EFT info migrate over from Xerox?

No. EFT information will not migrate over from Xerox. However, any EFT information you submitted in your enrollment or revalidation application will remain in the system.

Is the EFT/ERA information for the group level or the individual provider?

The EFT/ERA information is for the billing (group) provider.

Updating Provider Information/Affiliations

How do we affiliate a provider with a group?

You will need to login to the Provider Web Portal as either the Individual within a Group or a Group, and then click the Provider Maintenance link. From here you can click “Group Affiliations” or Affiliations" and then add the information. You can find detailed instructions for Affiliations here.

Important: Individuals Within a Group must be affiliated to a Group! Affiliating an individual to any other Enrollment type (Facility, Atypical, etc.), will likely cause claim denials.

If a provider floats to numerous service locations with different billing addresses, website addresses, etc. how will that be shown in the provider's data?

A separate revalidation enrollment application should have been submitted for each service location, unless the provider is an Individual within a Group. If the provider is an Individual within a Group, they just need to affiliate to each Group location. If the provider is not an Individual within a Group, a separate enrollment application needs to be submitted for each service location.

Is the addition of the network participation information a required element? What is it used for?

It is not required, unless you participate in (and have a signed contract with) a Managed Care Organization (MCO) or Behavioral Health Organization (BHO). This lets the MCO or BHO bill for the provider. It also allows members to search for a provider who is in that network.

If we have a new satellite location for our provider, can that be added via the Web Portal?

A new Provider Enrollment Application will need to be submitted for any new service location. In accordance with federal regulations and guidance, providers with multiple service locations (sites) must enroll each service location separately.

How quickly do changes in the Provider Web Portal become effective?

If they do not require approval, within 24 hours. If they do, then it depends on how long verification takes, generally 3-5 business days.

Can I change my Provider Type or Specialty in the Provider Web Portal?

You may add or update a secondary Specialty; however, a change to Provider Type or Primary Specialty will require a new Provider Enrollment Application.

If an Individual within a Group leaves the group, where do we update that information? Would that be considered a disenrollment?

If they are just leaving your group, but do not want to end their participation with Health First Colorado, you can just remove them from your list of affiliated providers.

If they are leaving your group and ending their participation with Health First Colorado, that should be a disenrollment.

If we are adding a new provider into the Health First Colorado System, do we do this through the portal as well? Or is this a separate enrollment application?

If the provider you want to add is already enrolled as an Individual within a Group, they can just add you to their list of affiliated groups, or you can add them to your list of affiliated providers.

If the provider isn’t enrolled with Health First Colorado yet, then they will need an enrollment application.

Will you still accept the paper provider update form?

No. As of 3/1/17, all updates to provider information need to be made online through the new Provider Web Portal.

Will all of this info be in the system based on the enrollment that was already completed? So, is it only necessary to make a change if it is different from the revalidation/enrollment?

Yes. The information shown in the Provider Web Portal is populated from the information you gave us during revalidation or enrollment. You only need to make a change if you need to add, remove, or update informatin.

Will we get some sort of notification that the update has been reviewed and updated?

Yes. You should receive an email confirming your update request, and then another when the update has been made.

Do we use the disenroll section when we term a provider?

The provider should use the disenroll section if they are ending their participation with Health First Colorado. If the provider is just leaving your group, but does not want to end their participation with Health First Colorado, you can just remove them from your affiliated providers list.

Member Information/Verification Questions

Can I see all claims for a member or only my services?

Only claims where you are the billing provider, per HIPAA regulations.

Can you verify Dental eligibility through the new Provider Web Portal?

Yes, you can verify if the Member is eligible for dental benefits.

How far back can eligibility be checked, a year?

Yes, and only one month at a time.

What are lock-in details?

The Client Overutilization Program (COUP, also known as ‘Lock-In’) is a statewide surveillance and utilization control program that safeguards against unnecessary or inappropriate use of care or services. The Lock-In Details describe the provider(s) the member is eligible to see for the given service.

When verifying eligibility: will it list if member has Denver Health, Colorado Access, Rocky Mountain Health plan or some sort of Medicare insurance?

Yes, the Member’s Managed Care Assignment will be listed on the Coverage Details page within the Provider Web Portal. A member’s Medicare insurance will display on the Other Insurance Detail Information page of the Provider Web Portal.

Will client IDs stay the same?

Yes. Member IDs will not be changing,

Will the eligibility verification screen list units? We bill most claims by unit and not $ amounts.

Yes, the Limit Details section will display both dollars and units.

Can you explain the "verification for newborn" box on the first page?

The Verification for Newborn option can be used to look up Newborn eligibility information, if the newborn Member ID is not known.

Will there be a way to search multiple members at one time?

No, not through the Provider Web Portal.

Does Member Focus viewing show patient address?

The Member Focus viewing page will show the members city and state.

Would a home modification provider have access to member eligibility?

If you have enrolled. have been approved, and have registered for Provider Web Portal access, yes.

Are we able to print the eligibility?

Yes, there is a Print Preview button at the top of the Coverage Detail page.

Are you referencing Member ID as a Client ID as it was in the old portal?

Yes, Member ID is the same as Client ID.

Provider Web Portal Registration/Delegation

Do I use NPI for myself as an individual, or for my company (of which I am the only provider). Both my individual and company revalidations have been approved.

Both! You will need to log-in as an individual to update your license information and other practitioner details; you will need to use your company NPI for billing.

Can we register our Administrative logon User?

A provider (or administrator, if the provider has someone else in charge of submitting their enrollment) will use the provider’s information to register with the Provider Web Portal. This provider (or administrator) can then create delegates for each user in the company who may need to access the Provider Web Portal on behalf of the member.

Does each user in the company do this, or an administrator?

A provider (or administrator, if the provider has someone else who is in charge of submitting their enrollment) will use the provider’s information to register with the Provider Web Portal. This provider (or administrator) can then create delegates for each user in the company who may need to access the Provider Web Portal on behalf of the member.

As a trading partner - MCO will our Provider ID - Portal ID/login credentials also be changing?

As an MCO, your Provider ID will be the same as your legacy ID. The Provider Web Portal login information will be changing with the new system, and will be created by you during registration. The new system will also require a HPE Trading Partner ID for those who will be submitting/receiving X12 transactions.

How does a delegate log into the portal?

A provider will use the Manage Accounts page within the Provider Web Portal to enter their delegates' information and will receive a delegate code for each delegate. The Delegate will then use their information, along with the assigned delegate code, to register with the Provider Web Portal.

We are a credentialing company that maintains several groups with numerous individual providers. Right now, we have individual logins and can maintain all provider information. What is the best way to continue to do this with these new login profiles?

Using the delegate functionality available in the Provider Web Portal is the best way. Each group and provider will link to the delegate on the Manage Accounts page. The delegate will then be able to use their one login to switch between each group and provider that has assigned them as a delegate.

Are we able to add employees as delegates under a group provider or are they done as each individual provider?

Both groups and individual provider can add delegates.

Can you change what you give a person access to if needed?

Yes, just return to the Manage Accounts page, click on the delegate’s name, and update the functions they are able to access on your behalf.

For providers in a group, will a delegate need to be set up for the group submitting the claims, etc.?

No, if the group is the billing entity on the claim, the group will register with the Provider Web Portal and be able to submit claims for the provider.

To add office staff so they can access the new Web Portal, I add them under the first tab under manage accounts, since they have not accessed this new Web Portal yet, correct? They have all been using the current Web Portal but just need to be registered in the new one…

Correct, if they are not already a delegate for another provider and do not have a delegate code for the new Provider Web Portal, then you will use the first tab. If the delegate is already assigned to another provider and already has a delegate code for the new Provider Web Portal, then you will use the second tab.

We are a group of providers. I'm guessing we register the Group, then each individual provider under the group?

Yes, you will register the group and the individual providers with the Provider Web Portal.

Does the trading partner need to be added to each provider in the practice?

The Trading Partner will need to be linked to each billing provider. The Trading Partner does not need to be linked to the rendering providers.

If I am the billing agent for 3 separate provider ID's, do I need to set up separate biller accounts?

No. If you are a billing agent with a Trading Partner ID, you will register with the Provider Web Portal using your Trading partner ID. Each of the providers you work on behalf of will need to use the Manage Accounts page to indicate which Provider Web Portal functions and X12 transactions you can perform on their behalf.

We used this system when we revalidated, will those logins work?

No, you will need to register with the Provider Web Portal to create a User ID and Password for the new system.

If a provider is enrolled as individual provider within a group does the provider need to register separately on the portal to update any information relating to locations within the group?

No, the group will register with the Provider Web Portal to update their location information.

Does each delegate receive a separate code for each registered location, or one delegate code for all locations?

For a given delegate (one individual), the same delegate code should be used for all providers (locations) for which they are a delegate. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.

Under registration: If we have two separate providers (two different Provider ID's) can we register once and link both providers or do we have to register separately?

Each provider would register separately.

On the Provider Registration, what if we have 2 taxonomy codes for the same NPI and zip code? Do we have to complete 2 different Provider Registration accounts?

You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. So if you submitted 2 Provider Enrollment/Revalidation applications you will need two different provider registrations. However, if you have two taxonomies on the same Enrollment/Revalidation application, you will only need to have one provider registration and you will register with the primary taxonomy.

Will the RCCO role be able to add delegates?

Yes, a RCCO will be able to add delegates.

If we were approved for enrollment as a group and individual provider do we enter group NPI or provider NPI when registering?

You will enter the Group NPI when registering the group, and the individual NPI when registering the individual provider.

Is our registration what we did with revalidation or this is completely different?

Registration for the Provider Web Portal is different than Revalidation. Registering with the Provider Web Portal will give you access to the new Provider Web Portal and can only occur after your Revalidation application has been approved.

How do you get the delegate code?

A delegate code is provided by the first provider to add you as a delegate.

We have 2 NPI numbers, will we have to register them individually? Also, some employees work both programs. Will they need to register twice under a specific NPI?

You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. If some employees work for both programs the delegate functionality can be used. For a given delegate (one individual), the same delegate code should be used for all providers for which they are a delegate. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.

We have several provider NPIs that are associated with our Tax ID number. Do we have to register each NPI and then assign delegates to each provider enrollment?

Yes, you will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted. You can then assign delegates for each in the Provider Web Portal. For a given delegate (one individual) the same delegate code should be used for all providers they are a delegate for. This will allow the delegate to have one login to the Provider Web Portal where they can then switch between providers using the Switch Provider function in the Provider Web Portal.

We have several staff members that are currently able to access the Portal, so do I need to add them under "NEW delegate" for the new Provider Web Portal?

Yes, you would add them as a new delegate in the new Provider Web Portal.

What date can we begin enrolling our profiles in the new Provider Web Portal?

2/6/17

What if we do not have an NPI number or an NPI number was not required for revalidation? Can we use the 8-digit provider number we have now to register?

Yes, if you did not provide an NPI during revalidation you can use your Provider ID to register with the Provider Web Portal.

How do I verify my registration is complete?

You will receive two emails after you have registered with the Provider Web Portal. In the first email there will be a link that you must click and then enter your Password to verify your registration. After this verification, you will receive a second email indicating you have successfully registered.

Can multiple users register under 'provider' with the NPI and taxonomy or does it only allow one registry and that person has to set up delegates?

No, you can only register as a Provider once with the NPI and taxonomy that was submitted during Enrollment/Revalidation. The provider will then create the necessary delegates for others that need to work on their behalf.

I currently have one user name and one password to access the Web Portal. Will this be the case when the new system takes effect?

You will need to create a separate registration on the Provider Web Portal for each Enrollment application you submitted.

Can we only register when we have our application approved?

Yes, your application needs to be approved to register in the Provider Web Portal.

Can I use the same 4-digit number (in place of the last 4 of driver’s license) over & over if I have 50-100 delegates?

This is not the recommended process but the system will not stop you from doing this.

We have 13 locations that are enrolled separately. Do we have to register each location to check eligibility, claims, etc.?

Each enrollment needs to register with the Provider Web Portal. Then, within each registration you can assign the same delegate. You can then use this one delegate to login to the Provider Web Portal and switch between the different providers.

What if I have more than one taxonomy number for registration?

Use the Primary taxonomy code.

Claims Questions

Will we be able to view or look up claims submitted electronically?

Yes. You can view claims submitted through any media: paper, electronic batch, portal.

Are we only able to 'copy' a claim for a member after one is submitted? Are we able to copy a previously submitted claim for a member in order to create a new claim?

You can copy any adjudicated claim (one that is denied or paid), including claims from Xerox. A suspended claim cannot be copied.

If we process our own claims, we do not need a trading partner ID. Is this true?

If you will use the Provider Web Portal to submit individual claims via the Submit Claim process, you do not need a Trading Partner ID. You only need a Trading Partner ID if you are going to submit/receive X12 transactions.

Our practice does single claims. I have been told we would not be doing single claims through this portal. Can you confirm this?

You can submit single claims thru the Provider Web Portal.

Will Claims Data be available in the new system based on Provider ID #s?

A provider and/or anyone to which the billing provider has delegated claims inquiry access, will only be able to see the claims on which they are the “billing provider”. The RAs will have the Provider ID on them.

If my staff manually enters claims on the Health First website - will we need to get a trading partner ID?

If you only enter individual claims via the Provider Web Portal you do not need a Trading Partner ID. You will only need a Trading Partner ID if you will be submitting/receiving X12 transactions.

Are all Dental claims still submitted on the DentaQuest site?

Yes. Only dental claims for members who have a non-citizen, emergency services only eligibility status, will be submitted via the provider Web Portal. All other Dental claims for Health First Colorado members will continue to be processed through DentaQuest.

Will there be a number to call for claims issues? For example, denied claims?

The main call center number will have an option specifically for claims on 3/1/17. You can also use the secure correspondence option in the portal. The Call Center is open 8am -5pm Mon. thru Fri. 1-844-235-2387.

I currently submit individual claims each month. I am not a batch submitter. How does this affect my situation?

You will use the new Provider Web Portal to submit your individual claims.

Can you edit a claim once it has been submitted?

You would have to do either an adjustment or a reconsideration after the originally submitted claim has been adjudicated.

How many total records does this hold for claims?

Via the Provider Web Portal, providers will have access to all of their claims stored in interChange.  Xerox data from the past 6 years will be migrated into the new system.

Can we submit attachments through the Provider Web Portal, instead of having to send a paper claim? For example, a Sterilization Consent Form.

You will be able to use the new Provider Web Portal to submit claims with attachments. On Step 3 of the Submit Claim process in the new Provider Web Portal, there is a section where you can upload your attachments and submit them with the claim.

Is there an LBOD option on the portal for Professional claim submission (LBOD=Late Bill Override Date)?

Yes. but the LBOD is now done differently. Instead of submitting an LBOD, you will enter the last submitted ICN for that service in the Previous ICN field. Please review the Guide to Go Live for more information on LBOD changes.

How do we bill the secondary/crossover claim?

Select crossover claim from the Claim Type dropdown menu. The Medicare Crossover Details section will be displayed to enter information.

I'm a hygienist who sees patients in the nursing home. Do I send claims under dental or institutional?

Dental

Do you have to have to be set up with a trading partner just to check specific claims?

No

Was there a section on the institutional claims submission for the bill type? Also, I didn't see a section to submit an outpatient or inpatient claim under the institutional claims submission on the portal.

The first two digits of the type of bill are the "Facility Type Code" (example - 13 for outpatient claims) - the third digit (frequency type) will be automatically added depending on what type of claim you are submitting (original vs adjustment vs void)

If you have the same recurring charges monthly, will the system save your entered information for each one of the patients, we enter every single month?

You could copy the claim for the patient for the month previous and modify that information to submit for the new month (using new dates of service).

We currently submit individual claims online, not as a batch. Will we be able to do so on the new website?

Yes

Will we still be able to look at claims through the old portal, or will claims information be uploaded into the new?

The old portal will not be available. However, Xerox data will be back loaded and searchable in the new portal up to 6 years in the past.

PAR Questions

Will this be replacing EQHealth?

The EQ Process will not change at all. If you have questions relative to how your Provider ID change affects the EQ process, contact EQ at 1-888-801-9355.

Are the Prior Authorization numbers changing? They are currently one letter and six numbers.

The PA number in interChange is 10 digits: 1 digit for the media type (how the PA enters interChange), 2 digits for the year, 3 digits for the Julian date, and a 4-digit sequence number.

Can you clarify what type of PARs are submitted through the portal?

Nursing Facility PETI and Referral PAs can be submitted via the HPE Provider Web Portal. Referral PAs are completely optional and have no impact on your claims.

Eligibility Questions

Do I have to be a trading partner if I need to check individual eligibility?

No, you only need to be a trading partner for batch eligibility and batch claims.

Enrollment Questions

Will there be training for Provider Enrollment?

There is Provider Enrollment information and training available here.

All enrollment inquiries and questions can be sent to COProviderEnrollment@HPE.com.

Alerts & Secure Correspondence

Can closed call tickets be viewed/researched in Secure Correspondence to see the history? Is there another method to retrieve history?

Yes, but you are not able to reply to a Closed Secure Correspondence message. Closed calls are logged in the CTMS (Call Tracking Management System) and accessible by the call center reps if further action is needed. When documenting your correspondence, please note the CTN (Call Tracking Number) automatically assigned to the case. This will make conversations with the call center easier to reference.

What type of correspondence should be transferred to and from HPE in the secure correspondence area?

Any written communication containing PHI and protected by HIPAA. All correspondence with HPE, aka the fiscal agent for Health First Colorado.

Will we be able to print off your response in the secure correspondence?

Currently, the Provider Web Portal does not provide a print option for Secure Correspondence but you could use your browser's print capability. 

What is the approximate turnaround time for secure correspondence?

The turnaround time depends on the question asked, but is typically 3-5 business days.

Can secure correspondence be used for claim status, PAR, eligibility inquiries.

Yes, these type of questions can be asked via Secure Correspondence on the Provider Web Portal.

Do I need to call first, then use secure correspondence?

If the request is urgent, we suggest you call. Otherwise, secure correspondence is the preferred method of communication for non-urgent requests.

Can you send appeals or reconsiderations for claims in the secure correspondence?

Yes

Online bill pay

Regarding the Online Bill pay....is this when a take back occurs and we owe money back to Health First Colorado?

Yes