Provider News: Delay in Paying Enhanced Primary Care Rates

"Some of you may have noticed that your E&M and/or vaccination claims are still being paid at the usual Medicaid rate.  The Department apologizes for the delay in implementation of the higher reimbursement rate and has approved the following information to be shared across the provider community.

• Beginning January 1, 2015, Colorado Medicaid is reimbursing covered office visit (E&M) and vaccine administration procedure codes at a rate equal to 100% of the December 2014 Medicare reimbursement rate.
• The new rate is available to all enrolled providers that submit fee schedule claims for office visits or vaccine administrations. The new reimbursement rate will remain in place through June 30, 2016.
• Due to a delay in CMS approval of the new rates, the higher rates have not yet been loaded in the Department’s claims processing system.  The Department does not have an anticipated approval date at this time.
• The Department will retroactively adjust claims with dates of service on or after January 1, 2015, to reflect the rate increase.
• Providers should continue to submit charges based on Usual and Customary rates, when applicable.  Automatic adjustments can be made by the Department’s MMIS only if the original submitted charge on a claim is greater than the newly revised rate; otherwise, the provider must resubmit a claim with the higher rate.
• Once CMS approval is received, the new rates will be loaded and will be paid upon claim submittal. "

Click here to view the latest issue of the Department of Health Care Policy and Financing’s ACA Implementation News.

Click here to view the February 2015 CICP Newsletter. [Source: HCPF]