Action Needed by September 1, 2020
Health First Colorado (Colorado’s Medicaid Program) requires certain evaluation and management (E&M) codes be billed through fee-for-service. All fee-for-service billing must be done through the Colorado Department of Health Care Policy and Financing (HCPF) via DXC Technologies. CCHA is working closely with HCPF regarding this change to minimize provider impact.
This billing policy went into effect July 1, 2018. Guidance is outlined in Appendix J of the Uniform Service Coding Standards Manual.
E&M codes with a behavioral health primary diagnosis, billed by provider types not considered behavioral health specialty providers, must be paid through fee-for-service via DXC Technologies, not CCHA.
What needs to happen?
All E&M codes billed and paid by CCHA under a billing NPI with a provider type that is not a behavioral health specialty provider has resulted in an overpayment and must be recovered by CCHA. These claims must be rebilled under fee-for-service through DXC Technologies.
Behavioral health specialty providers include:
- Community mental health centers
- Licensed psychologists
- Licensed behavioral health clinicians (including licensed associate counselors, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists)
- Substance use disorder (SUD) clinics
- SUD individual providers
- For each claim with a date of service that is over 365 days:
- Complete this Excel spreadsheet.
- Submit the Excel spreadsheet to CCHA@Anthem.com with the email subject line “ICN Tracker.”
- Following your submission, our team will reply to you within 10 business days confirming receipt.
- Deadline to submit is September 1, 2020.
- CCHA will then send the received ICNs to DXC Technologies to have timely filing waived, which will allow the claims to pay.
- If you have questions regarding the claims on the impacted claim list, please outreach your assigned analyst using the contact information contained in the Overpayment Request letter.
For all other questions, please contact your CCHA Provider Relations Representative listed in the CCHA Behavioral Health Provider Contact List. The Behavioral Health Provider Contact List can be found at CCHAcares.com/providertools under CCHA Resources & Support for Providers > Behavioral Health Providers > Manuals and Resources > Behavioral Health Provider Contact List.