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At Colorado Access, caring for you and your success is our top priority as you serve our members. With so much information out there, this monthly Provider Update serves as a highlight of important information and resources to help you as a contracted provider with us.
New Claims System Update
We have noticed a claims trend where providers are billing a mismatched NPI/TIN combination when billing their claims and/or missing a rendering provider. Our new claims system is better equipped to catch this billing error. For this circumstance, claims are being denied appropriately per billing standards. These claims can be corrected and resubmitted for payment. If you have questions about this or have other claims issues, please contact your provider network services manager. Click here to learn more.
Public Health Emergency (PHE) Update Under the recently-passed FY 2023 Omnibus Bill, the
COVID-19 PHE does not end, and is now separate from continuous Medicaid coverage. Continuous Medicaid coverage is expected to end beginning in April 2023. As more updates become available, we will share what this means for you.
2023 411 Audit We are required by the Department of Health Care Policy and Financing (HCPF) to perform an annual Regional Accountable Entity (RAE) Encounter Data Validation Review (411 audit) to ensure that providers maintain complete and accurate clinical records for our members. This ensures that patient needs are met, federal and state laws are complied with, and claims billed are supported.
411 chart records for each region are included in the scope of the review. Each region is audited across multiple behavioral health
services against the coding requirements of the Uniform Services Coding Standards (USCS) Manual. HCPF randomly selects providers to participate. This year’s 411 audit will review paid behavioral health encounters from inpatient, residential, and outpatient psychotherapy services with dates of service from July 1, 2021 to June 30, 2022 with paid dates between July 1, 2021 and September 30, 2022. If you are selected to participate in this audit, we will notify you.
Quality of Care Concern and Critical Incident Reporting Form Update
A Quality of Care Concern (QOC) is a concern that care provided did not meet a professionally recognized standard of health care. A general quality of care review or a beneficiary complaint review may cover a single concern or multiple concerns. A QOC is a complaint made about a provider’s competence, conduct, and/or care provided that could adversely affect the health or welfare of a member. A critical incident is defined as a patient safety event not primarily related to the natural course of the patient’s illness or condition that results in death, permanent harm, or severe
temporary harm. Critical incidents are subject to mandatory reporting under Colorado law as well as your provider agreement. The most common categories of QOCs submitted in 2022 included "lack of follow-up/discharge planning," followed by "lack of coordination of care/services."
Any potential QOCs and critical incidents identified during a course of treatment of a member must be reported, in addition to any mandatory reporting you may be responsible for. When a potential QOC or critical incident has occurred, fill out the updated Quality of Care Concern and Critical Incident
reporting form and email it to qoc@coaccess.com. The reporting provider’s identity will remain confidential.
If your facility is contacted with a medical records request pertaining to a QOC investigation, records should be returned to us no later than 10 business days of receipt of the medical records request. If you have any questions about QOCs, critical incidents, or reporting requirements, please email qoc@coaccess.com.
Mpox Update
The World Health Organization (WHO) has a new name for monkeypox: mpox. Numerous other agencies, including the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) have aligned with this change. Please visit the CDPHE website for more resources.
New Provider Reporting Tool
We have a new form on our website for members, providers, or staff to report issues finding providers, including missing or incorrect provider information, appointment or service access issues. The form is in the “Find a Provider” section of our website.
We value your input. This anonymous form will help us make sure that our network can serve our members. If you have any questions about the form, please call us at 866-833-5717.
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