Bulletin Board

ACA Status Letter and link to FAQ’s from Medicaid

December 8, 2016

Dear Esteemed Colleagues:

Since the election, there’s been a lot of speculation among media, politicians, policy makers, etc. on whether the Medicaid expansion will go away under the new administration. We wanted to provide information for you and your stakeholders before too much more speculation occurs. We will continue to post updates, as we have them, via our monthly Provider Bulletin, our Provider Portal, the Department’s social media outlets, and our Website. You are welcome to post the attachment and/or links on your websites or in your publications.

The bottom line is this: the Department’s job is to implement current law. The current law is still the ACA and until new legislation at both the federal and state level is passed, we will continue to implement the ACA. The Department monitors the conversations at the federal and state level closely and will update these resources as new information warrants.

If you have any questions – or you have received frequent questions not addressed in the FAQ attachment – please reach out to Marc Williams (contact info below).

Thank you!
Marceil Case

Marc Williams
Public Information Officer
Policy, Communications and Administration Office

P 303.866.3144 I C 720.626.0801 I State Relay: 711
1570 Grant Street, Denver, CO 80203
marc.williams@state.co.us I Colorado.gov/hcpf

Go-live for new Medicaid claims payment system has been postponed!

October 11, 2016

Today, Health Care Policy & Financing (HCPF) made the decision to postpone the Go Live date of:
• their new claims payment system (the Colorado interChange),
• The new provider web portal, and
• The new Pharmacy Benefits Management System.

The new Go Live date is March 1, 2017. Providers should continue to use their current processes for submitting claims, prior authorization requests and provider enrollment updates. Claims will continue to be processed and paid as they are currently.

The additional four months will allow providers and partners more time to complete the enrollment and revalidation process, receive comprehensive training, and prepare for associated changes in their business processes. HCPF will conduct additional systems testing during this time and will post updates and resources including revised deadlines on their Provider Resources web page.

Revalidate, revalidate, revalidate
Providers should not pause in their efforts to revalidate. If you have not started the process, PLEASE START IMMEDIATELY. For those providers who have started an application, it will continue to process. For assistance, please call the Health First Colorado Enrollment and Revalidation Information Center at 1-800-237-0757, option 5.

Web Portal Training is available now. Providers should visit the Medicaid Provider Resources web page for more information including an updated schedule of sessions.

Rate Changes for Evaluation and Management (E&M) and Vaccine Administration Services (Update)

July 1, 2016

The Health First Colorado reimbursement rates for E&M procedure codes and vaccine administration procedure codes are changing. The Department reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for Calendar Year 2013 and Calendar Year 2014 and temporarily extended the Medicare equivalent rate through June 2016. The funding to reimburse the E&M and vaccine administration codes at a Medicare equivalent rate has ended. Effective July 1, 2016, the E&M and vaccine administration services will be reimbursed at the December 2012 level, except as noted below.

From July 1, 2016 through June 30, 2017, through the efforts of the Department and provider associations, one year of additional funding is authorized to reimburse several E&M categories and vaccine administrations higher than the Health First Colorado rates in place in December 2012 (prior to the implementation of Section 1202). The E&M categories with temporary funding are standard office visits, preventive care office visits, newborn visits, neonatal and pediatric critical care visits, and counseling visits. These rates are scheduled to return to the December 2012 level on July 1, 2017.

Categories of E&M that did not receive additional funding will be reimbursed at the December 2012 level starting July 1, 2016. These include emergency room visits, inpatient visits, critical care visits (excluding neonatal and pediatric critical care visits), home visits, when visits are prolonged, and standby/warfarin/interdisciplinary conference visits.

Please refer to the E&M and Vaccine Administration Services rates appendix below for specific procedure codes in each category. The reimbursement amount for the procedure codes is also in the appendix. The appendix may also be found on the Provider Rates and Fee Schedule website.

Evaluation and Management and Vaccine Administration Services Rates Appendix

Categories with temporary funding Codes

Immunization Administration 90460-90461, 90471-90474
Office Visit 99201-99205, 99211-99215
Preventive Medicine Visits 99381-99397
Newborn Visits 99460-99465, 99477-99486
Critical Care Visit – Neonatal and Pediatric 99466-99476
Counseling and Health Risk Assessments 99401-99414

Categories without temporary funding
Emergency Department Visit 99281-99288
Inpatient/facility Visit 99217-99239, 99304-99337
Critical Care Visit 99291-99292
Home Visit 99341-99350
Prolonged Visits 99354-99359, 99415-99416
Standby, Warfarin, Interdisciplinary conf 99360-99368

Click here for the new rates

If you have questions, please contact Richard Delaney at richard.delaney@state.co.us.

Rate Changes for Evaluation and Management and Vaccine Administration Services

June 23, 2016

NOTE: Please find below a sneak preview of information that will appear in the Medicaid Provider Bulletin and At a Glance publications on July 1st. Please note: while rate changes take effect on July 1st, the Centers for Medicare and Medicaid Services (CMS) must approve changes to the Department’s State Plan before the rates may be paid. Due to the timing on CMS approval, the new rates may not be paid starting on July 1. If needed, the Department will mass adjust all qualified claims in the system once CMS approval is received. We apologize, in advance, for any inconvenience and administrative burden this places on your practices.

The Colorado Medicaid reimbursement rates for evaluation and management procedure codes and vaccine administration procedure codes are changing. The Department reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for calendar years 2013 and 2014, and temporarily extended the Medicare equivalent rate through June 2016. The funding to reimburse the evaluation and management and vaccine administration codes at a Medicare equivalent rate ends on June 30, 2016.

From July 1, 2016 through June 30, 2017, through the efforts of the Department and provider associations, one year of additional funding is authorized to reimburse several evaluation and management categories and vaccine administration at higher than the Medicaid rates in place in December 2012, prior to the implementation of Section 1202. The evaluation and management categories with temporary funding are:

• Standard office visits
• Preventive care office visits
• Newborn visits
• Neonatal and pediatric critical care visits
• Counseling visits

The FY16-17 reimbursement rates for these procedure codes are available online at E&M_Vaccine Code reimbursement. These rates are scheduled to return to the December 2012 level on July 1, 2017.

Categories of evaluation and management that did not receive additional funding will be reimbursed at the December 2012 level starting July 1, 2016. These include emergency room visits, inpatient visits, critical care visits (excluding neonatal and pediatric critical care visits), home visits, when visits are prolonged, and standby/warfarin/interdisciplinary conference visits.

If you have questions, please contact Richard Delaney, Policy Specialist, at richard.delaney@state.co.us.

Marceil Case | Manager, Provider Relations

Colorado Department of Health Care Policy and Financing
Health Programs Office
P 303.866.3054  I  F 303.866.2573 State Relay: 711
1570 Grant Street, Denver, CO  80203
marceil.case@state.co.us  |  Colorado.gov/hcpf

Medicaid Provider News – Call Center Open for Enrollment/Revalidation Questions

May 9, 2016

Dear Esteemed Providers and Stakeholders:

To better aid providers with Enrollment and Revalidation questions, the Department is pleased to announce the creation of the Colorado Medicaid Enrollment and Revalidation Information Center. Providers may still send emails regarding the status of their application(s) to the Provider.Questions@state.co.us email box; however, effective May 2, 2016, providers may also dial 1-800-237-0757, option 5, to speak with a representative. The Colorado Medicaid Enrollment and Revalidation Information Center is available Monday through Friday from 8:00am – 5:00pm, but will be closed from 12:00pm – 1:00pm.

Please note:  Call center representatives will be able to answer questions about the enrollment/revalidation process, check the status of pending applications, review corrections that may be needed, and refer callers to existing online enrollment/revalidation resources.  They will not be able to walk providers through an entire application, change application responses, or approve applications. Before calling the Information Center, please be sure to have the 5-digit Application Tracking Number (ATN) of your application and your tax ID number handy.

Please also note: Many Colorado Medicaid providers have not yet begun the Provider Revalidation process. Although the Centers for Medicare and Medicaid (CMS) has extended its deadline for states to complete provider revalidation, it is important that providers complete revalidation and/or enrollment as soon as possible. All providers who serve Medicaid and CHP+ members must enroll/revalidate.  By completing the enrollment/revalidation process as soon as possible through the Online Provider Enrollment (OPE) tool, providers will not experience delays in payment when the new enrollment and claims management system, Colorado interChange, launches on October 31, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied.

Please do not begin the application before reviewing all of the training resources available online. An incorrect or incomplete application requires additional review, which may add weeks to processing time.  Revalidation and Enrollment Instructions are available online. Be sure to review the Information by Provider Type before you begin the online training, as it will help you select the correct training. The Provider Enrollment Manual also includes valuable information to help providers complete applications correctly.  Questions may be sent to Provider.Questions@state.co.us or our new Information Center at 1-800-237-0757 (option 5).

Thank you, as always, for your service to Medicaid members!

Marceil Case | Manager, Provider Relations
Colorado Department of Health Care Policy and Financing
Health Programs Office
P 303.866.3054  I  F 303.866.2573 State Relay: 711
1570 Grant Street, Denver, CO  80203
marceil.case@state.co.us  |  Colorado.gov/hcpf

Dr. Jay Markson Wins Harold E. Williamson Award

February 25, 2016

Dr. Jay Markson is the 2015 recipient of The Harold E. Williamson Award. The award is presented in conjunction with the COPIC Foundation and honors a Colorado physician for volunteer medical services and contributions to the community. Having prescribed reading to more than 27,000 low-income youth and families at Children’s Medical Center, Dr. Markson knows the importance of creating a culture of literacy within the home. He believes that “Reading every day is as important to a child’s health as eating enough fruits and vegetables.” Read more about Dr. Markson…