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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.

Important Updates You Need To Know

We want you to have access to the most up-to-date information and requirements so your job is as easy as possible. Check back often to read the latest important updates.

Have you signed the new Professional Provider Agreement?

For Regional Care Collaborative Organization (RCCO) primary care medical providers (PCPs): An email and letter was sent to all Colorado Access Regional Care Collaborative Organization providers in early December 2017 letting you know all existing RCCO agreements expire on June 30, 2018 and will be replaced by the new Professional Provider Agreements. As a part of this change, the Department of Health Care Policy and Financing (HCPF) requires that all RCCO PCPs enter into new Value Based Payment Agreements with their respective regional organizations. We recently sent out new Professional Provider Agreements by encrypted email.

If you did not receive these, please send an email to the provider contracting team at provider.contracting@coaccess.com with your current mailing and email address.

Please note this only applies to current Regional Care Collaborative Organization primary care medical providers, and does not apply to behavioral health providers or Child Health Plan Plus HMO providers.

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 Avella 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 Avella, 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.