Please ensure Javascript is enabled for purposes of website accessibility Skip to main content

FAQs-testing

Testing page

Members

Out of Pocket Prescription Reimbursement

Pre-HMO

If you paid for a prescription while covered by CHP+, but before you enrolled in your health plan, you may ask the pharmacy for a refund.

Contact the pharmacy where you got the prescription. Give them your receipt, State ID number, BIN (018902), and PCN (P303018902). If you don’t know your State ID number or need help, call the pharmacy liaison. Call them at 303-866-3588.

You have 120 days from the date the prescription was filled to ask the pharmacy for a refund. Refunds are not promised.

HMO

There may be times when you are charged for the full cost of a prescription medication. This may be if you do not have your ID card when you go to pharmacy that is in our network. Or if you fill a prescription at pharmacy that is not in our network.

If you pay the full cost for a covered prescription medication, please follow these steps:

  • Ask for an itemized receipt. This will show that you paid for the medication.
  • Please also give us your name and address.
  • Mail the itemized receipt and this form for reimbursement to:

Colorado Access
Reimbursements
PO Box 17950 Denver, CO 80217-0950

We will look at what you send to us. We may ask for more details if we need them. This could be if the medication that you paid for is not on the formulary list. Or if it needs preauthorization (preapproval).

This request must be completed within 120 days from when you paid for the medication. If we need more details, we will ask the doctor who prescribed the medication. If your request is approved, you will be reimbursed. The amount will be based on the cost of the covered medication, minus any applicable copay.

What is Synagis?

Synagis is a prescription injection of antibodies. It is given each month to help protect high-risk infants from a bad virus. This virus is called severe Respiratory Syncytial Virus (RSV). Synagis is approved by the Federal Drug Administration.
The RSV season for begins November 26, 2018 and continues through the end of April in 2019. You can get Synagis through your CHP+ pharmacy benefit. A home health agency can give it to you at home. If you have questions, talk to your provider. Your provider can find a Synagis form here.

What is the Accountable Care Collaborative (ACC)?

The Accountable Care Collaborative (ACC) is Health First Colorado’s primary health care program. It is designed to improve your health and help you get the services you need to stay healthy. As an ACC member, you get the regular Health First Colorado benefit package and choose a primary care medical provider.

What is the complaint and appeal process?

You have a right to complain (also called a grievance) or file an appeal. You cannot lose your benefits for doing either. For detailed information about the complaint and appeal process, please visit this page.

I qualify for long term services and supports. How can you help me?

If you qualify for the Long Term Services and Support program and live in Adams, Arapahoe, Denver, Douglas or Elbert counties, we are your designated Single Entry Point (SEP) agency. We help people find their way through the long-term services system. This system is made up of organizations that help individuals with daily activities like eating, bathing, cooking, dressing and other routine tasks. They can be arranged at home, in an assisted living facility, or in a nursing facility. We are Colorado’s largest Single Entry Point agency for people who need long-term assistance through Medicaid. The services are available on a self-pay, insurance reimbursement, low-cost or Medicaid basis. If you qualify depends on your individual situation, but in any case we can help. Call us if you have questions.

How do long term services and supports work?

Long Term Services and Supports is paid for through private funds, long-term care insurance, or Medicaid. To qualify for Medicaid Long Term Services and Supports, you must have:

What prescription medications are covered?

CHP+ covers a 30-day supply of a prescription medication and a 90-day supply of approved maintenance medication from an in-network pharmacy. For a list of medications covered by CHP+, please refer to the formulary list. CHP+ also covers over 200 over-the-counter medications, like Tylenol and vitamins, with a prescription from your doctor. For certain prescription medications, we might ask your doctor to send additional information to determine medical necessity.

Do I pay a copay for prescription medications?

Some CHP+ offered by Colorado Access members pay a co-pay for prescription medications. If you have a copay, the amount will be listed on your CHP+ card. If you have a copay, you will need to pay it before you can pick up the medication. If you are filling more than one prescription, you will need to pay the copay amount for each medication. If the retail price of the medication is less than your copay price, you will pay the retail price.

Members COVID-19

Can I come to the Colorado Access office?

As of March 17, 2020, our building is closed to the public and we have stopped all face-to-face appointments. If you need assistance, please call us at 800-511-5010 or email customer.service@coaccess.com

I’m feeling anxious about COVID-19, and I want to talk to someone. What can I do?

If you need help finding behavioral health care, please call us at 866-833-5717. If you are experiencing a crisis, please contact Colorado Crisis Services: call 844-493-8255 or text TALK to 38255.

Where can I find information about COVID-19?

Please visit coaccess.com/covid19 for updated information about COVID-19.

I think I was exposed to someone who has COVID-19 symptoms, what should I do?

Please call your doctor for further instructions. Do not go to a hospital or emergency room unless instructed to do so. If you do not have a doctor and need help finding one, call us at 866-833-5717.

I’m feeling sick, but I’m afraid to come to the office. Is there another way I can be seen without coming into the office?

Please call us at 800-511-5010 or email us at customer.service@coaccess.com for general questions. Please call your provider if you have questions about your symptoms. Do not go to a hospital or emergency room unless instructed to do so.  If you do not have a doctor and need help finding one, call us at 866-833-5717.

Is testing free?

As of March 19, 2020, Health First Colorado and CHP+ will cover testing members for COVID-19, but you must have a doctor’s note. There will be no copays for testing for COVID-19. For more information, please visit healthfirstcolorado.com/covid.

I need an expedited Medicaid application. How can I get this?

Please contact Access Medical Enrollment Services, our medical assistance site. Visit accessenrollment.org, email appassist@accessenrollment.org, or call 303-755-4138. You can also call toll free at 855-221-4138.

I need to make an appointment with my care manager. What should I do?

As of March 17, 2020, our building is closed to the public and we have stopped face-to-face appointments. Please call your care manager directly for more information on how you can get care. If you do not have a care manager assigned to you, please call us at 866-833-5717.

Providers

How do I get Synagis for my patients?

Complete Synagis prior authorization form and fax to Navitus at 855-668-8551. You will receive a fax indicating approval or denial of prior authorization determination is made. If request is approved, fax order for Synagis to Lumicera Specialty Pharmacy at 855-847-3558. If you wish to have a home health agency administer Synagis to your patient, please indicate that the medication will be shipped to the patient’s home on your order. Upon receipt of Synagis order indicating that medication will be shipped to patient’s home, Lumicera will fax a home health request to Colorado Access utilization management (UM) team to set up the services. Our UM team will work to set up a home health agency to visit the patient’s home and administer the medication.

Is Synagis covered by Colorado Access?

Synagis is covered for eligible patients through the Colorado Access pharmacy benefit. The specific criteria for approval can be found here. Prior authorization forms should be faxed to Navitus at 855-668-8551.

Does Colorado Access provide training for contracted providers?

Yes, we have regularly scheduled webinar trainings. You can also request an in-office training with your provider relations representative.

What changes are being made to the Behavioral Health Organizations?

The Colorado Department of Health Care Policy and Financing will contract with one administrative entity in each of the seven regions defined by the state to be responsible for the duties traditionally performed by the Regional Care Collaborative Organizations (RCCO) and Behavioral Health Organizations (BHO). This change will improve the patient experience by creating one point of contact and clear accountability for whole person care. If you are a current Colorado Access behavioral health provider, you are automatically participating in our RAE network, and no contracting action is required at this time.

What are the standards for appointment availability?

We request that our network providers adhere to state and federal standards for appointment availability for members. If you are unable to provide an appointment within the required timeframes, listed below, please refer the member to our customer service department for assistance finding the care they need in a timely manner.

  Medicaid Physical Health Medicaid Behavioral Health Child Health Plan Plus
Routine Care 45 calendar days 7 days 7 calendar days
Non-Urgent Care 10 calendar days 7 days 7 calendar days
Urgent Care 48 hours 15 minutes 15 minutes

How do I notify you when my service, remit or mailing address changes?

Thank you for keeping us updated regarding address changes! Complete and submit a Provider Address Change Form. Note: when changing your remit address, please include a copy of your current W9.

How do I request a username/password for the Colorado Access website?

The first step is to complete and submit a Provider Logon ID Request Form. If you are having problems with your username/password, please email ProviderNetworkServices@coaccess.com. Note: you must have the most current version of Adobe to complete and submit this form electronically through the website.

How do I add or terminate a provider from my practice/group?

Complete and submit a Clinical Staff Update Form. Note: submission of this form is to initiate the process for adding a provider and there may be additional steps required for approval to provide services to our members. Please contact your provider relations representative for the provider’s effective date.

Providers COVID-19

If a clinician sends a DocuSign version of a treatment plan to a member, they sign it, and send it back, is this accepted?

An e-signature through DocuSign or Adobe is an acceptable type of signature. However, a typed provider or member signature saved in a Word document does not meet signature requirements.

I’m inquiring about services rendered during the COVID-19 pandemic. I believe that we currently have a waiver that indicates that signatures are not required on treatment plans and other financial documentation because of the barriers to obtaining client signatures with telephonic and/or telehealth rendered services. We are curious if we will need to go back and have those clients sign those documents once this waiver is ended?

For behavioral health, the clinician should make a note within the medical record that the member is unable to sign the documents due to the delivery method. If a member is unable to sign a document because the service was rendered by telehealth, this should be noted by the clinician. When the member is seen in person again, signatures should be obtained.

How do we accept copays through telehealth? It is challenging to collect copays when the visit is done through telehealth.

April 16, 2020: There are multiple ways you could collect a copay. Examples include using a patient portal, sending a bill, getting credit card number at beginning of call, etc. Please ensure that you find a method that works the best for you and your patients.

Is there going to be an extension on the timeline filing rules? We are short staffed right now, and our normal business process is being disrupted.

April 16, 2020: Colorado Access is not extending timely filing at this time. If you are experiencing issues with being able to bill timely, please contact your provider relations representative, or send an email to providerrelations@coaccess.com.

What is the code for billing phone mental health therapy?

March 27, 2020: When billing a service conducted by the telephone, please use POS 02.

CMS1500 Professional Claim Billing guidance:

Capitated behavioral health billing (RAE/Colorado Access):

For CMS1500 Professional Claim billing – Please use POS 02 for all telemedicine/telephone services rendered. Modifier 95 can also be added, though not required, as long as the placement is in the second through fourth modifier position. Please continue to follow the USCS coding manual for the appropriate modifier use, i.e. HE or other modifiers in the first modifier position.

Child Health Plan Plus (Colorado Access)

For CMS1500 Professional Claim billing – Please use POS 02 for all telemedicine/telephone services. Modifier 95 can also be added, though not required.

UB-04 Institutional Claims billing guidance (RAE/Colorado Access and CHP+ HMO/Colorado Access)

Since POS 02 does not apply to Institutional billing (not a POS field on a UB04 claim), Modifier 95 or Modifier GT can be added to the claim but it is NOT required. Adding these modifiers will help Colorado Access to track the services rendered through telemedicine/telephone during the COVID-19 state of emergency.

In regard to providing therapy through video conference (HIPAA compliant), I understand that the place of service is 02. I am wondering if the modifier remains HE, or should it be changed to GT? Or, is GT only for institutions?

March 27, 2020: Please continue to follow the USCS manual as it relates to the use of modifier HE, it should not be changed to GT.

CMS1500 Professional Claim Billing guidance:

Capitated behavioral health billing (RAE/Colorado Access):

For CMS1500 Professional Claim billing – Please use POS 02 for all telemedicine/telephone services rendered. Modifier 95 can also be added, though not required, as long as the placement is in the second through fourth modifier position. Please continue to follow the USCS coding manual for the appropriate modifier use, i.e. HE or other modifiers in the first modifier position.

Child Health Plan Plus (Colorado Access)

For CMS1500 Professional Claim billing – Please use POS 02 for all telemedicine/telephone services. Modifier 95 can also be added, though not required.

UB-04 Institutional Claims billing guidance (RAE/Colorado Access and CHP+ HMO/Colorado Access)

Since POS 02 does not apply to Institutional billing (not a POS field on a UB04 claim), Modifier 95 or Modifier GT can be added to the claim but it is NOT required. Adding these modifiers will help Colorado Access to track the services rendered through telemedicine/telephone during the COVID-19 state of emergency.

I have been offering behavioral telehealth for quite some time but my reimbursement rate has been over 10% lower than the normal in-person reimbursement rate. Now that almost all my sessions are online this is going to have a significant impact on my income. Also, my take on the new guidance from the state is that telehealth sessions are supposed to be reimbursed at the same rate as traditional services. Does Colorado Access have any plans to address this problem?

March 27, 2020: The reimbursement for a telehealth visit will be the same rate as an in-person visit.

Are telehealth copays suspended temporarily during the COVID-19 outbreak?

March 30, 2020: There are currently no copays for RAE behavioral health services.

For CHP+ members, there currently is no copay for telehealth services provided for behavioral health services. There is a copay for telehealth services provided for physical health services and this will only be waived if the service is related to a COVID-19 diagnosis.