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Providers Enrolled In Colorado Medicaid May Need To Obtain And Use A New National Provider Identifier

Providers say surprise bills from Colorado Medicaid group could impact patient care

Colorado House Bill 18-1282, signed into law on April 25, 2018, included a new requirement that all Colorado Medicaid providers obtain and use a unique National Provider Identifier for each site at which they deliver services and for each provider type specified. On all claims submitted to Colorado Medicaid, provider entities must use the unique NPI that identifies the site where the services were provided and the provider type rendering the services.

These new rules regarding the use of unique NPIs applied to any provider entity applying to enroll as a new provider on or after Jan. 1, 2020, but previously enrolled providers are not required to obtain and use unique NPIs until their first revalidation date after Jan. 1, 2021. As a result, some Colorado providers now working through the revalidation process with the Department of Health Care Policy & Financing are encountering errors in HCPFs Provider Web Portal and finding they are unable to complete the process because they have not yet obtained a unique NPI for additional locations or service types.

Providers encountering these issues as a result of changes to HCPFs billing and enrollment rules may be able to resolve their revalidation problems by taking the following steps:

Health First Colorado Program Who Might Be Eligible

  • Individuals and families who meet income limits
  • Children under 19For information about childrens Medicaid benefits see Healthy Communities.
  • Pregnant Women
  • Children with a disability
  • People ages 16-64 who are working and have a disability
  • Health First Colorado Buy-in Program for Working Adults with Disabilities provides adults with disabilities, who earn too much income or have too many resources the opportunity to purchase Health First Colorado benefits. Clients will pay a monthly premium based on their income. For more information see, HCPF:Adult Buy-In.
  • People who are eligible for Supplemental Security Income .
  • If you receive SSI, then you will automatically receive Health First Colorado. If you receive SSI and have not been enrolled in Health First Colorado, please contact your local county department of human/social services.
  • If you have not yet applied for SSI, you should apply at a Social Security Administration office.
  • People who receive Old Age Pension grants who do not qualify for other Health First Colorado programs. This program provides limited medical care only.
  • If you need nursing home or home and community based services , please see below for information about Long-term Care Medicaid.

    People Age 65 and Over: People age 65 or older who are eligible for Supplemental Security Income and/or Old Age Pension state supplemental payments are eligible for Health First Colorado.

    Welcome To Denver Health Medicaid Choice

    Health First Colorado is free or low cost public health insurance for Coloradans who qualify. Health First Colorado administered by Denver Health Medicaid Choice , is for individuals who live in Denver, Jefferson, Arapahoe, or Adams counties. As a DHMC member, you can get care at the Denver Health main campus and any of Denver Healths ten Family Health Centers throughout metro Denver, as well as various Denver Health School- Based Health Centers. In addition, Medicaid Choice members pay no copays for covered visits and medicines and have expanded benefits, including eyewear.

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    Unitedhealthcare Dual Complete Plans

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

    Provider Search Tool Frequently Asked Questions

    Medicaid Card Online Colorado / CPP Colorado

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    Help In Other Languages Or Formats

    RMHP will provide information in other languages and formats. For example, we can provide formats for Members who are Deaf, hard of hearing, blind, or have low vision. We can also help you communicate with health care providers.

    Para asistencia en español llame al . Español representantes de Servicio al Cliente están disponibles. For callers who do not speak English or Spanish, RMHP uses Certified Languages International interpreters. RMHP provides interpretation services at no cost to Members. Tell Customer Service if you need interpreter services or help in other languages.

    TTY and hearing impaired: If you are Deaf, hard of hearing, or have a speech disability, dial 711 for Relay Colorado. You can use this service 24 hours a day 365 days a year. This service helps people that are Deaf or hard-of-hearing communicate through a special state-sponsored service known as a relay center. Operators get calls from TTY users on their own TTY devices. The operator will speak the information to a hearing person using a telephone. When the hearing person replies, the relay operator types the response into their TTY phone and sends the response to the TTY user at the other end. If a hearing person needs to initiate a call to a TTY user, the hearing person will start the conversation and the relay center operator dials the hard-of-hearing person’s TTY device. The relay center can also help people with speech disabilities to communicate by phone.

    Unitedhealthcare Senior Care Options Plan

    UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

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    Unitedhealthcare Connected For Mycare Ohio

    UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

    Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

    Home And Community Based Services

    How to Register at CMS for the Colorado Medicaid EHR Incentive Program

    Adams County Human Services 303.227.2348

    Colorado Access 1.800.511.5010

    Provides Medicaid sponsored services for elderly, physically handicapped, or blind adults who can be appropriately cared for in their own home, rather than a nursing home. Colorado Access is the Single Entry Point designated agency for Adams County. Colorado Access determines the functional eligibility for participation in HCBS, while Human Services Department determines financial eligibility. Income and resource guidelines must be met.

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    Prior Authorization And Notification Resources

    Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans

    Visit UHCCommunityPlan.com/CO for current member plan information including sample member ID cards, provider directories, dental plans, vision plans and more.

    Member plan and benefit information can also be found at UHCCommunityPlan.com/CO and myuhc.com/communityplan.

    Other Health Care Options

    If you are denied Health First Colorado coverage, you may be eligible for other health care programs.

    • Connect for Health Colorado is a new online health insurance marketplace that opened on October 1, 2013. This marketplace is sometimes referred to as the health insurance exchange. Individuals, families and small employers can shop for and buy health insurance through the Connect for Health Colorado website. Boulder County is a Certified Connect for Health Colorado Assistance Site and has trained Health Coverage Guides to help residents enroll in health insurance. Call 303-441-1000 or email for more information or to make an appointment with a Health Coverage Guide.
    • Child Health Plan Plus a low-cost health insurance program for uninsured Colorado children ages 18 and under whose families earn too much to qualify for Health First Colorado.
    • Colorado Indigent Care Program is a discount rate offered at some clinics and hospitals for eligible Colorado residents.

    You can apply for Health First Colorado at any of our offices.

    • 515 Coffman Street in Longmont
    • 3460 Broadway in Boulder

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    Unitedhealthcare Connected Benefit Disclaimer

    This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

    You can get this document for free in other formats, such as large print, braille, or audio. Call , TTY 711, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.

    You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

    Language Line is available for all in-network providers.

    Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al , TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

    Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

    Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

    See If You Can Sign Up For Child Health Plan Plus

    Health First Colorado and Medical Assistance

    Who Qualifies?

    • Children age 18 and under and pregnant women age 19 and over
    • Applicants with household income under 260% of the Federal Poverty Level . See the CHP+ Income Chart for details
    • Lawfully present children and pregnant women with no five-year waiting period
    • Children and pregnant people not eligible for Health First Colorado
    • Children and pregnant people who do not have other health insurance
    Family Size

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    What Is Child Health Plan Plus

    Child Health Plan Plus is public low-cost health insurance for certain children and pregnant women. CHP+ has different rules for qualifying than Health First Colorado. Some individuals who earn too much for Health First Colorado qualify for CHP+.

    CHP+ covers doctor visits, emergency care, preventive care such as screenings and immunizations, and other procedures and treatments. CHP+ can help you and your family get healthy and stay healthy.

    What Does CHP+ Cost?

    CHP+ costs vary depending on your household size and income. CHP+ members may have to pay an annual enrollment fee. This fee is due within 30 days of your CHP+ approval. If the enrollment fee is not paid within the 30 days allowed then the family will be denied and will need to re-apply. Some CHP+ clients may also have to pay co-pays to their health care provider at the time of service. Pregnant women, American Indians and Alaskan Natives do not have to pay annual enrollment fees or co-pays.

    American Disabilities Act Notice

    In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

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    Billing And Coding Updates

    Weve seen an increase in claim denials as a result of the incorrect use of applicable modifiers with certain service codes. As a result, we want to remind you that all billed services must have an applicable modifier. Please note that many services can have more than one applicable modifier, and all must be included in order for the claim to be paid.

    Please note that all modifiers and requirements are listed out in the coding manual which can be found on the Department of Health Care Policy and Financing website.If you submit your claims through a clearinghouse, please contact your clearinghouse to inquire which fields in their software to enter the modifier that will interface to Box 24D of the CMS1500 form that we will receive.

    Substance Use Disorder Services: Any substance use disorder service should be indicated with the HF modifier, which can ONLY be in the second modifier position. There must be another applicable modifier placed in the first position.

    Effective Immediately: Claims with HF billed in the first position will be denied. Claims with HF in the second position and blank in the first position will also be denied.

    Effective January 1, 2018: All other services must have an applicable modifier in the first position. If this is blank, claims will be denied effective January 1, 2018. Please see individual code pages for applicable modifiers related to the billed code.

    See If You Can Sign Up For Health First Colorado

    Why some Medicaid providers in Colorado aren’t getting paid

    You may qualify for Health First Colorado if you meet the monthly income guidelines:

    Family Size

    Can I still sign up for a plan through Connect for Health Colorado if I qualify for Health First Colorado?

    • Yes. You can still purchase a private health insurance plan at full price if you qualify for Health First Colorado.
    • NOTE: If you qualify for Health First Colorado or CHP+, you will not qualify for financial help to lower the cost of your health insurance plan through Connect for Health Colorado. You will pay full price for your health insurance plan.

    I applied through Connect for Health Colorado and was told that my application was sent to Health First Colorado. Whats next?

    • Watch your mail or email. You will get a notification from the State of Colorado with your application results. You will also receive a letter or email if more information is needed to complete the process.
    • You may also check the results of your application through your PEAK account.
    • If you do not have a PEAK account, you can create one at Colorado.gov/PEAK.
    • You can use your Connect for Health Colorado log-in and password information to sign into PEAK.
    • You can also use PEAK to manage your Health First Colorado or CHP+ benefits, print benefit cards, report changes and more.
  • You do not need to submit another application through PEAK.
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    How To Find A Health First Colorado Doctor

    • To find a doctor or other medical provider who accepts Health First Colorado , first select Find Doctors from the Department of Health Care Policy & Financing home page or select Find Doctors & Other Providers at HealthFirstColorado.com.
    • You’ll see that at the top you can make selections to narrow down your search results. The list of providers will appear in the box just below.
    • You can enter a street address, city, or zip code where you’d like to begin your search. You can also click Find Me to have your approximate location entered automatically.Below that you can specify the radius of your search, or how far you’re willing to travel.
    • In addition to location you can select a provider type or specialty to narrow your search. And if you’re looking for a specific doctor you can enter any part of their name in the Find Providers By Name box.
    • As you search the results shown below will list each provider’s name, medical specialty, street address, and phone number.
    • As you search, the map updates automatically to show only the results of your current search. Clicking on any pin on the map brings up information about that provider.
    • Remember that you should always check with the individual provider to find out if they’re accepting new Health First Colorado patients. If you need additional help please call or email the Health First Colorado Member Contact Center.

    © 2021 colorado.gov/health All rights reserved

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