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Our Providers

We strive to provide information and resources you need to strengthen your practice and ultimately, strengthen health outcomes for patients.

Billing and Coding Updates

We’ve seen an increase in claim denials as a result of the incorrect use of applicable modifiers with certain service codes. As a result, we want to remind you that all billed services must have an applicable modifier. Please note that many services can have more than one applicable modifier, and all must be included in order for the claim to be paid.

Please note that all modifiers and requirements are listed out in the coding manual which can be found on the Department of Health Care Policy and Financing (HCPF) website.
If you submit your claims through a clearinghouse, please contact your clearinghouse to inquire which fields in their software to enter the modifier(s) that will interface to “Box 24D” of the CMS1500 form that we will receive.

Substance Use Disorder Services: Any substance use disorder service should be indicated with the HF modifier, which can ONLY be in the second modifier position. There must be another applicable modifier placed in the first position.

Effective Immediately: Claims with HF billed in the first position will be denied. Claims with HF in the second position and blank in the first position will also be denied.

Effective January 1, 2018: All other services must have an applicable modifier in the first position. If this is blank, claims will be denied effective January 1, 2018. Please see individual code pages for applicable modifiers related to the billed code.

Please send an email to your assigned provider relations representative with questions about this requirement. Please contact ProviderRelations@coaccess.com if you do not know your currently assigned provider relations representative.

Coronavirus (COVID-19) Information

With the coronavirus (COVID-19) outbreak in Colorado, we are looking to the Department of Health Care Policy & Financing for guidance. Please visit colorado.gov/pacific/hcpf/provider-telemedicine for more information.  

You can also check our COVID-19 resources page here. 

COVID-19 Administrative Changes

We have temporarily enacted several changes to our health plan business rules to ease provider administrative workload during the COVID-19 outbreak:

  • We have expanded options for telehealth, including video, telephonic, and synchronous live chat modalities. HCPF guidance also applies to CHP+ and is available here.
  • Emergency facilities, behavioral health walk-in centers, and crisis services do not need to seek prior authorization for psychiatric inpatient admissions.  Details are posted here. Admitting inpatient facilities have 24 hours to request authorization. Concurrent ongoing reviews will still be in place to help manage short lengths of stay.
  • We continue to promptly pay all claims. Currently, our claims turnaround time (TAT) is less than eight days. If we anticipate any changes to our average TAT, we will notify providers immediately.
  • To the extent permissible, we have postponed updates to our provider manual. No updates are planned. State or federal rule changes could require us to publish updates.
  • Except for changes that relax current payment and utilization management policies, we have suspended payment and utilization management policy updates. No updates are planned. State or federal rule changes could require us to publish unplanned updates.
  • Routine payment audits have been suspended through June 2020.
  • Hospitals transfers by ambulance (ground and air) do not require a prior authorization under the CHP+ benefit. Hospitals transfers for Medicaid members are accessed through the non-emergent medical transportation (NEMT) benefit. Information is available here. A Colorado Access care manager can also assist with this process.
  • Customer service representatives are available as usual. We are closely monitoring wait times. Currently, wait times are no longer than normal (< 40 seconds).
  • We will evaluate all other specific deadlines on a case-by-case basis to ensure the maximum amount of provider flexibility.
  • Provider agreements will not be amended as these changes are temporary, and after the State of Emergency has been ended by the governor, we will resume with our usual and customary practices for pre-authorizations and other activities that had emergency measures instituted by the COVID-19 outbreak.
  • Providers will be notified when the emergency business practices we instituted during the COVID-19 outbreak have ended.

Community Partner- Colorado Coalition for the Medically Underserved

Summer 2018

Community Partner- Denver Housing Authority

Summer 2018

Community Partner- Global Refugee Center

Summer 2018

Integrated Care

Summer 2018

Provider Frequently Asked Questions

How do I get Synagis for my patients?

Complete prior authorization forms and fax them to Navitus at 855-668-8551. All approved Synagis requests will be dispensed by Lumicera Specialty Pharmacy. 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. Upon prior authorization approval, Navitus will notify Lumicera, who will fax a home health request to set up the services. Our utilization management 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.