Colorado interChange: Resources for your Membership
Week of May 22, 2017
Milestones and Initiatives 
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.
 
To help with these types of issues as well as processes for navigating the new system, providers should visit our web site that provides quick guides. for many common procedures
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 19, the Department processed 860,621 submitted claims and paid $129,243,988, or 59 percent of all claims processed. 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.

Women's health questions
The national drug code for the IUD Mirena and procedure code combination associated with the drug is not currently available on the system portal. This blocks providers from billing for the drug and procedure combination. The issue is known and is being worked on.  

Additionally, codes for IUDs Mirena (J7302) and Liletta (J7297) do not have corresponding reimbursement rules loaded into the system. This causes claims for these drugs to be denied. This is a known issue and is being worked on.

Billing from the correct account
A common reason for claim denials is filing from the wrong account. For example, some providers continue to log in with an old provider identification number that has since changed. Other providers have more than one account because they are registered as more than one provider type. If this is the issue, a simple fix is available: double-check that you are logged into and billing from the correct account. Providers can see a simple primer on how to check your log in or correct issues with it . This primer includes screen shots to make it easy to use in real time.
 
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.

Denials for affiliation
Although the denial for affiliation appears on provider's remittance, this is informational only, and does not impact the claim. The Department is not denying any claims for a missing affiliation to allow providers more time to update their enrollment profiles.

You Will Be Happy to Hear...
Member eligibility in member-focused viewing has been fixed
Previously, when using the member-focused viewing option in the web portal, either no coverage details were listed or listed details contained incorrect eligibility dates. This issue has been fixed and data should now be showing correctly in the member-focused viewing. 

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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