Welcome to the Navigator, Our Provider Newsletter
Some of you may be receiving this newsletter for the first time. In our ongoing effort to improve communication with our network, we’ve expanded the reach of our newsletter to all contracted providers and their office staff. We hope you find the information informative and useful. Be on the lookout for the latest news and information along with all of our events.
We will be launching a new website soon thanks to your help! Over the course of the project we have conducted research through focus groups, input from stakeholders, and interviews with many of our providers and members, identifying best practices and digital health care trends. The new website has been reworked to facilitate a better user experience with a focus on members & providers. The website address will be the same. If you have other pages bookmarked, it is possible that they have changed. If old bookmarks don’t work, please update them after navigating through the new site. Thank you to everyone who participated in this project and we look forward to hearing your feedback.
Thank you to all the Providers that attended our Quarterly Provider Meeting and took the time to fill out a comment card. Your feedback is greatly appreciated.
The winner of the $50 gift card is:
Inner City Health Center
In a commitment to improve accessibility to behavioral health services, providers can now bill a series of behavioral health procedure codes to the Health First Colorado (Colorado Medicaid fee-for-service benefit) with or without a covered behavioral health diagnosis in the primary care setting.
Will this change how I bill services? Well, that depends!
- YES: If you are a provider in a primary care clinic, federally qualified health center, rural health clinic, or an Indian Health Center who provides behavioral health services (and employ their own behavioral health clinicians).
- MAYBE: Clinics with co-located clinicians - if services are billed by a community mental health center or other behavioral health provider, then this process does not apply. If the PCP bills for the behavioral health services, then this process does apply
- NO: Community mental health centers, group practices, or individual licensed clinicians will continue to bill services to us via the Capitated Behavioral Health Benefit
What services are included in this benefit?
- The following codes can be billed by primary care providers, FQHCs, RHCs, or Indian Health Centers: 90791, 90792, 90832, 90834, 90837, 90846, 90847. Up to six of these services (in any combination) can be provided and billed directly to Health First Colorado (Colorado Medicaid fee-for service) with or without a covered behavioral health diagnosis. The six-visit count restarts July 1st of each year.
- If you provide other prevention/early intervention services in the primary care setting (such as H0002, H0023, or H0025), those services can continue to be billed to us via the Capitated Behavioral Health Benefit
- If a member requires additional visits after the first six, a provider may request additional services from us. To request additional services, please complete the Behavioral Health Prior Authorization Request form, including the number of additional services being requested. Please include evidence of a covered behavioral health diagnosis and evidence/attestation that the member has already utilized the first six visits (which have been billed to fee-for-service). Our utilization management Team will review your request within 10 calendar days. These services can then be billed to us via the Capitated Behavioral Health benefit. Failure to request authorization prior to the delivery of additional services will result in an administrative denial.
ECHO (Extension for Community Health Outcomes) Colorado offers a free, online learning platform that provides health professionals and those whose work impacts health the opportunity to be part of a community where experts and peers share knowledge and experience using technology, not proximity, to connect.
ECHO sessions combine the interactive learning and case-based sharing aspects of an in-person training with the improved access and convenience of connecting through an audio and video-based online experience.
Upcoming ECHO Series:
Prenatal Substance Exposure: Perinatal Care for Women and Newborns
Commitment: Eight weekly ECHO sessions held virtually
Wednesdays 12:15 p.m. - 1:15 p.m. MST
July 11, 2018 - August 29, 2018
Audience: Colorado perinatal providers and support personnel working in the medical setting (MDs/DOs, PAs, NPs, RNs, Social Workers, Care Coordinators)
Click here to learn more about this Echo series
HCPF Fee for Service: Timely Filing Update and Clarification
The Department of Health Care Policy and Financing (HCPF) recently sent out a provider bulletin announcing the extension of their timely filing to 365 days for their fee-for-service (FFS) benefit programs. Please note that our timely filing will not change and remains at 120 days from the date of service for behavior health, CHP+ and State Managed Care Network claims. This extension is for FFS claims submitted to the state for Health First Colorado members. For more information about our claims timely filing, please visit our Provider Manual located on our website.
Join us for an open house to get more information about the changes that are coming to health care this summer. We will discuss the next phase of the Accountable Care Collaborative (ACC 2.0), Colorado’s innovative approach to improving the experience and outcomes of both physical and behavioral health care services for people who are part of Health First Colorado (Colorado’s Medicaid program). Learn how these changes will affect you and your patients.
Morning and afternoon sessions are available. Please select which date and session you plan to attend when you register. Information provided will be the same at all sessions.
*Please note that there has been a change to times in the agenda.
- 10:00 a.m. - 10:30 a.m. ACC 2.0 Overview
- 10:30 a.m. - 11:00 a.m. Provider Questions & Answers
- 11:00 a.m. - 12:00 p.m. Lunch Provided (morning and afternoon sessions are both welcome)
- 11:00 a.m. - 12:00 p.m. Lunch Provided (morning and afternoon sessions are both welcome)
- 12:30 p.m. - 12:30 p.m. ACC 2.0 Overview
- 12:30 p.m. - 1:00 p.m. Provider Questions & Answers
- July 26, 2018
- August 23, 2018
Location: 10065 E. Harvard Avenue
Denver, CO 80231
Conference Room #1
This event is free, however, registration is required. For questions or to register please contact Amber Garcia at email@example.com. You can also register here.
Reasonable accommodations will be provided upon request for persons with disabilities. Please contact Amber Garcia at 720-744-5487 prior to the meeting to make arrangements. Requests should be made as soon as possible but at least one week prior to the scheduled meeting.
Important Information for Primary Care & Behavioral Health Providers
The Department of Health Care Policy and Financing (HCPF) is working hard to keep providers informed of the changes and requirements for the next phase of the Accountable Care Collaborative (ACC 2.0). We encourage you to check in regularlyhere for more information, starting July 1, 2018.
Providers with multiple service sites must enroll each location separately. Each claim must include the appropriate service location address and billing ID with a unique Medicaid site ID. Claims should not use one billing address for all sites. It is important that providers bill by location if they want to receive member attributions for the next phase of the Accountable Care Collaborative.
For information on how to enroll individual sites, billing by location and more, click here.
More information about the next phase of the Accountable Care Collaborative, starting July 1, 2018, can be found here.
HCPF has contracted with IBM Watson Health (formerly Truven) to host the new Data Analytics Portal (DAP), which replaces the former SDAC. The Data Analytics Portal is a tool for primary care medical providers and Regional Care Collaborative Organizations that includes population and performance information for the Accountable Care Collaborative. HCPF has updated the DAP website to include background information, job aids, trainings and contact information. To visit the website, click here.
Primary care medical providers contracted with us can gain access to the portal by contacting Sandy Rangel at firstname.lastname@example.org.
Regional Organization Contracting for Behavioral Health Providers
If you are an existing behavioral health provider with us, there is no need to update your contract for the regional organization implementation date of July 1. You are considered part of our network for the lines of business in your existing contract, and that includes future services provided to our members associated with the regional organization. If you have questions, please contact your provider relations representative.
New Inbound Claim Rules
We are implementing a new EDI front end validation process to ensure that inbound claims are meeting the standard HIPAA validation rules and to increase auto-adjudication rates. With this change, we will be applying stricter front-end transaction validation, which may result in an increase in rejections on your 277CA reports. Your clearinghouse may contact you with items that have been rejected that need to be corrected. Please work with your clearinghouse in this effort. If you have questions about these changes, please contact your provider relations representative.
Behavioral Health Modifier Requirements:
As a reminder per the USCS Coding Manual effective 1/1/18 and forward, all covered CPT/HCPCS codes billed on a 1500 will require the applicable modifier to be billed on the claim. Please reference the coding manual for applicable modifiers for each code as well as the applicable modifier position. If you have questions about these requirements, please contact your provider relations representative.
Important Information from HCPF for Primary Care & Behavioral Health Providers
The Department of Health Care Policy and Financing (HCPF) is working hard to keep providers informed of the changes and requirements for the next phase of the Accountable Care Collaborative (ACC 2.0). We encourage you to check in regularly here for more information, starting July 1, 2018.