The work to modernize our Medicaid provider payment system proceeds as we add resources to improve call wait times as well as training to help call center staff resolve issues on the first phone call, whenever possible. This newsletter was launched to help you support providers in your network by highlighting new resources for assistance and calling out known issues, updates and work arounds for ongoing challenges.
As we have said previously, the quickest path to resolution of individual provider issues continues to be the Health First Colorado Provider Call Center. Please urge providers to call 1-844-235-2387 for help. Hold times have dropped dramatically since the system launch.
With the system change and updated policies, the way messages and codes display has evolved. Additional data may be required that was not needed in the previous system. Providers accustomed to the old codes, messages and requirements may need help as they make the transition. Here are a few differences that can create confusion:
- Why is my claim marked "suspended"?
This is the new identification for claims that simply need further manual review. In the old system, they would have been identified as "In Process". Suspended claims are in process and our vendor is working to reduce the backlog of claims by June 1st. Currently, less than 3 percent of claims fall into this category each billing cycle.
- I saw a suspended claim last week in my remittance advice. Why don't I see it again this week?
Suspended claims appear once on the remittance advice when they are filed and placed in the queue for additional manual review. They will only appear again when they are either paid or denied. Our fiscal agent keeps the claims on file and processes them for payment as soon as they are reviewed.
- Why do claims now require a national drug code on medications not required before?
Today, the Center for Medicaid Services requires that a national drug code be collected on all drugs, even over-the-counter medications. This was not previously required.
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