Starting March 1, 2010, members of Colorado Access Health Plan (Medicaid physical health) will transition to a new plan through the State’s passive enrollment process.  This plan is called Colorado Access Enhanced Primary Care Case Management.

Enhanced Primary Care Case Management is a partnership between Primary Care Providers, Colorado Access and State Medicaid.  Through this partnership:

• Members receive services from a medical home;
• Colorado Access will provide care management services only;
• State Medicaid will provide all other benefits and services, including claims adjudication and payment, customer service and pharmacy service.

**This change does not affect Colorado Access’ other lines of business (CHP+, our Medicare Advantage plans, or Access Behavioral Care)**

General Provider Information

Frequently Asked Questions (PDF) about Colorado Access Enhanced Primary Case Management.

Care Management Program Description (PDF)

Claims

Starting March 1, 2010, members of Enhanced Primary Care Case Management receive care management services from Colorado Access only; State Medicaid will provide all other benefits, including claims payment.

• For dates of service March 1, 2010 and after, please submit claims to State Medicaid.
• For dates of service before March 1, 2010, please submit to Colorado Access.

Your office should collect applicable State Medicaid copays for services rendered to Enhanced Primary Care Case Management Members on or after March 1, 2010.

Verify Eligibility

Remember to verify eligibility each time your office sees a Medicaid member.

You can check eligibility by logging onto the State’s Web portal at http://www.colorado.gov/hcpf.  The State Web portal will show Colorado Access as the prepaid health plan. 

You can also check Colorado Access’ Web site, http://www.coaccess.com/our-providers.

Copays

Starting March 1, 2010 members of Enhanced Primary Care Case Management receive care management services from Colorado Access only; State Medicaid will provide all other benefits, including claims payment. This means that members will pay the State Medicaid copays.  Remember to collect copays and submit claims to State Medicaid for dates of service March 1, 2010 and after.

• Inpatient Hospital Services: $10.00 per covered day or 50% of the average allowable daily rate whichever is less.
• Outpatient Hospital Services/Specialist services: $3.00 per visit
• Doctor Visits (including Nurse Practitioner and Physicians Assistant): $2.00 per visit
• Optometrist Visit: $2.00 per visit
• Podiatrist Visit: $2.00 per visit
• Rural Health Clinic/ FQHC Services: $2.00 per date of service
• Durable Medical Equipment: $1.00 per date of service
• Laboratory: $1.00 per date of service
• Radiological Services: $1.00 per date of service
• Prescription Services (each prescription or refill)
• Generic drugs: $1.00   
• Brand name drugs: $3.00

Referals & Authorizations

State Medicaid benefits for Enhanced Primary Care Case Management.  Please follow State referal and authorization rules.  More information can be found online at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197969485906

Remember, if a member of Enhanced Primary Care Case Management needs specialty care, please refer them to a State Medicaid provider. A list of providers can be found online at: https://sp0.hcpf.state.co.us/mercury/ProviderSpecialtyLookupCriteria.aspx

State Medicaid Contact Information

If you have questions about becoming a State Medicaid provider, your contract with State Medicaid, or any billing/claims questions, please visit the Department of Health Care Policy and Financing’s Web site at http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197364127336.  

Phone Numbers:

Provider Services: (303) 534-0146, toll free 1-800-237-0757

State Medicaid Member Services (Denver Metro Area): (303) 866-3513

State Medicaid Member Services (Outside of the Denver Metro Area): Toll free 1-800-221-3943

TDD/TTY for the Deaf or Hard of Hearing: 1-800-659-2656

Provider/Member Services Hours: Monday – Friday: 8:00 a.m. – 5:00 p.m.

E-mail:

Customer Service: customer.service@hcpf.state.co.us 

To Report Provider Fraud: ReportProviderFraud@hcpf.state.co.us

Fax:

(303) 866-3220

Mail:

General Address
Department of Health Care Policy and Financing
1570 Grant Street
Denver, Colorado 80203

Claims and Prior Authorization Requests Submission
P.O. Box 30
Denver, CO 80201

Correspondence, Inquiries, and Adjustments
P.O. Box 90
Denver, CO 80201

Enrollment, Changes, Signature authorization and Claim Requisitions
P.O. Box 1100
Denver, CO 80201