Important Updates
We like to keep our providers in the loop. Should there be any important updates or changes, they will be conveniently located here.
2025 Updates
Medicaid RAE changes
Instead of the 7 regions we have now - there will be FOUR.
Current contracts end June 30.
Medicaid New Manual (Jan 2025)
Update Your Info.
First of the Year is a great time to make your changes & update every thing!
Be Mindful that insurances also change their contracts and make updates - so watch out for those newsletters and info they send out!
Dont forget a lot of clients will have new insurance or a new deductible!
Medicaid Region Changes Summer 2025
July 1 2025.
The regions are changing! Carelon is no longer included in hte list. Geography has changed - so be mindful of that.
Tricare / TriWest
(Jan 2025)
Medicaid consultations
There are a lot of changes in 2025 - new provider manual released and more changes coming down the road! Be aware and mindful of that.
Make sure that your documentation and charts are up to par!
2024 Updates
January 2025 Medicaid Billing Manual
The new manual has been released with a few updates. "Changes must be implemented prior to January 1"
--- DO NOT USE The Medicaid Modifiers (HE) from past. Jan 2024 they were discontinued. Jan 2025 they are going to deny claims that still use them.
-- E&M Code changes
-- etc
(link here)
4th Qtr - 2024
Tricare West - urgent changes!
Effective Aug 1 TriWest is in charge of Tricare West credentialing/contracting process.
Effective Jan 1 2025 they will be handling everything - so your current contract will need to be "transferred over" and your clients will need an auth to continue seeing you until you are offered a contract with TriWest.
There is a request form on the TriWest website that you will need to complete. (here)
Quarterly Data Update Time!
Please be sure that you are going in to update all of your portals and profiles -- CAQH, NPPES, HCPF (Medicaid), Availity. Then your insurance portals too!
Medicaid "Bible" Changes
An updated manual was released in Oct 2024.
United JUST put out an update -- SUPERVISORY BILLING IS APPROVED!!!!
Effective Oct 1 for Colorado -- there are some rules -- but YAY!!!! (here is a PDF of the full policy)
Demographic Updates and Moving!
I have had a few providers move and with that comes its own set of challenges. IF you have moved IN state - not that big of a deal. Just update your address everywhere (same as the quarterly data update - go to all of those places) -- you will need a new W9 with the new address to attach. If you have moved OUT of state - that is important.
Are you going to maintain a practice in Colorado or start a new practice in the new state? These are important things to think about -- its not just "change my address"
Adding Licensed Providers to your Contracts
As you are growing your practice, you may want to add a licensed provider. This is fantastic! But please remember that in order to bill insurance, they must be added to YOUR practices contracts, not just "well they are in network already" (through another practice or on their own). This process is different for each insurance but is necessary.
September 2024
United JUST put out an update -- SUPERVISORY BILLING IS APPROVED!!!!
Effective Oct 1 for Colorado -- there are some rules -- but YAY!!!! (here is a PDF of the full policy)
Quarterly Data Update Time!
Please be sure that you are going in to update all of your portals and profiles -- CAQH, NPPES, HCPF (Medicaid), Availity. Then your insurance portals too!
Medicaid "Bible" Changes
An updated manual was released in July 2024 -- and another one may hit next month!
Demographic Updates and Moving!
I have had a few providers move and with that comes its own set of challenges. IF you have moved IN state - not that big of a deal. Just update your address everywhere (same as the quarterly data update - go to all of those places) -- you will need a new W9 with the new address to attach. If you have moved OUT of state - that is important.
Are you going to maintain a practice in Colorado or start a new practice in the new state? These are important things to think about -- its not just "change my address"
Tricare West - application changes!
Effective Aug 1 TriWest (which is yes, different than Tricare West) is the new company handling new provider applications etc - for Tricare West. This changes the process and there is not currently a time frame that I am aware of as TriWest says to wait 90 days before we reach out to inquire (I don't do that, but they keep telling me that).
Adding Licensed Providers to your Contracts
As you are growing your practice, you may want to add a licensed provider. This is fantastic! But please remember that in order to bill insurance, they must be added to YOUR practices contracts, not just "well they are in network already" (through another practice or on their own). This process is different for each insurance but is necessary.
Medicaid Revalidation
Some providers are up for their revalidation. Yes, this must be done. IF you dont - this will impact all of your Medicaid umbrella (RAE's).
Documentation and being "ready"
This is important for insurance clients, duh. BUT! You should be maintaining this for ALL of your clients. Due to your license, there are certain CYA things you should be doing anyways. If you get pulled in to court, there are things you want documented. And then yes, for insurance audits. So -- just CYA all the way around and keep all the boxes checked.
Treatment plans - yes. If you are going to be billing insurance it is necessary. Different insurances have varying requirements.
Diagnosis - yes. If you are going to be billing insurance it is necessary. Self pay is less specific (you can use the R and Z etc codes)
Progress notes - yes. If you are going to be billing insurance it is necessary.
Disclosure (MDS) - yes. If you are going to be billing insurance it is necessary.
Intake Consent & Assessment. - yes. If you are going to be billing insurance it is necessary. (looks different for different folks though).
Consent for Therapy / Treatment - yes. If you are going to be billing insurance it is necessary.
Consent for Telehealth - yes. If you are going to be billing insurance it is necessary.
Consent to release PHI to bill insurance - yes. If you are going to be billing insurance it is necessary.
Consent to charge the card. YES.
JUne 2024
We MOVED!!!
A lot of you already know, but we partnered up with local therapy practice for office space. I have been renting space from him for a while now and his vision finally took an amazing new step. With that came a new location. So -- we moved too! :) We are just a few miles south from where we were -- we are no longer next to the post office. We have a great space with a great view. I added some bird feeders outside of the window for mostly I just get to watch the squirrels try to get to it! I am not able to host in-office meetings yet as we are still getting situated, but will be able to restart soon!
Quarterly Data Update Time!
Please be sure that you are going in to update all of your portals and profiles -- CAQH, NPPES, HCPF (Medicaid), Availity. Then your insurance portals too!
Medicaid "Bible" Changes
An updated manual was released April 1 and its likely another will hit July 1.
Insurance "New Year"
Some insurance policies restart their benefits on July 1 so be mindful of that when billing. Some deductibles start over & session allowance count starts over!
Demographic Updates and Moving!
I have had a few providers move this last quarter and with that comes its own set of challenges. IF you have moved IN state - not that big of a deal. Just update your address everywhere (same as the quarterly data update - go to all of those places). If you have moved OUT of state - that is important.
Are you going to maintain a practice in Colorado or start a new practice in the new state? These are important things to think about -- its not just "change my address"
Tricare is Open!!! WAHHOOO!!
So far we have lucked out and Tricare West region has been open for new providers!
Adding Licensed Providers to your Contracts
As you are growing your practice, you may want to add a licensed provider. This is fantastic! But please remember that in order to bill insurance, they must be added to YOUR practices contracts. This process is different for each insurance.
Medicaid Revalidation
Some providers are up for their revalidation. Yes, this must be done. IF you dont - this will impact all of your Medicaid umbrella (RAE's).
March 23 - 2024 - updates
Its Time!!
Please be sure that you are going in to update all of your portals and profiles.
First -- Update your CAQH profile (insurances pull here, so I recommend start here).
Make sure that your address is correct and that ALL practices you are working with are listed as practice locations. I recommend that the contact information is YOUR information not someone else, this avoids any "it was lost" but -- that is your decision of course. Headway/sondermind/etc -- that is a different situation, as they will have their own contacts - leave those ones as-is.
Make sure you have selected to release all information automatically.
Second - NPPES profile needs to be reviewed -- make sure your Type 2 Organizational profile (this is the profile for your group practice) has the correct name, address, etc. And then review your individual profile as well. Your taxonomy needs to be correct as well. If you have questions please reach out!!
Third -- If you are a Medicaid provider -- login to your group profile and make sure its correct & that your "Revalidation" is not due or past due. Then login to your individual profile and make sure your information is correct. For the individual - look at the group affiliations and make sure you are only linked to current practices and add any that are not listed :)
Fourth -- Update Availity A lot of insurances use this portal. But it pulls from CAQH and NPPES. So that is why you do those prior :) Make sure that Availity has your group info & your individual information, the address is correct, your taxonomy information, license, etc.
Then --- go to your insurance portals and update them as needed.
This has to be done quarterly -- most of the time you will get an email -- but as we all know, you guys get 100 emails a day so these sometimes get overlooked or filtered into spam even. So -- here is a formal reminder that YES it needs done!
IF you have questions please let us know!
March 1 - 2024 - updates
There has been a lot going on in Feb - so sorry for the lack of updates here directly.
Aetna made a statement about the data breach in terms of claims filing and the steps they are taking as a work around
Medicare expanded their network to allow LPC and LMFT - and with that came OPT-OUT issues with Tricare West and Medicaid. So, if you take either of those, then you will need to ensure you are covered all the way around! You have to participate with Medicare in order to stay in good standing with TC and Medicaid. Sheryl (the Tricare director) is a great direct contact and HCPF as well - to ensure you are getting correct information. Medicare website -- We strongly encourage you to create a portal with PECOS/CMS/Novitas
Tricare West Updates
United newsletter / updates March 2024
Anthem Updates March 2024
Aetna Updates March 2024
Carelon also has some trainings - they can all be found on Availity and Provider Connect.
HCPF (Colorado Medicaid) Provider Updates & news
CCHA Newsletters
Colorado Access Provider Resources and trainings they offer
I hope this helps you guys out and if you have any other questions -- as always, reach out to us directly!
ccha - Jan 2024
Claims Issue Update
CCHA has identified an issue where claims submitted without program modifiers are being erroneously denied. Impacted claims have dates of service from January 1, 2024, to January 11, 2024, for claims received on or before January 11. Impacted claims can be identified on the explanation of payment (EOP) as having a primary denial of a “non-covered service” with the denial code MB9. CCHA will be reviewing all claims received from January 1, 2024, to January 11, 2024, with the MB9/non-covered service denial for automatic claims reprocessing- providers do not need to take any action to have their impacted claims reprocessed.
CCHA has implemented a process in our claims system to manually correct claims submitted outside of the previously mentioned dates so they will process correctly. As we manually review and process these claims, providers may see a slight delay in claims processing timelines.
We appreciate your understanding while we work to correct this issue. Please outreach your Behavioral Health Provider Representative via our Contact Us form with any additional questions or assistance with denied claims not in scope of this issue.
Tricare West status - Jan 2024
As of today - Tricare West is closed for SOME new providers wanting to join the network. Some because they do allow some specialties. I will keep checking for all of our new providers inquiring - because you never know!
medicare allowances update - 2024
Medicare expanded their network allowances - LPC, LAC and LMFT can now apply! Eligible providers have until the end of March to complete their Medicare enrollment.
I have been asked a few times - can we opt out? What happens if I don't want to take Medicare but I do take Medicaid and have dual eligible members?
The TPL (third party liability) rules state that Medicaid is the payor of last resort and that you must bill the primary insurance first. Private insurances are first, federal/state payors secondary, Medicaid is always last. Medicare is considered primary when the member has Medicare and Medicaid (dually eligible).
If the provider is NOT eligible to enroll in Medicare then claims can be submitted directly to the MCE however now that Medicare allows more providers - we wont see as much of that :)
January 2024 - Medicaid / HCPF Updates
As they do -- HCPF made some new updates!!!
Click here to pull up the full list so you can always click on the most recent :)
Some of my favorite updates:
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Information on the BHA additions
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The first-position Modifier is NO LONGER required!! Why? Medicaid reports "were regularly a point of
difficulty/administrative burden for providers" YAY!!! -
H0046 Drop-in CPT code addition!
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Autism Spectrum Disorders (diagnosis) are NOW COVERED for psychotherapy by the MCEs for non-medical / non-BCBA providers!!! Specifically for members under 21 years of age. (codes applicable: 90785, 90791,90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846,90847, 90849, 90853.)
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Added more clarification and language changes for a handful of codes and added more covered services.
Also -- don't forget to check their bulletins as well! They do have one for January 2024
Updates from 2023
12/20/2023
Tricare West Updates!!!
Preview the 2024 TRICARE provider handbook. The 2024 TRICARE West Region Provider Handbook is online for you to preview. This handbook is effective
Jan. 1, 2024, and includes important information about TRICARE and HNFS contract requirements. As a reminder, network providers are required to review the handbook annually, in its entirety, as a component of your TRICARE Provider Agreement
Review 2024 cost-share and copay information. Effective Jan. 1, 2024, some TRICARE copayments, cost-shares, and other beneficiary out-of-pocket costs will change. Find 2023 and 2024 beneficiary cost details on our website in the New Year. You can direct your patients to preview costs at www.tricare.mil.
A look at TRICARE Select. Recently, TRICARE beneficiaries had the opportunity to review their health plan choices for the coming year. TRICARE Open Season ran from Nov. 13-Dec. 12, 2023, with enrollment changes becoming effective Jan. 1, 2024. As providers, it’s important to understand the plan options offered to TRICARE patients. Review some of the most frequently asked questions about TRICARE Select, a self-managed, preferred provider organization (PPO) plan for eligible non-active duty service members.
12/15/23
Autism Spectrum Disorder (ASD) as a Covered Diagnosis Under the Regional Accountable Entity (RAE) for Psychotherapy Services
Managed Care Entities (MCEs) will be responsible for Autism Spectrum Disorder (ASD)
(International Classification of Diseases [ICD] codes F84.0-F84.9) as a covered diagnosis for
psychotherapy services only for members under 21 years of age, effective January 1, 2024.
Specifically, the following services will be required to be billed to MCEs when treating ASD:
90785 90834 90838 90849 90832 90836 90846 90853 90833 90837 90847
Codes 90791 and 90792 will be covered under both Fee-for-Service (FFS) and the Capitated
Behavioral Health Benefit (responsibility of the MCE) since these codes are used for both
assessment as well as to initiate psychotherapy services.
Codes that currently do not require a covered diagnosis as indicated in Appendix I of the State Behavioral Health Services Billing Manual should already be paid by the MCEs when an ASD diagnosis is used.
Removing First Position Modifiers
A first position modifier will no longer be required to distinguish a State Plan or B3 service
effective January 1, 2024. Refer to the State Behavioral Health Services Billing Manual, which
will be updated to reflect this change.
First position modifiers are:
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State Plan: HE
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B3 Service: HK (Residential), U4 (Intensive Case Management), TM (Assertive Community Treatment), HM (Respite), HJ (Vocational), TT (Recovery), HT (Prevention/Early Intervention), HQ (Clubhouse/Drop-in), HF (Substance Use Disorder)
These modifiers will be removed from every coding page and in Appendix I of the State
Behavioral Health Services Billing Manual.
This action will leave six (6) codes that would require a new first position modifier (currently
a second position modifier that will move to the first position) - Please reference HCPF policy for those
Medicare Allowing Licensed Marriage and Family Therapists (LMFTs), Licensed Professional Counselors (LPCs) and Licensed Addiction Counselors (LACs) to Enroll
The Centers for Medicare & Medicaid Services (CMS) has announced a rule change that now allows marriage and family therapists and mental health counselors – including eligible addiction, alcohol or drug counselors who meet qualification requirements for mental health counselors – to enroll for the first time in Medicare.
Newly eligible practitioners can enroll in Medicare starting November 1, 2023, and can start billing Medicare effective January 1, 2024. Refer to the CMS announcement for more information.
These providers currently must use Modifier HO on claims submitted directly to Medicaid
without a Medicare denial. The policy will be changing effective April 1, 2024. The use of the
HO modifier will only be allowed after April 1, 2024, in situations where enrolled Medicare
providers are supervising unlicensed behavioral health providers and submitting claims as the rendering provider
BHA Coverage Type Not Eligible for Medicaid or Child Health Plan Plus (CHP+)
Providers may now see a new “Coverage” type for Behavioral Health Administration Benefits, shown in the Provider Web Portal as “BHA Benefit Plan” and “BHAB.” Behavioral Health Administration Benefits (BHAB) is a new program utilizing the Colorado interChange system. It is overseen by BHA, a separate entity that is addressing behavioral health needs of individuals not covered by other medical assistance programs. BHAB “benefits” are not the same as BHO+B benefits provided through the Regional Accountable Entities (RAEs).
Note: This program is not part of Health First Colorado (Colorado's Medicaid program) or CHP+. Individuals who only have “BHA Benefit Plan” listed are not eligible for any service under Medicaid or CHP+.
Reminder: Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+) providers must confirm coverage types before rendering any Medicaid or CHP+ services or submitting claims.
Eligibility coverage types (not an all-inclusive list):
• Medicaid: "Medicaid State Plan" and "TXIX" (Title XIX)
• Child Health Plan Plus: “CHP+B”
• Behavioral Health Coverage through the Regional Accountable Entities (RAEs): "Medicaid Behavioral Health Benefits" and "BHO+B"
Claims submitted for individuals who do not have current Medicaid or CHP+ coverage listed will be denied.
12/05/2023
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Todays Memo! ** Revalidation **
It is the time of year to do updates!
A lot of providers have been getting emails from Availity to Revalidate your profiles!
If you are one of our clients - you can send that email over to us and we can help you!
Its also a good time to make sure if you have any demographic updates - that you do those in all the other profiles as well: NPPES, CAQH, Availity, EHR, any insurances you are paneled with (most have their own direct demographic update process).
12/02/2023
Tricare Provider Handbook Updates!
The 2024 Tricare West Region Provider Handbook is ready to preview! Check out everything you need on their website!
12/02/2023
Medicaid BHA Denials
There was an email sent out to Medicaid providers regarding some denied claims for the members that had coverage changes (from their normal billable plan to BHA with no RAE assigned/FP/etc)
The issue: Members that do not have Health First Colorado (Medicaid) or CHP+ coverage listed in their elig anymore, they have the BHA plan listed. What are we doing?
Some providers billed Medicaid directly to see if they would pay.
The result: those claims will be denied.
As a reminder - it is the providers responsibility to check eligibility prior to the session. If the member does not have coverage then the client is self pay or a write off. Yes this is a confusing page sometimes as Medicaid does have a lot of different coverage types. Some of those are: Medicaid (this can look like “Medicaid State Plan” and “TXIX”, BHO, CHP+, Regional Accountable Entities (RAEs).
A lot of providers are seeing the new coverage listed and have received correspondence about it. What is it? Behavioral Health Administration Benefits - BHA Benefit plan and BHAB. It is a new program overseen by BHA which is completely separate from Medicaid. This plan is offered to members that are not otherwise covered. It is NOT a Medicaid coverage or CHP+ Therefore these members are not eligible for any of those Medicaid services.
If you want more information about BHA - Medicaid does have a document on it - head over to their website and check out the resources and other information.
10/10/2023
HCPF (Colorado Medicaid).
I have encouraged providers to ensure they either have the section detailed in their disclosure or have an independent document regarding financials, patient responsibility and insurance billing practices. I was reminded today from another provider ... so I decided to share again with yall!
If you do not have it clearly outlined in your policy somewhere with a signature line - PLEASE - add i😊 Even if you do NOT take Medicaid, you still must abide by their rules (you cannot charge a Medicaid client for a Medicaid-covered-service regardless of YOUR network status). HCPF Policy Statement
If you have questions about this - either get with your biller or reach out for a consultation!
For commercial plans - you do not HAVE to bill insurance - that is the clients right (to not authorize you to release PHI, opt for super bills, just self pay, etc), but for government-funded-plans (Medicaid, etc) there are different rules for sure.
09/08/2023
Quarter 4 is fast approaching!! I know its not January yet but its on my mind so I want to pass along a couple reminders to squeeze into your calendars these last few months.
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Update your disclosures
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Update your forms
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Update your self-pay agreements
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Update your billable rates
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Update your demographics if youve had any changes
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Update your NPPES and CAQH