Provider Buzz
Here's a look at hot topics for providers and others:
Related to the Colorado interChange:
- Over the last several weeks, leadership at the Department has been meeting with RCCOs and others to learn more about resources and supports that continue to be needed to assist providers through the transition to the Colorado interChange. In response to feedback from those meetings, the Department is developing additional educational materials and working with DXC to schedule provider training sessions. A schedule for those sessions will be available here in the coming weeks.
- You may have heard from some providers that crossover claims for services that are covered by Medicare but not Medicaid were denying inappropriately, specifically crossover claims filed by Federally Qualified Health Centers for certain services. The Colorado interChange should have reimbursed these claims based on the Medicare assigned coinsurance and deductible. Providers were previously advised to continue to submit these claims, and resubmit them now that the issue is resolved.
- Effective today, November 30, 2017, the Eligibility page on the Provider Web Portal will require users to complete a CAPTCHA human verification step by identifying which images fit the given description. This change is intended to minimize issues and slowness affecting all portal users. This email communication was sent to providers in response to increased call volume.
Other hot topics from the Department
- The Department is moving forward with the implementation of the Alternative Payment Model for Primary Care (APM). The survey to select measures in the model is now open. A link to the survey is available on the Department's website. The website also has pre-survey instructions, links to resources including the APM Survival Guide and a short video demonstrating how to use the APM model. The survey will remain open through January 31, 2018. As the Department moves forward with the APM, a workgroup is forming to assist with the implementation of the APM. Similar to the process used to design the APM, the Department is looking for representation from primary care physicians, primary care practice coordinators, office managers, and Regional Care Collaborative Organization representatives. The group would provide feedback and input on how best to implement the APM and help the Department understand the impact of operational decisions.
- The next phase of the Accountable Care Collaborative (ACC) seeks to leverage the proven successes of Health First Colorado's (Colorado Medicaid's program) programs to enhance the member and provider experience. The goals of the next phase are to improve health and life outcomes of members while using state resources wisely. Learn more here. The Department is pleased to announce the protest period associated with the Request for Proposal for the Regional Accountable Entities (RAEs) for the next iteration of the Accountable Care Collaborative (ACC) has ended. The entities listed below will be awarded contracts. The Department has made available online the proposals from each of the awarded entities on CO.gov/HCPF/ACCPhase2
News You Can Use
Provider Resources for the Colorado interChange
As you continue to learn how the Colorado interChange works for your organization, many resources are available to assist you. While no resource can answer every question, many new resources are being added regularly to help. You can also subscribe to receive emails from the Department that address hot topics and ongoing issues.
Other resources include:
· The Read Your RA Quick Guide. The Department is also working to publish a webinar with more dynamic explanation of the document.
· Interim payments for providers experiencing financial difficulties are still available. You can learn more information from this document.
· Timely Filing has been a topic of confusion for many providers. A clarifying article in the October 2017 edition of the Provider Bulletincan help as well as finding answers to frequently asked questions.
A variety of resources, including step-by-step instructions with screenshots for frequent tasks and Provider Web Portal training videos, related to using the Provider Web Portal
Colorado interChange Numbers
Since March 1, 2017...
· More than $5.8 billion paid to providers
· 37 million claims have been processed
In our latest financial cycle on Friday, Nov. 24 ...
· $94 million paid to providers
· 645,000 claims processed
As a reminder, the Department frequently updates its Known Issues & Updates web page with new issues, work arounds and resolution ETA. |
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