In April 2018 there were 1,277,738 Coloradans enrolled in Health First Colorado (Colorado's Medicaid Program) and 90,564 enrolled in
(CHP+).
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Upcoming Events and Helpful Resources
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| Health First Colorado videos for use in waiting rooms and other areas members visit are available for download on our website. |
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 May 2018 edition of At a Glance!
Thank you for your interest!
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Update from the Executive Director
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Last week, we held the kick-off press conference for the Lift the Label opioid anti-stigma event. More than one hundred press and industry leaders joined us. The speakers included me, Larry Wolk, executive director and chief medical officer at the Department of Public Health and Environment; Reggie Bicha, executive director at the Department of Human Services; Governor Hickenlooper and two Coloradans sharing their personal stories of addiction and recovery.
At the peak of opioid overprescribing, there were enough opioids prescriptions written to have one bottle of narcotics in every household in America. Clearly, we had work to do to reverse these destructive trends.
Through our collaborative efforts, over the last three years we have seen a cumulative 30 percent reduction in both the number of pills prescribed to Colorado's Medicaid members and the number of our members taking opioids. This is outstanding progress in preventing addiction going forward.
While we continue to drive improved prescribing patterns to prevent addiction, we need to increase our energy and focus on helping our members who are addicted to opioids through their journey to recovery. You and your organizations are critical to our continued progress on that front. Our Medicaid members account for nearly 29 percent of opioid overdose deaths in Colorado. That is devastating, but it is just one indicator of the catastrophic impact that opioids are having on individuals and families across our community.
I ask you to help us stand strong to support Medicaid/Health First Colorado members struggling through opioid addiction. The first barrier to their recovery is the stigma attached to addiction. Help us show our Medicaid members and all those struggling with opioid addiction that there is no shame in reaching out for help - that it is the critical first step to recovery. Please join us in communicating that it would be our joint privilege to provide the treatment, care and support that our members need to transition out of this destructive chapter and to thrive through the months and years to come.
Labels are for packages. They're not for people. For more information about the kick-off event and the campaign to reduce the stigma associated to opioid addiction, please visit LiftTheLabel.org.
Thanks,
Kim Bimestefer
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Save the Date: Electronic Visitation Verification System Design Subcommittee Meeting
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The next Electronic Visitation Verification (EVV) System Design subcommittee meeting has been confirmed. This meeting will recur every second Wednesday of each month.
The purpose of this subcommittee is to discuss business requirements and configuration of the EVV system to meet the needs of community stakeholders within the parameters of section 12006 of the 21st Century Cures Act.
When
: June 13, 2018
Time
: 2:00 p.m.-3:00 p.m. MST
Where
: Department of Health Care Policy and Financing
303 E. 17th Avenue, Denver CO 80203
Room 7C
Call in Information
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Local: 720-279-0026
Toll Free: 1-877-820-7831
Participant Code: Participant Code : 869804
Reasonable accommodations will be provided upon request for persons with disabilities. Please contact
[email protected]
, or the 504/ADA Coordinator at
[email protected]
at least one week prior to the meeting to make arrangements.
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Behavioral Health Provider Type Changes
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Health First Colorado has recently updated two provider types.
- Provider type 38, Psychologists- Masters, is now named Licensed Behavioral Health Clinicians.
- Provider type 37, Psychologists- Doctorate, is now named Licensed Psychologists.
Also, Licensed Addiction Counselors (LACs) may now enroll under provider type 38 to provide behavioral health services within the scope of their licensure per 10 CCR 2505-10 8.746.
Providers will continue to enroll under the most appropriate provider type.
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Timely Filing Period Extended to 365 Days - Effective June 1, 2018
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Effective June 1, 2018, the timely filing period will be permanently extended to 365 days.
- Providers always have at least 365 days from the Date of Service (DOS) to submit a claim. A timely filing waiver is needed if a claim is submitted beyond the 365-day timely filing period.
- Providers are required to resubmit claims every 60 days after the initial timely filing period (365 days from the DOS) to keep the claim within the timely filing period even if the claim denies. The previous ICN must be referenced on the claim, even if the claim is over 365 days.
- Providers who receive payment from Medicare or other insurance/third party liability no longer need to attach the EOB to the electronic claim. Providers have an additional 120 days from a Medicare payment or denial and must include the Medicare Explanation of Benefits (EOB) date on the claim.
- Waiting for prior authorization or correspondence from the Department or the fiscal agent is not an acceptable reason for late filing. Phone calls and other correspondence are not proof of timely filing. The claim must be submitted, even if the result is a denial. Issues resulting in failure to transmit accurate and acceptable claims or failure to identify transmission errors in a timely manner. If the issue is between the provider and the software vendor, billing agent or clearinghouse, this does not constitute an acceptable reason to be outside the timely filing period.
Claims that are not submitted within the 365-day guideline, but have one (1) of the below documents proving timely filing attached to the submission will be reviewed by the fiscal agent. Attachments should be submitted with the claim via the Provider Web Portal. The fiscal agent does not accept attachments via batch submissions.
- Claims that have been date-stamped by the fiscal agent or the Department and returned to the provider.
- A backdate approval letter (new enrollments, affiliations or updates are not acceptable reasons for late filing). Providers must enroll and submit claims within 365 days from the date of service.
- A load letter for member eligibility backdate.
- An affidavit of delayed notification of member eligibility.
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| Billing Policy Change Coming July 1, 2018 |
Beginning July 1, 2018, Rocky Mountain Health Plans Prime (RMHP Prime) and Denver Health Medicaid Choice (Denver Health) will be responsible for the coverage and payment of laboratory codes 80047 - 89398 submitted on professional claims and provided to their members by all provider types for certain mental health and substance use disorder (SUD) ICD-10 diagnoses.
Providers should always determine if a member is assigned to RMHP Prime or Denver Health before submitting a claim to either for reimbursement. If a member is not assigned to RMHP Prime or Denver Health, providers should submit claims to Health First Colorado for Fee-for-Service reimbursement.
For all other Fee-for-Service laboratory coverage policy questions, contact Raine Henry
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The second session of the
71st General Assembly adjourned May
9, 2018.
Department Legislation
The Department had five bills on its legislative agenda this session, including:
- Redesign of Children's Habilitation Residential Program (CHRP) Waiver. The JBC approved our budget request and agreed to run this legislation; it was introduced as HB18-1328. Status: Signed by Governor Hickenlooper.
- Conflict-free Case Management (CFCM) for Single-Entry Points HB18-1288. Status: This bill did not pass this legislative session. The Department will be looking at ways to address this issue in the future.
- Cost Savings through Transition Services & Community Living. The JBC approved our budget request and agreed to run this legislation; it was introduced as HB18-1326. Status: Signed by Governor Hickenlooper.
- Align Managed Care Statute with Federal Regulations. HB18-1431. Status: Signed by Governor Hickenlooper.
- Remove Outdated Waiver References from Statute--introduced as SB18-093, this bill removed references to the Persons Living with AIDS Waiver from statute. Status: Signed by Governor Hickenlooper.
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Delivery Systems Innovation
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| Accountable Care Collaborative Phase II Resources |
New Fact Sheets Available
It is important for Health First Colorado members to have a focal point of care, which is why in the next phase of the Accountable Care Collaborative the Department will automatically attribute all enrolled members to a primary care provider (PCP). Once the member has been attributed a PCP, they are then assigned to a regional organization (or RAE) region in which the PCP's practice is located.
For more information on the attribution process, check out these new fact sheets:
Additional information and resources about the Accountable Care Collaborative Phase II is available on the
Colorado.gov/HCPF/ACCPhase2 web page.
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Health First Colorado Recovery Audits Contractor Begins Work
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The Department has contracted with Health Management Systems, Inc. (HMS) to serve as its Recovery Audit Contractor (RAC) to conduct post-payment reviews of claims submitted for fee-for-service and managed care services. This is a federally-mandated contract program.
In February, HMS began to identify overpayments and assist the Department in recovering any overpayments made to providers for Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) medical claims.
The RAC audits claims from as far back as 7 years (84 months) from the date the claim was originally paid, and this lookback period applies to all claim and provider types.
All providers are encouraged to update their contact information using the HMS RAC Provider Portal, even if they have not received a letter that they are in an active audit. This is separate from the DXC Technology (DXC) Provider Web Portal. Updating contact information insures letters get to the preferred address and personnel. Providers who have access to the HMS Provider Portal already for other contracts will need to register for HMS RAC Provider Portal to have access to the RAC audit information.
The HMS RAC Provider Portal is a tool that providers can use to track the progress of their audits and add contact information that is specific to RAC correspondence.
If a provider does not update address and contact information in the HMS portal, all correspondence will go to the provider's service address listed in the Colorado interChange. Providers can access the HMS RAC Provider Portal and update contact information.
The Department website has RAC resources and information available for providers. HMS has also published a number of resources for providers including a webinar and frequently asked questions.
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New State Innovation Model Report Provides Strategies to Improve Mental Health in Boys & Men
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The Colorado State Innovation Model (SIM) has
released a new report that suggests new partnerships that extend beyond traditional health care circles to address mental health conditions in boys and men.
The call-to-action was spearheaded by the SIM population health workgroup and findings will help all populations in the state.
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State Innovation Model Helps Practices Integrate Care, Improve Patient Health
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New practice data shows that State Innovation Model (SIM) providers are screening more patients for depression and developmental delays, and have more confidence in the data they report and use to drive better patient care and ongoing quality improvement.
Check the SIM data hub for more details and listen to a SIM podcast about the evaluation efforts of SIM.
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State Innovation Model Helps Practices Connect to Broadband
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SIM has helped 196 practice sites gain access to broadband.
Adequate broadband capacity is essential for providers to collaborate, coordinate care and take advantage of telehealth, health information exchange (HIE), unified communications and cloud services. However, many healthcare providers lack adequate broadband capacity to leverage technologies that can transform health care delivery and outcomes.
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Updated Paper Application & Webinar
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The Department and Connect for Health Colorado will soon release an updated paper application for Medical Assistance, the
Application for Health Insurance & Help Paying Costs.
The application was updated to improve readability for applicants and members and to improve data entry efficiency for eligibility site workers. As with current paper application version, the Department will not print the updated paper applications for eligibility sites. The updated paper application will be posted by the beginning of June to the Department website in English and Spanish.
The Department will also host an informational webinar and post a desk aid to explain the updates made to the new paper application. This webinar will be offered twice with the same content. Space is limited, and the recording will be available online after the live sessions.
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Member Experience Survey: Medical Assistance Sites
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The Department has created a survey for Health First Colorado and Child Health Plan Plus
members who visit medical assistance, presumptive eligibility, hospital outstationing or certified application assistance sites.
The information in the survey will be used to improve the member experience at our many assistance sites. Survey participants can remain anonymous. The survey should take no more than a few minutes to complete.
The survey will be ongoing. Please help us by encouraging members who visit these sites to take the survey. The survey is available through the sites listed above only.
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Agency Letter HCPF 18-007 - Returned Mail Process Update
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The Department has issued an
Agency Letter Regarding Returned Mail for Health First Colorado and Child Health Plan
Plus. This Agency Letter provides updates on the revised Medical Assistance returned mail process.
The returned mail process has been revised for action to be taken on a case after the first piece of returned mail. This supersedes the previous process of waiting for three pieces of mail before action is taken. Cases must be updated to insure members receive important documentation without delays, such as verification checklists and redeterminations.
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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
