Colorado Medical Society

http://www.cms.org/articles/colorado-medicaid-interchange-help-for-practices/

Colorado Medicaid interChange: Help for practices

Wednesday, March 15, 2017 08:11 PM

As you know, Health First Colorado and Child Health Plan Plus (CHP+) transitioned to a brand-new claims payment system and fiscal agent on March 1. Since go live, the agency has processed more than two million claims in the Colorado interChange and have paid providers more than $280 million.

However, some providers have experienced challenges and Health First Colorado is continually identifying issues that need technical intervention and addressing them with HPE to ensure providers can provide services and receive appropriate payments for those services.

Here is a brief overview of some of the top claims denial reasons, reminders, and other items to know.

CLAIMS SUBMISSION
Are your Clearinghouses having trouble with your claims?
Specifically, are their files being approved, but all your claims are denying? Your Clearinghouse needs to add CO_TXIX to their inbound transactions. Depending on the inbound transaction type, they may need to add this as either the:

Please refer them to the companion guides at Colorado.gov/HCPF/EDI-Support for more detail.

GENERAL UPDATES
Provider Web Portal Availability
Due to scheduled maintenance, the HPE Provider Web Portal will be unavailable from 7 p.m. MST until 7 a.m. MST every night the week of March 13.

Provider Services Call Center Hours
Until further notice, the Provider Services call center (1-844-235-2387) hours will be: 8 a.m. - 5 p.m. MST Monday, Tuesday and Thursday, and 10 a.m. - 5 p.m. MST Wednesday and Friday. The Provider Services call center, will be utilizing the time between 8 a.m. and 10 a.m. on Wednesdays and Fridays to return calls to providers.

Remittance Advice (RAs) are the new Provider Claim Reports (PCRs)
RAs will be available for download every Monday morning, by 12 p.m. MST. You can get to your RA by logging into the Provider Web Portal → Resources Tab → Report Download → choose “MMIS Reports - RA” from the Report dropdown box.

835 Availability
835s will be available the Monday following the Friday financial cycle, almost a week earlier than previously available.

Provider Web Portal Cheat Sheets and FAQs
Health First Colorado is regularly updating the Provider Web Portal Cheat Sheets and FAQs. Access them at: Colorado.gov/HCPF/Web-Portal.

HPE Billing Manuals
Please make sure you’re referring to the new HPE Billing Manuals for claims submission instructions. While certain fields may not be required in the Provider Web Portal, they might be required for the claim to process correctly.

CLAIMS DENIALS
EOB 1473 Multiple Provider Locations for Billing Provider Specialty.
Why you’re getting this error: In general, EOB 1473 is an indication that the system cannot determine which of your locations to look at. If you share a National Provider Identifier (NPI) with more than one (1) provider type or location address, additional steps are needed to ensure proper claims adjudication. A unique nine (9) digit zip code or taxonomy code is required to identify the correct billing provider ID.

How to fix it: There are several reasons that a provider may receive EOB 1473, including an issue that caused single claims submitted via the Provider Web Portal to incorrectly deny because the system wasn’t processing the Zip Code + 4. This particular cause has been resolved, and providers may resubmit all claims that denied for EOB 1473. Note: Rebilling these claims is not a guarantee of payment, and some claims may still hit other edits and deny.

There were approximately 60 providers receiving EOB 1473 because two or more of their locations have the same address, and (incorrectly) have the same taxonomy codes. The fix for this particular issue is in place, and these claims will automatically be recycled for the effected providers. However, please remember that some claims may still hit other edits and deny.

If you are receiving EOB 1473, you should also follow these instructions to ensure your service location includes the Zip Code + 4. Note: a change (or update) of address will generate a new Application Tracking Number (ATN) for the update request. The change will take a few days to process so it will not show-up immediately, please do not submit multiple requests for the same update.

CLAIMS SUSPENSION
Qualified Medicare Beneficiary program (QMB)
Claims suspended for QMB clients for the EOB codes below will not be processed until an update is made to the Colorado interChange system. The department is developing an interim solution that will allow the claims to process and will communicate additional information as it becomes available. EOB 4223 - Medical Review Restriction on Procedure Code Coverage Rule. EOB 4253 - Medical Review Restriction on Revenue Code Coverage Rule.