Colorado interChange: Resources for your Membership
Week of January 18, 2018
As the Colorado interChange moves toward normal operations, we'll be broadening the focus of this newsletter to bring you hot topics and useful information on a larger variety of issues related to Health First Colorado (Colorado's Medicaid Program) and other initiatives from the Department of Health Care Policy & Financing (the Department). We'll continue to focus on issues we believe your members we be discussing and resources to share. 
Provider Buzz
Here's a look at hot topics for providers and others:

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
  • 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 December federal Continuing Resolution passed by Congress may impact the CHP+ program in Colorado. Once the Department's analysis is complete, we will update our Future of CHP+ Provider Resources web page. Visit this page frequently and  sign up for our Future of CHP+ newsletter  for updates straight to your inbox. 
  • Three Health First Colorado co-pay amounts changed January 1, 2018 as part of SB 17-267 implementation:
    • Outpatient hospital visit co-pays increased from $3 to $4
    • Non-emergency ER visit co-pay increased from $3 to $6
    • Generic drug co-pay increased from $1 to $3
Please see the December Provider Bulletin for more information.
  • Providers, please be aware that Health First Colorado members are liable for no more than 5 percent of their monthly household income towards co-payments per month. The Provider Web Portal will display whether a member is co-pay eligible as of the date it is checked. Please note: Members may reach their 5 percent co-pay maximum for the month before the Provider Web Portal reflects this because of the time allowed for providers to submit claims. Please consider this possibility if Health First Colorado members believe they have met their monthly co-pay maximum, but the Provider Web Portal indicates the member owes a co-pay amount at the time of their visit. Please see the December Provider Bulletin for more information.
  • 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. 
News You Can Use
Here's some content for membership newsletters:

New FAQs and webinars available for Colorado interChange
New resources are coming on line to assist you with learning about hot topics and important issues. Over the last couple of months, new information has been added on the following topics in various formats:
Also available are new frequently asked questions on a variety of areas including revalidation and enrollment backdating, provider identification and taxonomy as well as timely filing
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