Colorado interChange: Resources for your Membership
Week of June 12, 2017
Milestones and Initiatives 
As a periodic feature of this newsletter, we'll be spotlighting recurring questions we're hearing from providers seeking to better understand the Colorado interChange system and learn about new formats or major changes from the previous system. There are some issues with the operation of the current system and they are being addressed by our vendor as they are known. Providers can see a list of known issues.
 
Other challenges providers are finding with the system stem from the real differences between the operation of the old system versus the new system. These changes, while necessary, can create confusion.
 
Spotlight on Recurring Provider Questions
  • Why is our provider type not contracted for this procedure code?
As we gain more experience with the system, issues like missing procedure codes, contracted provider types, and reimbursement rules are being identified. If the provider believes a procedure code is valid for their provider type or they have successfully billed this in the past, the provider should call the call center and request assistance.
  • How do I check the status of my reconsideration? Is that the same as an appeal?
Appeal and reconsideration are different processes. Appeal is a formal process that involves a court hearing and the status cannot be checked in the billing system. The status of a reconsideration can be checked in the same ways that any claim can be checked, which are logging into the Web portal, calling the call center, or looking at detail on the provider's remittance advice (RA).
  • How can I fix my 1473 Error when submitting through a clearinghouse?
Remittance Advice code 1473 is an indication that the system cannot determine under which unique program provider ID to process the claim. If the provider shares a National Provider Identifier (NPI) with more than one (1) provider type or location address, additional steps are needed to ensure proper claims adjudication. A unique nine (9) digit ZIP code or a taxonomy code is required to identify the correct billing provider ID. Though we do not require this as other states do, providers are strongly encouraged to obtain a unique billing NPI for every location address and provider type. Providers receiving a 1473 error should that ensure the service location includes the ZIP+4. Providers can update ZIP codes and taxonomy codes in the Provider Web Portal under Provider Maintenance. Please contact the call center for issues with shared taxonomy and to update the record to include a unique taxonomy code. Providers using a clearinghouse should also make sure that the clearinghouse is putting the ZIP4 code in the right loop and segment. If the clearinghouse needs additional information on the correct loop and segment, please refer them to the TR3 .  
  • Are my inquiries tracked by the call center?
Yes, and this tracking is important for future conversations, should they be needed. When each caller is greeted, they should be given a Call Tracking Number (CTN) and providers can ask for this number at any time. This number then becomes the log for the call. Providers who need more than one call for resolution of their issue can use this number to speed their issue resolution because it allows the call representative to enter the conversation with all the background they need.
  • Why are we getting our claims mass adjusted?
All claim adjustments are initiated by either the provider or the Department's fiscal agent. Providers should refer to their remittance advice to understand all aspects of all claims adjustments. To help providers learn about the new remittance advice, the Department has published an easy-to-use, line-by-line Remittance Advice Quick Guide to reading Remittance Advices.
  • How do I void a claim?
A Quick Guide walking providers through the complete process for copying, adjusting or voiding a claim on the web portal is available. The guide shows screen shots and offers step by step instructions for the provider web portal.  Providers filing on paper should use the billing manual as a reference. If a batch void is necessary, they should contact their clearinghouse. 
You Might Be Hearing...

Claims Update
The interChange has processed nearly 12 million claims and paid more than $2.2 billion to providers. 

On a weekly basis, an average of 60 percent of claims are paid. In the financial week ending June 9, the Department processed 772,275 claims and paid $139 million or 61 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. 

A portal error is occurring when the provider is attempting to change the rendering or referring provider on the service detail line of a claim after the initial entry. Currently, the portal does not save the change. Until the issue is resolved, if an entry needs to be changed, the line should be removed and re-entered. The line can be removed by clicking "Remove" in the Action column or clicking the Reset button at the bottom of the window. Our vendor is working to resolving the issue.
 
Missing Affiliations Do Not Cause Claim Denials
Providers have questions about claims with EOB code 3110 for "the rendering provider is not a group member". While it may be unclear on the remittance advice, notations that affiliations are missing do not cause the claim to deny and are informational only. Currently, the Department is giving providers an extended grace period to make all necessary updates to their affiliations to avoid future claims denials. If EOB code 3110 appears on a claim, providers should check their affiliations and make sure they are up to date, and check other EOB codes to see why the claim denied. Updated affiliations are currently taking at least three weeks for final approval.  Providers should not submit duplicate update requests.
 
Claim Denials for EOB 4000 - Member Has Other Insurance
Secondary Claims with third party liability (TPL) information was incorrectly denying for EOB 4000 - "The member has other insurance. Bill the charges to the other insurance before billing Medicaid. Complete the other insurance payment information fields on the claim and retain a copy of the explanation of benefits." As an interim solution, claims will suspend for review rather than deny. During this time, providers may see the claim temporarily suspend for EOB 4000, but no action is required. Claims will be adjudicated appropriately. Our vendor is working on a permanent fix. In order for claims prior to June 5, 2017, when the interim fix was implemented, to be processed correctly, providers are asked to resubmit any claims denying for EOB 4000 that included TPL information.

Inpatient/outpatient claims using a diagnosis from a mental health diagnosis group or substance use disorder group are incorrectly denying for EOB 2580 - "The services must be billed to the HMO/PHP listed on the eligibility inquiry." Our vendor is working to resolve the issue and claims will be reprocessed when the issue is resolved.
 
Intermittent Portal Error
Some providers have reported intermittent portal errors when attempting to access their accounts. The Department is aware of this problem and the vendor is working to isolate and resolve the issue. While no single workaround has been identified, some providers have had success by trying the following:
  • Clear the browser's cache.
  • Log out and come back at a later time - even a few minutes may help.
  • Use the system during non-peak hours, which are Monday through Friday before 9 a.m. or after 4 p.m. or anytime Saturday or Sunday.
  • Try using another browser. Internet Explorer is recommended.
You'll be happy to know
Some providers were receiving a "Member not found" error message when trying to submit a claim.   A workaround is available as our vendor works on a permanent fix.
Help Us Help Providers
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