Colorado interChange: Resources for your Membership
Week of June 26, 2017
From the Editor
Thank you to the readers who have provided feedback on this content and frequency of this newsletter. We will resume publication of an updated version in mid-July.
Milestones and Initiatives 
As known issues with the interChange are resolved and providers become more familiar with changes the number of issues related to the transition continue to decrease, however, the Department and our vendor continue to work through reprocessing claims and resolving outstanding claim suspensions.

Reminder: The timely filing deadlines have been doubled for claims -- from 120 days to 240 days -- through Oct. 31, 2017. Providers can read the initial notice of this change as well as a helpful FAQ about the change to timely filing . 
 
The Department has discovered the 60-day rule functionality in the system is not operating as intended. The Department and the vendor are currently creating a solution for this known issue and will be communicating that shortly.  
You Might Be Hearing

Claims Update
Since system launch, interChange has processed 13,219,544 claims and paid more than $2.5 billion to providers. In the financial week ending June 23, the Department processed 719,060 claims and paid more than $133 million or 69 percent of all claims processed during that cycle.

Claims adjustment with zero net financial impact
In order to comply with state and federal reporting requirements, all claim types were reprocessed. For all claim types except pharmacy, this applies to those claims processed between March 1 and March 5 in the first two financial cycles of March 2017. For pharmacy claim types, this applies to claims processed between March 1 and March 29. This reprocessing took place on June 27. All claim types filed before the new system launch will not be affected. Reprocessing for all provider types will have a zero net financial impact. No monies will be paid or recouped during this process for any provider type. Providers will see this mass adjustment on their remittance advice (RA) in the adjustment section. For all adjustments of this type, the region code will be 58 and will appear as fully recovered with no money due. A quick guide for understanding remittance advice is available .
 
Clinical Laboratory Improvement Amendments issues resolved, modifier needed
All system issues regarding Clinical Laboratory Improvement Amendments (CLIA) processing have been resolved. Please see the Known Issues & Updates page for more details. If providers continue to encounter denials for tests appropriate for their CLIA certification type, their first step should be to check their CLIA end date in the Provider Portal. The end date for the CLIA license must read 12/31/2299 to be considered active. If their license has an end date other than 12/31/2299 but is currently active, they need to update their CLIA information in the Provider Maintenance section of the Provider Portal and ensure that a copy of their current CLIA license is attached on the last page. The update request must be approved before denied claims can be resubmitted.

Providers have noted that some CLIA waived tests are being denied when the provider has an active CLIA Certificate of Waiver on file. Many tests need a "QW" modifier to indicate they are waived tests. If the modifier is not present, it indicates that the type of test being performed is of a higher complexity than the Certificate of Waiver allows, and the test will be denied. Providers should reference the CMS website to determine if the test you are performing requires a "QW" modifier.
 
Retroactive Updates to Eligibility Spans
A system issue is currently preventing the Colorado interChange from processing some retroactive changes to a member's eligibility span. If a member believes a fix to their eligibility information is necessary, the process is the same as it was in the old system. The member must call the Health First Colorado Member Contact Center to initiate the correction. If the member has already contacted the Member Contact Center and obtained the Proof of Insurance, the provider should accept this as eligibility verification and render services. The eligibility update may take 2 to 3 business days to appear in the system. Once the fix is made, the provider will be able to submit or resubmit claims for services to the member.   For more detailed information, please refer to this fact sheet.
You'll be happy to know
HCBS and DME Claims No Longer Suspending for BHO-Level Edits
Claims for Home and Community Based Services and Durable Medical Equipment were previously suspending incorrectly for Behavioral Health Organization-level edits. The Explanation of Benefits code is 3026. This issue has been resolved and suspended claims are being recycled. For quicker results, if desired, providers can resubmit claims themselves.
Help Us Help Providers
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