Week of May 8, 2017
Welcome to the first installment of our weekly updates as we move through the process of modernizing our Medicaid provider payment system through the COMMIT project. We hope these regular updates will assist you in supporting your membership and networks as we work through the challenges involved with launching a new system of this size and complexity. In short, this update is intended to:
  1. Highlight new resources for provider assistance
  2. Share timely fixes for known issues and updates on progress for ongoing issues
We've heard from many providers and want to continue to hear their issues and challenges. Please urge providers to use the Health First Colorado Provider Call Center at 1-844-235-2387, where hold times have dropped dramatically since our initial launch.

Additionally, here are two key updates for providers:

Interim Payments for Providers in Financial Distress:  Call center options now include a direct pathway to requesting interim payments from the Department while provider issues are resolved. Interim payments are meant to provide temporary relief to providers until their claims are processed correctly and will offset the balance of claims billed to the Department. Struggling providers can call the Health First Colorado Provider Call Center at 1-844-235-2387 and select option 2 to "speak with an agent" and then option 4 to inquire about interim payment options.

Call Center Wait Times:  With the hiring of additional staff in the call center, wait times are continuing to decrease. On Monday (5/8) the call center handled 1,012 calls - nearly half were complex claims questions and issues - and did so with an average speed of answer for all call types of one minute, 15 seconds with a maximum hold time of just 23 minutes. We understand that wait times continue to present a challenge to providers and their staffs.  We have and will continue to dedicate serious attention to reducing hold times as well as attempting to provide issue resolution in just one contact wherever possible. Please urge providers to continue to use the call center at 1-844-235-2387 as the path to the quickest resolution of their issues.

You Might Be Hearing...
We'll use this section to address hot topics and key changes impacting providers.

Optometrists
  • We recently resolved an issue in the system for Optometrists attempting to submit claims for eyeglasses and certain other eye-care needs. Missing optometry codes were to blame for the denied claims. Those issues have been resolved and claims will now process correctly, previously denied claims are being reprocessed by DXC, so there is no action needed on the part of providers. These claims will be reprocessed in the 5/12/17 financial cycle.
Paid Claims
  • Processing and paying correctly submitting claims continues to be both our biggest challenge and the biggest area of progress as we work to make the new system seamless for providers. To date, more than 9.3 million claims have been processed in the new Colorado interChange and we have paid providers more than $1.2 billion. During the most recent cycle, which ran on May 5th, 833,963 claims were processed and $120,556,322 was paid to providers. Sixty percent of all claims submitted were paid. Based on historic trends under the old system, we would expect about 85 percent of all claims submitted to be paid. That remains our goal for the new system as well, and based on implementations in other states this goal will be reached within six to nine months after implementation. The Department has never paid 100 percent of submitted claims due to a variety of factors including everything from errors in submissions to requests for reimbursement for services not covered.
Timely Filing Extension
eQHealth Submissions
  • Prior authorization requests transmitted from eQHealth were processing incorrectly, which caused approvals to be delayed. This issue was resolved and should be operating correctly.
Incorrect Identifiers
  • Some Medicaid members were incorrectly identified as "incarcerated" in the system. This issue was resolved and members should now be identified accurately. 
Help us help providers
We need your help to identify struggling providers as well as ongoing issues in need of attention. Please help providers in your network get the assistance they need by connecting them to resources or direct assistance:
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