As the Colorado Department of Health Care Policy and Financing continues to work through the transition to the state’s new interChange system, providers and their claims staff need educational resources, for example, to know how the revalidation process works, understand new formats within Remittance Advice, and learn new terms like “Suspended” rather than “In Process” for claims that need additional information.
To help providers work through these changes, the Department is continuing to develop Quick Guides and Frequently Asked Questions aimed at providing step-by-step, visual guidance for common issues and changes that can be confusing. Topics available include:
- Provider Maintenance, including updating contact information, opting out of the provider directory and managing affiliations
- Pulling Remittance Advice (RA)
- Reading Remittance Advice (RA)
- Verifying Member Eligibility, including managed care assignments, primary care provider, Medicare coverage and member co-pay amounts
Since system launch, interChange has processed nearly 12 million claims and paid more than $2.3 billion to providers. On a weekly basis, an average of 60 percent of claims are paid. In the financial week ending June 16, the Department processed 767,581 claims and paid more than $115 million or 60 percent of all claims processed during that cycle.
Anesthesia units rounding
Current anesthesia policy reimburses claims based on 15-minute time units where any fractional unit of service is rounded up to the next 15-minute increment. The system is currently pricing fractional units without rounding up to the next 15-minute increment. The Department is aware of this issue and their vendor is working on a system solution. HCPF asks you to continue to submit claims normally and the Department will resubmit affected claims once the issue is resolved.
Retroactive updates to eligibility spans
A system issue is currently preventing the Colorado interChange from processing some retroactive changes to a member’s eligibility span. If a member believes a fix to their eligibility information is necessary, the process is the same as it was in the old system. The member must call the Health First Colorado Member Contact Center to initiate the correction. If the member has already contacted the Member Contact Center and obtained the Proof of Insurance, the provider should accept this as eligibility verification and render services. The eligibility update will take two to three business days to appear in the system. Once the fix is made, the provider will be able to submit or resubmit claims for services to the member. For more detailed information, please refer to this fact sheet.
Changes to rendering or referring provider on service detail line not saving
An error is occurring when providers are attempting to change the rendering or referring provider on the service detail line of a claim after the initial entry. Currently, the portal does not save the change. Until the issue is resolved, providers need to remove and re-enter the line if they need to change the original entry. To do this, the provider needs to remove the entry by clicking “Remove” in the “Action” column or clicking the “Reset” button at the bottom of the window. Their vendor is working to resolve this issue.
Medicare deductible greater than annual amount issue resolved
If a provider submitted a $0 deductible on a claim and the Medicare deductible had been met, claims were incorrectly denying for EOB 3620 - “The Medicare deductible on the claim is greater than annual amount. The deductible amount must match the amount on the Medicare explanation of benefits. Correct the deductible amount.” This issue has been resolved and claims will be reprocessed by our vendor. No action is needed by providers.
How to get help
- HCPF has a new “Known Issues and Updates” page where providers can find help with common issues and updates on ongoing fixes.
- Providers can sign up to receive emails from HCPF.
- Providers in financial distress can call Health First Colorado Provider Call Center at 1-844-235-2387 and select option 2 to “speak with an agent” and then option 4 to learn about interim payment options.
- The department limit on timely filing has been extended from the previous 120 days to 240 days through Oct. 31, 2017 to ease provider concerns as issues in the new system are resolved. Providers can read the initial notice of this change as well as a helpful FAQ about the change to timely filing.