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.
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.
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 firstname.lastname@example.org 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.
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.