Improve health care equity, access and outcomes for the people we serve
while saving Coloradans money on health care and driving value for Colorado.
Provider Bulletin
Reference: B2300501
Nov
2023
Table of Contents
Page Title
All Providers
1
Did You Know? Provider Enrollment
Revalidation
1 RAC Provider Stakeholder Webinar
2
DRA of 2005 Due November 1, 2023
2 EFT Changes or Updates
3
Provider Services Call Center
3
Update Address for IRS Form 1099
ColoradoPAR Program
3 Acentra Provider Training
Behavioral Health
4 Access to Behavioral Health Services
HCBS, Case Managers, CCBs,
Contracted CM Agencies
4
HCBS for Persons with IDD Waiver Programs
Billing Manual Update
Hospital
5
General Updates
6
Updates to Hospital Policy
Immunization
6 Vaccine Code Updates
7
Rabies Vaccine Rates
Outpatient Hospital
7
Specialty Drugs: Medications List Update
Pediatric Personal Care
8
Underpayment of Rate Increase
Pharmacy
8
Pharmacist Prescriptions
Physician Services
9 eConsult Platform Update
10 SBIRT
School Health Services
10
Update to SHS Billing Manual
Speech Therapy
11
Speech Therapy Before a PAR is Required
Transportation
12 Claim Editing for NEMT Providers
Provider Billing Training Sessions
13
November and December 2023 Training
Did You Know?
Providers that do not complete the enrollment
revalidation process by their revalidation due date will
be subject to claim denials or disenrollment effective
November 11, 2023. Providers can locate their new
revalidation date on the Provider Revalidation Dates
Spreadsheet, which is located on the Revalidation
web page under the Revalidation Resources section.
All Providers
Colorado Recovery Audit Contract
(RAC) Provider Stakeholder Webinar
All Health First Colorado (Colorado’s Medicaid
program) providers are invited to a Recovery Audit
Contract (RAC) stakeholder webinar. This quarterly
meeting will take place via Zoom on Thursday,
November 2, 2023, at 12:00 p.m. MT.
Register
in advance for this webinar.
A confirmation email containing information about
joining the webinar will be received after registering.
Want RAC Updates?
The
Colorado RAC Stakeholder Contact List Request
Form has been created to ensure RAC program
information is quickly and efficiently communicated
externally. Providers are encouraged to update
their contact information in the Provider Web
Portal. Visit the RAC Program web page under the
Provider Requests and Surveys subsection to view
the form to sign up for email communications.
B2300501 November 2023
Page 2
Deficit Reduction Act (DRA) of 2005 Due November 1, 2023
Section 6032 of the Deficit Reduction Act (DRA) of 2005 requires that providers meeting the
definition of entity and making or receiving annual Medicaid payments of $5 million or more
establish and disseminate certain written policies for preventing and detecting fraud, waste
and abuse. The entities must also provide information to employees and contractors about
the following:
• T
he Federal False Claims Act (FCA) and other applicable
federal and state false claims laws
• The administrative remedies for false claims and statements
• The whistleblower protections afforded under such laws
Providers subject to Section 6032 are required each year to furnish
certain documentation to show compliance with these requirements. Providers will receive an
email requesting this documentation. Ensure the contact information in the Provider Web
Portal is current to receive this email.
Entities subject to the DRA must complete and return the DRA Declaration to the Department of
Health Care Policy & Financing (the Department). Entities with multiple identified locations
must send one (1) DRA Declaration with an attachment listing all National Provider Identifiers
(NPIs) and service location IDs covered by the DRA Declaration. The due date for the Federal
Fiscal Year (FFY) of October 1, 2022, through September 30, 2023, is November 1, 2023.
The completed DRA Declaration
and all required documents must be emailed to
HCPF_DRAAact2005@state.co.us.
Contact Eileen Sandoval at HCPF_DRAAct2005@state.co.us with questions related to the DRA.
Electronic Funds Transfer (EFT) Changes or Updates
Making Electronic Funds Transfer (EFT) Changes or Updates?
Submit a provider maintenance update. All information should be updated and current,
including:
• Mailing, billing and service location address(es)
Note: Mailing and billing addresses must be current to receive paper checks.
• Contact information
• Owner and/or managing employee information
Including all this information will expedite an EFT change and minimize disruptions to
payments. It can take up to two (2) weeks for the EFT changes to take place. Paper checks
will be mailed in the interim.
Refer to the EFT Quick Guide and the Provider Maintenance Quick Guide
or contact the
Provider Services Call Center with questions.
B2300501 November 2023
Page 3
Previously Receiving EFT Payments and Now Receiving Paper Checks?
Immediately verify if there was an EFT change submitted and contact the Provider Services
Call Center with the suspected EFT tracking number if a fraudulent EFT is suspected.
Provider Services Call Center
Providers are reminded to contact the Provider Services Call Center with any billing
questions. The phone number 1-800-221-3943 is for Health First Colorado members only and
cannot assist with provider questions.
Reminder: Update Address for Internal Revenue Service (IRS)
Form 1099 in Provider Web Portal
Providers are encouraged to ensure the Internal Revenue Service (IRS) 1099 form mailing
address on file with Health First Colorado is accurate and current prior to January 2024.
Providers may add, view or modify the IRS 1099 form mailing address through the Provider
Maintenance option in the Provider Web Portal. A confirmation letter will be sent to all linked
provider service locations when an update is completed.
The letter will contain:
• T
he provider service location ID
• Information about the user who completed the change
• Details of the address changes made (previous and new)
Note: The IRS 1099 form mailing address is linked to the associated tax ID. If multiple
provider IDs share the same tax ID and one provider changes the 1099 address, that address
will change for all providers with that tax ID.
Refer to the Provider Maintenance - Provider Web Portal Quick Guide web page u
nder the
Address Changes section for instructions on how to update an address in the Provider Web
Portal.
All Providers Who Utilize the ColoradoPAR Program
Acentra (Formerly Kepro
®
) Provider Training
Provider-specific training offers Prior Authorization Request (PAR) submission information
focused on the benefit. Acentra’s November provider-specific training is for the Physician-
Administered Drug (PAD) Provider Benefit Specific Training (PBST). This training will include
an overview of the benefit and will have Acentra staff pharmacists on hand to answer
questions.
B2300501 November 2023
Page 4
• PAD PBST: November 8, 2023, at 8:30 a.m. MT
• PAD PBST: November 8, 2023, at 12:00 p.m. MT
• PAD PBST: November 8, 2023, at 3:30 p.m. MT
Acentra’s provider PAR portal, Atrezzo
®
.
• P
AR Submission: November 15, 2023, at 8:30 a.m. MT
• PAR Submission: November 15, 2023, at 12:00 p.m. MT
Behavioral Health Providers
Access to Certain Behavioral Health Services
The Colorado Legislature passed Senate Bill (SB) 23-174 in 2023, which requires the
Department to provide access to a limited set of behavioral health services to members under
the age of 21 without a covered diagnosis. The services will include an array of outpatient
psychotherapy services. The policy will go into effect July 1, 2024.
The legislation requires that the Department seek stakeholder input regarding the scope of
s
ervices that should be covered under this policy as well as key information that should be
included in the annual report to the legislature. The SB 23-174: Coverage Policy web page was
created with reference materials for this policy.
A stakeholder webinar will be held on Friday, November 17, 2023, at 12:30 p.m. MT.
Providers are invited to attend the webinar and to visit the SB 23-174: Coverage Policy web
page to review the resources and provide input.
Home and Community-Based Services (HCBS) Providers,
Case Managers, Community Centered Boards,
Contracted Case Management Agencies
Home and Community-Based Services (HCBS) for Persons with
Intellectual and/or Developmental Disabilities (IDD) Waiver
Programs Billing Manual Update
The HCBS for Persons with IDD Waiver Programs and Targeted Case Management Billing
Manual has been updated to include the new Targeted Case Management codes related to
Case Management Redesign.
Contact HCPF_CMRD_Enrollment_Billing@state.co.us wit
h questions.
B2300501 November 2023
Page 5
Hospital Providers
General Updates
All Hospital Providers
Hospital Stakeholder Engagement Meetings
Bi-monthly Hospital Stakeholder Engagement meetings will continue to be hosted to discuss
current topics regarding payment reform and operational processing. Sign up
to receive the
Hospital Stakeholder Engagement Meeting newsletters.
• T
he next All-Hospital Stakeholder Engagement meeting is scheduled for Friday,
November 3, 2023, from 9:00 a.m. to 11:00 a.m. MT and will be hosted virtually
on Zoom.
• An extra meeting will be added on Friday, December 15, 2023, from 9:00 a.m. to
11:00 a.m. MT to discuss fiscal hospital impacts related to the All Patient Refine
d
Diagnosis Related Groups (APR-DRG) Version 40 Update currently scheduled for
implementation on July 1, 2024.
Visit the Hospital Stakeholder Engagement Meeting web page
for more details, meeting
schedules and past meeting materials. Calendar Year 2024 meeting dates have been posted.
Contact Tyler Samora at Tyler.Samora@state.co.us wit
h any questions or topics to be
discussed at future meetings. Advanced notice will provide the Rates Team time to bring
additional Department personnel to the meetings to address different concerns.
Outpatient H
ospitals
The Enhanced Ambulatory Patient Grouping (EAPG) rate calculation for the Peer Group
Averages contained an error impacting the payment rates for certain out-of-state hospital
claims, as discussed in the September Hospital Engagement meeting. The rates were updated
within Colorado interChange during the end of October with adjustments to claims planned
for early part of November.
Rural H
ealth Clinics (RHCs)
Rural Health Clinic (RHC) Bi-Monthly Meeting
• The next RHC meeting is scheduled for Thursday, November 2, 2023, from
12:30 p.m. to 1:00 p.m. MT and will be hosted virtually on Zoom.
Visit the RHC and Rural Hospital Meeting web page for more details, meeting schedules and
past meeting materials.
Contact Andrew Abalos at A
ndrew.Abalos@state.co.us with any questions or topics to be
discussed at future meetings. Advanced notice will provide the Rates Team time to bring
additional Department personnel to the meetings to address different concerns.
B2300501 November 2023
Page 6
Updates to Hospital Policy
The hospital services policy has been updated effective October 30, 2023. The update
clarifies covered hospital services by providing guidance for when inpatient (IP), outpatient
(OP) and observation stays are appropriate based on medical necessity. Refer to the IP/OP
Billing Manual for details.
with questions.
Immunization Providers
Vaccine Code Updates
Reminder
All Advisory Committee on Immunization Practices (ACIP)-recommended immunizations are a
covered benefit for all members without cost sharing. This includes flu and COVID-19
vaccines. All ACIP-recommended adult vaccines may be administered in the pharmacy.
Providers seeking reimbursement for administering immunizations to members under the age
of 19, including flu and COVID-19 vaccines, must enroll in the Vaccines for Children (VFC)
program and use VFC-distributed products.
Respiratory Syncytial Virus (RSV) Immunization Updates
Correction: RSV vaccines are a covered benefit for adult members at least 60 years of age
without cost-sharing effective June 21, 2023. Common Procedural Technology (CPT) codes
90678 and 90679 should be used as well as the applicable vaccine administration code.
CPT 90678 is also available for pregnant individuals effective September
22, 2023. The provider must be VFC-enrolled to receive reimbursement
for administration of the RSV vaccine if the pregnant member is under
the age of 19.
Vaccine Counseling for RSV Monoclonal Antibody (MAB) Guidance and
Preventive Medicine Counseling Codes
Health First Colorado covers vaccine counseling visits in which healthcare providers talk to
families about the importance of vaccination.
Health First Colorado will also reimburse for stand-alone vaccine counseling visits as part of
vaccine administration required for all routine vaccines. Providers should bill CPT G0310,
G0311, G0312, G0313, G0314 or G0315 for visits in which healthcare providers give counseling
about the importance of vaccination. Providers should include modifier CR for all COVID-19
vaccine counseling-only visits. Providers should not bill for the vaccine counseling code and
the vaccine administration code on the same date of service when vaccine administration
codes are inclusive of counseling.
B2300501 November 2023
Page 7
CPT G0310, G0311, G0312, G0313, G0314 or G0315 can be billed at only one (1) visit for each
member per day, but there are no quantity limits for the number of times this education is
provided to an individual member.
Providers may bill the appropriate Preventive Medicine Counseling Code (CPTs 99401-99404)
for the counseling portion of the visit if a specific vaccine or Monoclonal Antibody (MAB)
administration code does not include a vaccine counseling component (e.g., administration
code 96372 used for RSV MAB injections) and providers counsel and administer the vaccine or
MAB on the same date of service.
Keep documentation in the member's chart that shows the duration of counseling and a list of
the prevention topics covered during counseling.
A separate Evaluation and Management (E/M) visit code may be reported with modifier 25 if
there is a separately identifiable E/M service performed outside of vaccine counseling and
immunization administration.
Contact Christina Winship at Christina.Win[email protected]o.us
with any questions.
Rabies Vaccine Rates
There are new rates for rabies vaccines and immune globulin effective September 26, 2023, for
the following Common Procedural Technology (CPT) codes: 90375 ($293.67), 90376 ($274.36)
and 90675 ($338.27). New rates are available on the Immunization Rate Schedule. Claims
submitted at the previous lower rate must be adjusted in order to receive the higher rate.
Contact Christina Winship at C
hristina.Winsh[email protected]s with any questions.
Outpatient Hospital Providers
Outpatient Hospital Specialty Drugs: Medications List Update
Outpatient Hospital Specialty Drugs – Enhanced Ambulatory Patient Group (EAPG)
Carveout Program
Approved outpatient hospital specialty drugs fall under the Outpatient Hospital Specialty
Drugs – EAPG Carveout policy. Ultomiris (ravulizumab-cwvz) and Xenpozyme (olipudase
alfa-rpcp) have been added to the list of approved outpatient hospital specialty drug
carveouts effective August 2, 2023, and August 10, 2023, respectively. Refer to
Appendix Z:
List of Outpatient Hospital Specialty Drugs for the entire list of specialty drugs subject to this
policy.
Member-sp
ecific Prior Authorization Requests (PARs) must be submitted directly to the
Department and approved prior to administration of the specialty drug. Visit the Physician-
Administered Drug (PAD) web page under the Outpatient Hospital Specialty Drugs – EAPG
B2300501 November 2023
Page 8
Carveout drop-down for resources, including Appendix Z, coverage standards, request forms
and submission requirements.
General Information
Retroactive requests are not usually considered; however, as an exception, the Department
will review PARs for members who have received treatment with either specialty drug for
dates of service between the respective effective dates as outlined above and November 1,
2023. An approved PAR must be on file for any future dates of service prior to the member
receiving treatment or the claim line will be denied.
Prior authorization does not guarantee payment. The outpatient hospital benefits require the
National Drug Code (NDC) of the PAD administered to the member to be billed on the claim
line. Refer to
Appendix X
: Healthcare Common Procedural Coding System (HCPCS)/NDC
Crosswalk for guidance and valid and reimbursable HCPCS/NDC combinations.
Refer to the PAD Billing Manual and the Inpatient/Outpatient (IP/OP) Billing Manual or visit
the PAD web page for additional policy information.
Contact HCPF_PAD@state.co.us with additional questions.
Pediatric Personal Care Providers
Underpayment of Rate Increase
The July 1, 2023, Pediatric Personal Care rates (procedure code T1019) were not
appropriately allocated the Across-the-Board increase. The rates for Pediatric Personal Care
have been adjusted to reflect the increase received. Rates have been corrected in the
Colorado interChange and on the Health First Colorado Rate Schedule located on the
Provider Rates and Fee Schedule web page.
Providers billing the fee schedule rate instead of their usual and customary charges must
manually adjust claims to the increased rate. Providers billing usual and customary charges
will see claims adjustments via claims reprocessing.
Pharmacy Providers
Pharmacist Prescriptions
Enrolled pharmacists submitting pharmacy claims and receiving denial code 6Z/50602 –
“Provider Not Elig To Perform Serv/Dispense Product” are encouraged to call Magellan to
complete a prior authorization to confirm meeting applicable criteria as established in C.R.S
12-280-103 (39)(g)(IV) and Department of Regulatory Agencies (DORA) rules to receive
reimbursement for the claim, effective November 15, 2023. The prescribing pharmacist
should be the point of contact with Magellan.
B2300501 November 2023
Page 9
Refer to the Pharmacist Services Billing Manual for additional details.
Contact the Magellan Rx Management Pharmacy Call Center 24 hours, 7 days a week, for
further technical assistance.
Contact Korri Conilogue at Korri.Conilogue@state.co.us with additional questions related to
this policy.
Physician Services Providers
eConsult Platform Informational Update
Health First Colorado providers will soon have access to an electronic consultation (eConsult)
platform. The anticipated launch date for the eConsult platform is February 1, 2024. The
eConsult platform will be accessible to all Health First Colorado providers without any
charges. Providers can access the eConsult platform on the
Colorado Medicaid eConsult
website.
The eConsult platform will enable asynchronous (store and forward) clinical communications
between a Primary Care Medical Provider (PCMP) and a specialty provider. The PCMP will be
able to transmit an electronic clinical question to a specialty provider. The specialty provider
will be able to review the case without the member being present. The specialty provider will
then provide electronic medical consultative guidance that assists the PCMP in the diagnosis
or management of the member’s healthcare needs or facilitates the appropriate referral for a
face-to-face visit with a specialty provider when clinically appropriate.
Several webinars are being hosted with the eConsult vendor Safety Net Connect. Sign up for
one of the upcoming webinars to access in-depth information about Colorado Medicaid
eConsults and to ask questions or share feedback.
Webinar Schedule
• November 29, 2023, from 8:00 a.m. to 9:30 a.m. MT
- Topic: Enhancing Access with eConsults: General Overview
- Register
in advance for this webinar.
• December 6, 2023, from 8:00 a.m. to 9:30 a.m. MT
- Topic: Enhancing Access with eConsults: General Overview
- Register
in advance for this webinar.
• December 13, 2023, from 8:00 a.m. to 9:30 a.m. MT
- Topic: Enhancing Access: eConsults for PCMPs
- Register
in advance for this webinar.
• January 10, 2024, from 8:00 a.m. to 9:30 a.m. MT
- Topic: Enhancing Access: eConsults for Specialty Providers
- Register
in advance for this webinar.
B2300501 November 2023
Page 10
Anticipated Timeline
• Fall/Winter 2023 - Implementation Activities
• February 1, 2024 - Anticipated eConsult Platform Go Live
Note: The timeline is subject to change without prior notice and is only provided as a
reference.
for more
information.
Screening, Brief Intervention and Referral to Treatment (SBIRT)
Screening, Brief Intervention and Referral to Treatment (SBIRT) is designed to prevent
members from developing a Substance Use Disorder (SUD), for early detection of a suspected
SUD or to refer members for treatment. The current best practice for billing for SBIRT
services when the screening and brief intervention do not meet the minimum 15-minute
threshold required by procedure code 99408 are highlighted below.
Current SBIRT policy outlined in 10 CCR 2505-10 8.747.6.C
allows SBIRT
codes to be billed on the same day as other Evaluation and Management
(E/M) services. Providing SBIRT for less than 15 minutes can be
reimbursed by factoring in the time or level of medical decision-making
to an E/M code.
Use modifier 25 to indicate that the E/M service is separately
identifiable if billing for an E/M service in addition to SBIRT. Ensure
that the E/M service is documented and coded appropriately.
Procedure code H0049 can be billed when a full screening is conducted and the result is
negative. H0049 may be billed in addition to the E/M code for the visit.
Refer to the SBIRT Program Billing Manual
for further clarification regarding billing for SBIRT
using code H0049 or E/M codes for short encounters. Contact Janelle Gonzalez at
Janelle.Gon[email protected]o.us with questions.
School Health Services (SHS) Providers
Update to School Health Services (SHS) Billing Manual
The School Health Services Billing Manual has been updated to include the 120-day timely
filing requirement. This is not a change to program requirements but rather an addition to the
billing manual. Although the SHS program is a cost-based program, fee-for-service claims are
still required even though they are paid at zero. The timely filing period for SHS claims is 120
days from the date of service.
Visit the SHS web page for detailed information on the SHS program.
B2300501 November 2023
Page 11
Speech Therapy Providers
Speech Therapy Before a Prior Authorization Request (PAR)
is Required
A Speech Therapy Stakeholder Engagement meeting was hosted on August 23, 2023, regarding
the footnote in the 2023 Long Bill mandating 12 speech therapy sessions before a Prior
Authorization Request (PAR) is required. This change is anticipated to be implemented in
December 2023, and applies to services for both children and adults.
This change applies only to the outpatient speech therapy benefit and not the outpatient
physical therapy or outpatient occupational therapy benefits. The new allowed sessions will
be based on one (1) date of service, which equates to one speech therapy session. While
billing of timed and untimed codes equates to a specific number of units, the decrement of
the one session will be solely based on the date of service.
Many providers had questions during the stakeholder engagement meeting surrounding
Common Procedural Terminology (CPT) codes 92507 and 92526 and whether this would equate
to either one (1) or two (2) sessions. CPT code 92507 is an encounter-based code with a
Medically Unlikely Edit (MUE) of one unit per day and should only be billed at a maximum of
one unit of service per day. CPT code 92526 has an MUE value of one unit. Providers are still
expected to follow all National Correct Coding Initiative (NCCI) and MUE policies when billing
for speech therapy services.
Example: A provider bills one (1) unit of 92507 and one unit of 92526 for a total of two (2)
units on one date of service. This equates to one date of service and only decrements one
session from the member’s allowed 12 sessions before a PAR is required.
Current policy states that services are limited to five (5) units per day, which equates to one
(1) session and one date of service. Separate limits of 12 sessions for habilitative and
rehabilitative services are available for adult members enrolled in the Alternative Benefit
Plan. Outpatient speech therapy services must have an order from any of the following, even
when a PAR is not required:
• Physicians (MD/DO)
• Physician Assistants
• Nurse Practitioners
• An Individualized Family Service Plan for Early Intervention Speech Therapy
Providers should verify the remaining sessions to determine whether a member has utilized
any of the sessions within the rolling calendar year. Refer to the Verifying Remaining Service
Units - PT/OT section of the Verifying Member Eligibility and Co-Pay Quick Guide
located on
the Quick Guides web page for instructions on how to check available sessions.
The Colorado interChange is only capable of showing the units that have been reported, and
the utilization count could change at any time when a new claim is reported. There is no
guarantee of payment based on the utilization count provided in the eligibility verification
response. Providers are advised to request a PAR before the 12 sessions are exhausted if it is
B2300501 November 2023
Page 12
believed that a member will need more than 12 sessions. Sessions will only decrement from
the allowed number of sessions when a provider submits a claim for payment.
When a claim is denied due to a claims processing issue, providers must submit a retroactive
PAR to the Utilization Management (UM) vendor for those units and any additional units if
applicable.
Contact the Provider Services Call Center
with questions on claims and available sessions.
Contact Devinne Parsons at Devinne.Parsons@state.co.us with questions related to speech
therapy policy. Contact the UM Team at HCPF_UM@state.co.us with PAR questions.
Transportation Providers
Claim Editing for Non-Emergent Medical Transportation (NEMT)
Providers
A claim edit related to the policies found in program rules 10 C.C.R. 2505-10 8.014.4 has been
implemented. Non-Emergent Medical Transportation (NEMT) must be provided to transport
the member to the closest available provider qualified to provide the treatment service the
member needs. The closest provider is defined as a provider within a 25-mile radius of the
member’s residence or the nearest provider if one is not practicing within a 25-mile radius of
the member’s residence.
Exceptions are allowed based on the following:
• The closest provider is not willing to accept the member.
• The member has complex medical conditions that restrict the
closest medical provider from accepting the member.
• The member may use NEMT to their established treatment
provider seen in their previous locale if the member has moved
within the three (3) months preceding an NEMT transport.
• Note: The client and treatment provider must transfer care to the closest provider
as defined at Section 8.014.4.B. or determine transportation options other than
NEMT during these three (3) months.
Any NEMT claim billed for procedure codes A0425 or S0209 will be suspended for review if the
billed units of service exceed 52. Suspended claims will be denied if they do not have an
attachment which meets the requirements as specified below. Reviewed claims will be denied
if the attachment is not sufficient pursuant to these specifications.
Claims must have a document attached which contains the following information about the
trip which is being billed:
• The pick-up address
• The destination address
• Date and time of the trip
• Memb
er’s name or identifier
B2300501 November 2023
Page 13
• Confirmation that the driver verified the member’s identity
• Confirmation by the member, escort or medical facility that the trip occurred
• The actual pick-up and drop-off times
• The driver’s name
• Identification of the vehicle in which the trip was provided
• A rationale and certification from the member’s treating provider as to why the
member cannot be treated by the closest provider within 25 miles of the member’s
residence
Refer to program rules 10 C.C.R. 2505-10 8.000, 8.130.2 and 8.014.3.C
for further details on
NEMT and provider record maintenance. Each provider shall maintain legible, complete and
accurate records necessary to establish that conditions of payment for Medical Assistance
Program-covered goods and services have been met and to fully disclose the basis for the
type, frequency, extent, duration and delivery of goods and/or services provided to Medical
Assistance Program members, including but not limited to the following:
• Billings
• Prior Authorization Requests (PARs)
• All medical records, service reports and orders prescribing treatment plans
• Records of goods prescribed, ordered for or furnished to members as well as
unaltered copies of original invoices for such items
• Records of all payments received from the Medical Assistance Program
• Records required elsewhere in Section 8.000 et seq. The records shall be created
at the time the goods or services are provided.
Contact HCPF_NEMT@state.co.us
with any questions.
Provider Billing Training Sessions
November and December 2023 Provider Billing Training Sessions
Providers are invited to sign up for an upcoming beginner billing training webinar. Two (2)
beginner billing trainings are offered each month:
1. Professional claims (CMS 1500)
2. Institutional claims (UB-04)
Click “Which Training Do I Need?” on the Provider Training web page
to
find trainings aligned to provider type. All sessions are held via webinar
on Zoom, and registration links for the next two months are shown
below.
Visit the Provider Training web page under the Billing Training – Resources drop-down section
to preview training materials.
Refer to the Provider Web Portal Quick Guides located on the Quick Guides web page for
more training materials on navigating the Provider Web Portal.
B2300501 November 2023
Page 14
Who Should Attend?
Staff who submit claims, are new to billing Health First Colorado services or who need a
billing refresher course should consider attending one or more of the provider training
sessions.
These training sessions provide a high-level overview of member eligibility, claim submission,
prior authorizations, Department website
navigation, Provider Web Portal use and more.
Live Webinar Registration
Click the title of the desired training session in the calendar to register for a webinar. An
automated response will confirm the reservation.
Note: Trainings may end prior to 11:30 a.m. MT. Time has been allotted for questions at the
end of each session.
November 2023
Monday
Tuesday
Wednesday
Thursday
Friday
1
2
Beginner Billing Training: Professional Claims
(CMS 1500) – Thursday, November 2, 2023,
9:00 a.m.-11:30 a.m. MT
3
6
7
8
9
Beginner Billing Training: Institutional Claims
(UB-04) – Thursday, November 9, 2023,
9:00 a.m.-11:30 a.m. MT
10
13
14
15
16
17
20
21
22
23
24
27
28
29
30
December 2023
Monday
Tuesday
Wednesday
Thursday
Friday
1
4
5
6
7
Beginner Billing Training: Professional Claims
(CMS 1500) – Thursday, December 7, 2023,
9:00 a.m. – 11:30 a.m. MT
8
11
12
13
14
Beginner Billing Training: Institutional Claims
(UB-04) – Thursday, December 14, 2023,
9:00 a.m. – 11:30 a.m. MT
15
18
19
20
21
22
25
26
27
28
29
B2300501 November 2023
Page 15
Upcoming Holidays
Holiday Closures
Veterans Day,
Saturday, November 11
(Observed Friday,
November 10)
State Offices and the ColoradoPAR Program will be closed.
Capitation cycles may potentially be delayed. The receipt of
warrants and EFTs may potentially be delayed due to the
processing at the United State Postal Service or providers’
individual banks. Gainwell Technologies and DentaQuest will
be open.
Thanksgiving Day,
Thursday, November 23
State Offices, Gainwell Technologies, DentaQuest and the
ColoradoPAR Program will be closed. Capitation cycles may
potentially be delayed. The receipt of warrants and EFTs may
potentially be delayed due to the processing at the United
State Postal Service or providers’ individual banks.
Day After Thanksgiving,
Friday, November 24
State Offices, DentaQuest and the ColoradoPAR Program will be
closed. Capitation cycles may potentially be delayed. The
receipt of warrants and EFTs may potentially be delayed due to
the processing at the United State Postal Service or providers’
individual banks. Gainwell Technologies will be open.
Christmas Day,
Monday, December 25
State Offices, Gainwell Technologies, DentaQuest and the
ColoradoPAR Program will be closed. Capitation cycles may
potentially be delayed. The receipt of warrants and EFTs may
potentially be delayed due to the processing at the United
State Postal Service or providers’ individual banks.
Gainwell Technologies Contacts
Provider Services Call Center
1-844-235-2387
Gainwell Technologies Mailing Address
P.O. Box 30
Denver, CO 80201
