Provider Buzz
Here's a look at hot topics for providers and others:
Related to the Colorado interChange:
- The Department is implementing two new policies related to co-payments. Providers can find details about each of the policies in the December Provider Bulletin. The Department has also recorded an informational webinar. These policy changes include:
- Notification of members by mail when their household has met its co-pay maximum, which is 5 percent of the household monthly income.
- Changes to co-pays for outpatient hospital visits, non-emergent emergency room visits and pharmacy co-pays.
- Providers who are an "individual within a group" (rendering provider only) with two or more Provider IDs that share an NPI in the Colorado interChange, should have received an email communication from DXC and the Department on 11/30/17 with the subject line "Colorado Medicaid Provider Enrollment Application." Rendering providers should only have one Medicaid Provider ID in the interChange, even if they provide services in multiple locations. Duplicate IDs can cause claim denials. DXC will be inactivating any duplicate provider records and IDs so they only have one ID in the system.
- Clarification: Please note that once DXC has inactivated any duplicate records and IDs in the system, providers will receive a second email, which will include the Provider ID they should use moving forward. This applies only to Individuals Within a Group that have duplicate IDs. Their NPI should still be used for claims submission. The Medicaid Provider ID is not needed on the claim. Note: The Department sent a clarifying email to these providers 12/13/2017.
Other hot topics from the Department
- Health First Colorado members having difficulty determining the appropriate type and level of care needed based on a unique medical situation can get help. The Health First Colorado Nurse Advice Line helps members determine the appropriate course of action when faced with health issues. The Nurse Advice Line provides Health First Colorado members 24/7 free access to medical information and advice in both English and Spanish. Nurse Advice Line features include free access 365 days a year, support from registered nurses, advice for medical conditions, such as diabetes or asthma and advice on the type of doctor that may be right for a particular medical condition.
- 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.
News You Can Use
Here's some content for membership newsletters:
Timely filing questions and answers
As you work to better understand rules and changes around timely filing, here are some commonly asked questions as well as a link to additional resources.
What is the deadline for meeting timely filing requirements?
The Department of Health Care Policy & Financing has extended timely filing to 240 days from the date of service. Therefore, the traditional 120-day window to file a claim is no longer applicable until May 1, 2018.
What date is used when considering timely filing deadlines?
A claim is considered filed when the fiscal agent documents receipt of the claim.
How can a provider qualify for a timely waiver (override)?
There are reasons that a provider may qualify for a timely waiver. If any of the following scenarios apply but are still within the 240-day window, a waiver is not needed and the provider only needs to resubmit the claim. Please note that providers always have at least240 days from the date of service to submit the claim. A timely filing waiver is only needed if the dates of service have exceeded 240 days.
Colorado interChange Numbers
Since March 1, 2017...
- $6.2 billion paid to providers
- More than 39 million claims processed
In our latest financial cycle on Friday, Dec. 8...
- $145 million paid to providers
- More than 1 million 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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