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Upcoming Events and Helpful Resources
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New to PEAK or Need a Refresher?
The Intro to PEAK and Application Walk-Through recorded webinars are available anytime. For more information and trainings, visit the
PEAK Outreach Initiative website.
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Public Rule Review Opportunities
Anyone interested in a one-on-one discussion with Department staff about upcoming rules is invited to attend the Department's
Public Rule Review Meeting. Information is available on the
Public Rule Review Meetings web page.
For more information, or to be added to the Medical Services Board email distribution list, please contact
Chris Sykes.
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Employment Opportunities
Applying for state government jobs is easy. Applications are electronic, you will receive updates, and you do not need to answer any written questions until it is determined that you meet the minimum qualifications.
Check out the
website for State of Colorado jobs including the Department of Health Care Policy and Financing jobs.
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Welcome to the June 2017 edition of At a Glance!
Thank you for your interest!
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SB 16-120 Member Explanation of Benefits-Implementation Update
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The Department is required to make available an explanation of benefits (EOB) to all Health First Colorado (Colorado's Medicaid program) members. The EOBs will allow Health First Colorado members to see claims made on their behalf so they can discover and report administrative and provider errors or fraudulent claims. The EOBs must comply with federal requirements (42 CFR 433.116 and Section 11210 of the State Medicaid Manual) and those outlined in Senate Bill (SB) 16-120.
The Department has developed a summary of recent activities related to stakeholder and member engagement that was mandated by SB 16-120.
Due to the extension of the interChange system go-live, the EOBs that comply with SB 16-120 will not be available beginning July 1, 2017. Once launched, the EOBs will be available in the interChange Member Portal. The Department is working to identify a launch date for the Member Portal and the SB 16-120 mandated EOBs.
The Department is currently working to resolve policy, system and operational issues identified through internal workgroups and stakeholder engagement as they relate to the implementation of SB 16-120. This Department is also working with the Centers for Medicare and Medicaid Services on federal approvals.
As required by SB 16-120, the Department has developed a draft EOB letter and educational material messaging that include member and stakeholder feedback. Following the resolution of the identified policy, system and operational issues, additional updates may be made to the draft EOB letter and educational material messaging and resources.
As information becomes known, updates on the EOBs and information on the launch timing of the new Member Portal will be posted on Colorado.gov/hcpf.
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Colorado interChange Update
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As we continue to work through the transition to Colorado's new interChange system, we know providers and their claims staff are on a sharp learning curve. For example, they need to know how the revalidation process works, understand new formats within Remittance Advice, and learn new terms like "Suspended" rather than "In Process" for claims that need additional information.
Spotlight on Recurring Provider Questions
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Q: Why is our provider type not contracted for this procedure code?
A: 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.
Q: How do I check the status of my reconsideration? Is that the same as an appeal?
A: 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).
Q: How can I fix my 1473 Error when submitting through a clearinghouse?
A: 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.
Q: 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.
Q: Why are we getting our claims mass adjusted?
A: 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.
Q: How do I void a claim?
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To help providers work through these changes, the Department is continuing to develop
Quick Guides and Frequently Asked Questions aimed at providing step-by-step, visual guidance for common issues and changes that can be confusing. Topics available include:
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Chronic Pain Disease Management Program
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The Department's Chronic Pain Disease Management Program began in 2015 with over 42 practice sites and 80 providers participating. The program ended as planned on May 30, 2017.
The Department was able to offer this program because of a two year appropriation by the state legislature and it enjoyed maximum participation by providers during both years. The program was modeled after Project ECHO (Extension for Community Healthcare Outcomes) programs in New Mexico and Connecticut. It was administered using teleconferencing to connect primary care medical providers to specialists. The specialists shared the latest evidence- based practices for treating Health First Colorado members who had chronic pain with primary care medical providers, who presented de-identified member cases and received consultations on how to assist the member.
This program was one of many Department efforts focused on reducing opioid misuse. The efficacy of the program is in the process of being evaluated. The evaluation is expected to be completed in late summer.
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ACC: Access KP Program Ends, Members Enrolled in Colorado Access
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Health First Colorado ACC: Access KP Program (Access KP Program) was a payment reform initiative within Colorado's Accountable Care Collaborative (ACC). The initiative was a limited benefit, capitated primary care model designed to pilot an alternative to the current fee for service payment mechanism. The initiative was a partnership between the Department, Colorado Access, and Kaiser Permanente.
The initiative was implemented on July 1, 2016, with enrollment of ACC Region 3 Health First Colorado members who were attributed to Kaiser Permanente (KP) as their Primary Care Medical Provider. The enrollment was approximately 23,000 members.
The ACC: Access KP contract term expires June 30, 2017. The decision was made not to renew the contract for an additional year.
On June 30, 2017, Health First Colorado members will no longer be enrolled in the Access KP Program. Members currently enrolled in the Access KP Program will be automatically enrolled in Colorado Access on August 1, 2017.
This change in health plan enrollment will not change a member's benefits or services. No action is needed by Health First Colorado members. Additionally, members can continue receiving their care through Kaiser Permanente.
Members were notified of this change by letter from Health First Colorado Enrollment.
Members should contact Colorado Access with questions about this change, their health plan, benefits, or if they want to change their provider at 1-855-4MY-RCCO.
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ACC: Medicare-Medicaid Program Transition
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The Department is approaching the end of the three year Accountable Care Collaborative: Medicare-Medicaid Demonstration on December 31, 2017. The Department will be transitioning into a new phase of care for this population by incorporating key learnings from the Medicare-Medicaid Program into our ACC delivery system, and the Demonstration will
come to an end
as planned this December.
Members will remain in the Accountable Care Collaborative and with their assigned Primary Care Medical Provider, and their Medicare and Health First Colorado benefits will not change.
You are invited to provide comment on the draft transition plan by July 26th, 2017. For additional details or questions, please email
Van Wilson
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New Supplemental Resource--Medicaid Buy-In for Working Adults with Disabilities and Children with Disabilities
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Colorado's General Assembly adjourned on May 10, 2017.
The Department had a successful 2017 legislative session, with many major policy initiatives approved with broad bipartisan support.
Read our Long Bill Overview on our website with high level information on budget actions and provider rate increases passed last session. More detailed information about the across the board and targeted provider rate increases is available in our Provider Bulletin.
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Medicaid provider rate increases were approved during the 2016-2017 legislative session and are effective for dates of service on or after July 1, 2017. All rates require approval from Centers for Medicare and Medicaid Services (CMS). Please see the July Provider Bulletin for additional detail.
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Primary Care Payment is Changing
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The Department conducted a webinar for primary care providers on May 24 to provide details on the coming alternative payment methodology (APM). The webinar is available for viewing, along with all the handouts and informational materials, on the Department's website.
If you have questions or would like to request a presentation on the APM, contact [email protected]
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Partnerships to Improve Population Health
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Accepting Applications for the New Colorado Indigent Care Program Advisory Council
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In accordance with new rules, effective July 1, 2017, the Department's Executive Director will appoint eleven (11) members to a newly-created Colorado Indigent Care Program (CICP) Stakeholder Advisory Council.
The Advisory Council will advise the Department of operation and policies for the CICP and make recommendations to the Medical Services Board regarding rules for the program. Applications will be accepted through July 14, 2017 at 5:00 p.m. MDT. Appointments will be announced by or on August 1, 2017. For more information on how to apply, please
visit our web page and click on Advisory Council.
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Delivery Systems Innovation
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Accountable Care Collaborative Enrollment Update
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As of June 2017, 1,073,008 Health First Colorado members were enrolled in the Accountable Care Collaborative.
This number includes 37,698 who are members of the Accountable Care Collaborative PRIME program on Colorado's western slope and 21,679 who are members of the ACC: Access KP Program in RCCO Region 3.
Approximately 758,406 Accountable Care Collaborative members are attributed to a medical home.
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| Long-Term Services and Supports Scorecard |
The Long-Term Services and Supports (LTSS) Scorecard measures state-level, system performance from the perspective of people who need LTSS and their families. Colorado has been in the top 10 states for all three scorecards, however, this year we dropped from an overall rank of 4th in the nation to 8th. Below are a couple highlights for Colorado from this year's Scorecard.
- While we dropped in ranking, Colorado's performance largely stayed the same, with little or no change in performance on 12 of the 25 indicators.
- We improved in eight indicators and declined in performance on only two indicators (there were three new indicators this year that weren't tracked in previous Scorecards).
You can
view the full scorecard online
. The LTSS Scorecard is released every three years and is supported by the AARP, The SCAN Foundation, and the Commonwealth Fund
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The Colorado Department of Health Care Policy and Financing complies with applicable federal and state civil rights laws and does not discriminate on the basis of race, color, ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity and expression, religion, creed, political beliefs, or disability. Learn more about our Nondiscrimination Policy.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-221-3943 (State Relay: 711).
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-800-221-3943 (State Relay: 711).
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At a Glance
