Latest from the CO Dept. of Health Care Policy & Financing (HCPF)

• At a Glance - December 2017
• Colorado interChange: Week of January 4, 2018, Provider Buzz:

Related to the Colorado interChange
Effective January 1, 2018, the Department will be enforcing new Medicaid regulations that require all ordering or referring physicians or other professionals providing services must be enrolled as providers, and that Medicaid must require all claims for the payment of items and services that were ordered, referred, and prescribed to include the National Provider Identifier (NPI) of the ordering, referring or prescribing physician or other professional. The Department will not pay for new prescriptions written on or after January 1, 2018 if the prescriber is not enrolled with Colorado Medicaid. If a prescriber does not wish to enroll with Colorado Medicaid they should begin referring their patients to a prescriber that is enrolled. The Department has been identifying and making direct calls to these unenrolled providers since October 2016, has sent many faxes to pharmacies about the implementation and has been noticing pharmacies.

Other hot topics from the Department
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. 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 and changes to co-pays for outpatient hospital visits, non-emergent emergency room visits and pharmacy co-pays.

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 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.

On December 21, 2017, the Joint Budget Committee approved Governor John Hickenlooper's request for one-time, short-term funding to extend funding of CHP+ at least until February 28, 2018. An exact end date for CHP+ in Colorado is not known at this time because of changing legislative action. The Department is currently analyzing how the recent federal Continuing Resolution passed by Congress may impact the CHP+ program in Colorado. Once the Department's analysis is complete, the resources and information on this page will be updated to reflect the most current information.You can get updates by visiting the Department's Future of CHP+ page and signing up for the future of CHP+ newsletter.

News You Can Use

Using the void claim option in the Provider Web Portal
The void claim option on the Provider Web Portal will only appear on eligible claims. Only paid claims can be voided and the most recent paid Internal Control Number (ICN) must be used to adjust or void. For more instructions on how to adjust or void a claim, refer to the Copy, Adjust or Void a Claim Quick Guide on the Web Portal. As a reminder, providers should be submitting all claims electronically. Please see the November 2017 Provider Bulletin (B1700406) for information on submitting claims with attachments. Denied claims do not need to be adjusted or sent as a request for reconsideration. A denied claim can be resubmitted electronically as a new claim once corrections have been made.

Colorado interChange Numbers
Since March 1, 2017...

$6.5 billion paid to providers
More than 41 million claims processed In our latest financial cycle on Friday, Dec. 29...

$93 million paid to providers
Nearly 800,000 claims processed As a reminder, the Department frequently updates its Known Issues & Updates web page with new issues, work arounds and resolution ETA.