October 12, 2018
The rates posted on the current Physician Administered Drug Fee Schedule for Quarter 3, effective July 1, 2018, were loaded to the Colorado interChange system on October 9, 2018.
Claims affected by this issue will be reprocessed by DXC.
Department of Health Care Policy & Financing
ACC Phase II: July 1, 2018 Implementation
The next iteration of the Accountable Care Collaborative (ACC) begins July 1, 2018. The goals of the next phase are to improve member health and reduce costs.
The contact information, proposals and contracts for each of the new seven Regional Accountable Entities are available on CO.gov/HCPF/ACCPhase2.
Key Milestone Updates
Attribution & Enrollment Letters
Health First Colorado members began receiving letters indicating a member’s attribution and enrollment. The majority of letters will be mailed between June 26 and mid-July.
- Members should contact Health First Colorado Enrollment if they have any questions regarding their letter at 1-888-367-6557. State Relay: 711 for callers with hearing or speech disabilities. Call Monday to Friday, 8 a.m. to 5 p.m.
- Providers should contact their RAE for information about the attribution process or if they have questions about their list of assigned members.
Payment for Physical Health Services
Physical health services will continue to be reimbursed fee-for-service. Member assignment to a primary care medical provider (PCMP) does not affect fee-for-service payments to providers.
While the ACC program promotes member utilization of the assigned PCMP and use of referrals for specialty care, the ACC does not lock members into a PCMP or require referrals for health services.
- A member’s assignment to a PCMP does affect the administrative payments made by the RAE to the PCMP, so providers should encourage members to change their PCMP by contacting Health First Colorado Enrollment.
Providing Behavioral Health Services During Transition to Regional Accountable Entities
Behavioral health providers who are working with the RAEs to finalize contracts may continue providing services to meet members’ needs. The Department has a Transition of Care policy that requires their managed care entities to honor a member’s ongoing course of treatment for 60 days following a change in a member’s managed care entity.
For more information, contact the RAE in your region.
The Department has developed a Member Messaging Resource Center for their partners on CO.gov/HCPF/ACCPhase2. This resource center has the latest information and messaging for Health First Colorado members related to the ACC. Some of the following resources are included below:
- Member Terminology
- Member Contact List-Who to go to for What
- Health First Colorado Enrollment Letters
At this time, Health First Colorado is requesting that members, providers and other interested parties start by contacting their RAE if they have questions. In addition, interested parties can submit their questions to the Department using this form.
The Department has shared that they will not be able to respond directly to all inquiries but will direct questions to the appropriate entity while we work closely with the RAEs and other contractors to address critical issues. The Department will continue to use the questions submitted to tailor upcoming communications and resources.
Also see these links for more contracting information:
ACC Phase II web page
Contracting Guidance for Primary Care Medical Providers
Contracting Guidance for Behavioral Health Providers
Medicaid Fee Schedule Confusion/Clarification
Some confusion has resulted from Medicaid’s decision to no longer list all codes/rates in a single fee schedule. There are now multiple separate fee schedules for different code categories. See below for further details:
All fee schedules are available on the Provider Rates & Fee Schedules web page:
The “Health First Colorado Fee Schedule (master fee schedule)” no longer lists all codes. There are now separate fee schedule spreadsheets for E&M codes, immunizations, dental, etc. So if a code is not listed on the “Health First Colorado Fee Schedule” it may be listed on a benefit-specific fee schedule. Here are the links to the most common fee schedules:
• January 2018 Fee Schedule Data File and January 2018 Fee Schedule Instructions
• E/M and Vaccine Administration Services
• Immunization Rates
• HCPCS Rate Updates
• Physician Administered Drug Fee Schedule
Also: The Department of Health Care Policy & Financing and DXC Technology (DXC) are working to implement rate increases for rates approved as of July 1, 2017. DXC will adjust affected claims to apply the new rates to those claims. As a reminder, claims already billed with a rate lower than the new rate cannot be adjusted for the higher rate, as the Department will always use the “lower of” pricing logic. Providers are advised to bill their usual and customary charges. The Department will not waive timely filing rules (to find more information about timely filing, refer to the Frequently Asked Questions web page) to allow providers to adjust and rebill at the new rates. The Department and DXC will keep providers updated on implementing the new rates and reprocessing qualified claims. Please continue to check the provider bulletins for updates on rate increases, fee schedules and reprocessing.