Colorado interChange: Resources for your Membership
Week of May 15, 2017
Milestones and Initiatives 
As we move through the process of modernizing our Medicaid provider payment system with the COMMIT project, we will be providing regular updates to assist you in supporting your membership and networks. In launching a new system and fiscal agent services of this size and complexity, we need partners like you to help reach providers as well as uncover issues that require attention. 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
The quickest path to resolution of provider issues continues to be the Health First Colorado Provider Call Center. Please urge providers to call 1-844-235-2387 for help. Investment in increased staffing and improved training to handle call volume have resulted in significantly reduced hold times. Early this week, the call center handled 1,026 calls in one day with an average wait time of just 12 minutes and the longest hold time at 32 minutes. While these specific numbers can differ from day to day, using the call center allows for individual and specific resolution of each issue.  Additionally, here are two key points for providers:

Revalidation is the first step to submitting successful claims
To date, 45,113 providers have successfully completed the revalidation process required for all Medicaid providers. However, nearly 2,200 provider applications are still awaiting more information needed for approval. Until the application is approved, claims cannot be processed. Reminders have been sent to these providers with details about the outstanding issues on their application. These emails go to the person who completed the application. In some cases, the email address we have on record is a billing agent or office staff member. Please urge providers to verify their organization has not received a reminder regarding their application. Providers unsure of their enrollment status should call the Health First Colorado Provider Call Center at 1-844-235-2387 and select the "enrollment" option.
 
The top reasons for denied claims are:
  • The billing provider is either not revalidated or has billed for a location that is not revalidated. (EOB 1960)
  • The billing provider does not have a location status because the provider is either not revalidated or billed for a location that is not revalidated. This edit typically posts in tandem with 1960. (EOB 0956)
  • The billing provider has multiple service locations and did not provide enough data to determine for which location the bill is intended. (EOB 1473)
Revalidation corrections can make a difference
To help providers understand the types of revalidation issues that cause claims denials, we will be sharing resolutions we've handled. Recently, we have seen providers identify as the incorrect provider type in their applications. The system, appropriately, does not pay claims submitted by the incorrect provider type. As an example, we recently worked with a provider who submitted an application as a case manager instead of as a waiver provider. After resubmitting an application with the correct provider type, the Department was able to expedite the application and the provider is now successfully submitting claims. Please encourage struggling providers in your network to ensure their revalidation applications are correct so claims aren't delayed. Share this helpful resource to assist providers in correctly identifying their provider type.
You Might Be Hearing...
We'll use this section to address hot topics and key changes impacting providers. The Department website continues to be the best place to find current information on known and resolved issues.

Claims update
  • In the financial week ending May 12, the Department processed 734,951 claims and paid $118,613,382. That represents 61 percent of all claims. 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 we are continuing to push toward that goal. The Department has never paid 100 percent of all claims due to a variety of factors from errors in submissions to requests for reimbursement for non-covered services.
Hospital Claims
  • All inpatient and outpatient claims that posted Explanation of Benefits (EOB) code 1970 and 1977 (Unique Provider Service Location could not be found for Other 1 NPI) have been reprocessed and will appear on the 5/15/17 remittance advice. A note to Hospice providers: We continue to work to resolve this issue for this provider type. These providers may continue to receive this denial until the known issue is corrected.
835s and Trading Partner delegations
  • Providers need to designate a trading partner when filing an 835 transaction. Providers can see a handy cheat sheet for this process. Once a trading partner has been designated 835 files will be available to the trading partner on an ongoing basis. However, 835 files for previous cycles will not be available. Trading partners will need to use the remittance advice as an alternative solution.
Crossover Claims
  • Crossover claims covered by Medicare but not Medicaid are currently being denied by the system. This is a system error. These claims should be reimbursed based on Medicare assigned coinsurance and deductible. Providers should continue to submit these claims and then resubmit them once the issue has been resolved. We will be updating providers on an estimated fix date for this known issue.
Place of service codes
  • Some claims are denying for the explanation of benefits (EOB) code 1030. The denial states "the place of service code is invalid for procedure code". Place of service designations 11, 19 and 20 were not set up for all appropriate procedure codes. The Department is working to add a large volume of codes to allow providers to use these three designations. When this issue is resolved, providers will need to rebill affected claims.
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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