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Effective November 20, 2024, the “Selected Benefit Plan” in the Pre Prior Authorization (PPA) in the Bridge will be the primary source of truth for a member’s HCBS Waiver Benefit Plan in the interChange, as long as the member has a current eligibility span from the Colorado Benefits Management System (CBMS) that covers the entire certification period of the PPA. If the HCBS eligible member does not have an HCBS PAR, the interChange will look for a Waiver Span from the CCM (R4) to try to create the member’s benefit plan. Case managers are encouraged to ensure the member’s Program Card in the CCM matches the certification period recorded on PPAs in the Bridge. The interChange processes member benefit plan updates each night at 4 p.m. and the process is completed the same evening. Any active PARs will be evaluated on a nightly basis to determine if the member’s benefit plan needs to be updated in interChange. All benefit plan updates in interChange for LTSS members are sent back to the CCM after the nightly interChange processing. Absent other issues with the PPA, the finalized PAR, and the Benefit Plan will be in place the day after the case manager submits the PPA.
When a case manager selects the “Check Limits” button on the PPA, the Bridge will verify the member’s waiver eligibility. If a member does not have a valid HCBS waiver eligibility span in the interChange, for the certification period on the PPA, the “Check Limits” button will return a B074 error message in the “Messages” tab of the PPA. A B074 message requires that the case manager contact the county to request an updated CBMS HCBS eligibility span. Case managers may view the member’s eligibility span in “Health Coverage” in the CCM system or in the PeakPro system. Once updated, the case manager will resubmit the PPA in the Bridge. B074 will no longer suspend a PAR if the Benefit Plan in interChange does not match the Selected Benefit Plan on the PAR.
Case managers are encouraged to prospectively create PPAs for future certification periods to avoid billing issues.
HCPF will be addressing existing Prior Authorizations with the B074 error with a conversion process. Only PARs with a PAR ID from the interChange (those that have been submitted and approved at some point in interChange) are subject to this conversion; PPAs that only have a Pre Prior Authorization ID (PPID) (those that suspend before submission and approval in iC) that have the B074 error will not be subject to the conversion process. HCPF is still in discussions regarding solutions; however, the case manager may resubmit these manually.
Job aides for the CCM that reference B074 are being revised and HCPF will notify case managers when those updates are made.
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