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Colorado Access is a nonprofit health plan
that provides access to behavioral and
physical health services for Coloradans.
Established in late 1994, the company is
sponsored by Children's Hospital Colorado,
Colorado Community Managed Care Network
and University of Colorado
Hospital/University Physicians, Inc.
http://www.coaccess.com/
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Access Long Term Support Solutions
Access Behavioral Care
Child Health Plan Plus offered by Colorado
Access
Colorado Access Advantage (Medicare)
Regional Care Collaborative Organization
(RCCO)
Colorado Access also provides administrative
services for the CHP+ State Managed Care
Network and CHP+ Prenatal Care Program.
Child Health Plan Plus (CHP+) is low-cost
health insurance for Colorado's uninsured
children and pregnant women. CHP+ is public
health insurance for children and pregnant
women who earn too much to qualify for
Medicaid, but cannot afford private health
insurance.
CHP+ is not Medicaid. They are two
completely separate programs.
http://www.cchp.org/
Link to the SMCN CHP Provider and Member
Website:
http://www.chpplusproviders.com/
What you can find here:
 Provider Manual
 Member Benefit Booklet
 Updated Rate information
 Claims and billing processes
 Provider materials…. and much more…..
http://www.coaccess.com/child-healthplan-plus
What you can find here:
 Information about Colorado Access
 Check member eligibility for Co Acc CHP+
members and SMCN members.
 Co Acc CHP updates
http://www.cchp.org/
What you can find here:
 Who is eligible for CHP
 How families can apply for CHP
Children up to age 19 whose families fall within
the Federal Poverty Levels of 133% to 250%
Members can CHURN between CHP+ and Medicaid
There is a State rule that requires members on
Medicaid and CHP to have their income reviewed
quarterly to determine if they are on the right
program. If there is a change in the families
income then members can move between the
CHP and Medicaid plans.
How can a provider know if a member is on CHP+ or Medicaid??
Providers can apply to have access to the State Web Portal
(SWP).
This link explains how to get access, logging in, changing
password, etc.
https://sp0.hcpf.state.co.us/Mercury/Training/player.html
This link has information on how to look for eligibility in the SWP.
https://sp0.hcpf.state.co.us/Mercury/Training/player.html
You can also check the on the Colorado Access Website at:
http://www.coaccess.com/for-our-providers
(contact PNS@CoAccess.com to get a login ID and password)
Colorado Access
Provider Network Services
and
Contracting Department
How to contract (who to contact/web link/where to send):
Go to the Colorado Access Website under the section “For Our
Providers”
http://www.coaccess.com/become-a-colorado-access-provider
Send an email to PNS@coaccess.com and include the following
information:
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Provider/Practice Name
Contact name, e-mail and phone number
Address
Provider specialty
Provider Tax ID Number (TIN)
Provider NPI Number
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What is required to contract? To start the contracting
process a current W-9 is needed.
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How long does the contracting process take?
- Two to five business days for staff to prepare the
contract for the provider.
- Once the complete contract is returned it will go
through credentialing.
- The entire process can take up to 60 days
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Delays in getting the contract back from the
provider
Contracts sent back with incomplete
information
Missing or expired documentation
**To expedite the contracting process follow
the instructions included with the contract
SCA – Single Case Agreement – Colorado Access will utilize
network providers in favor of non-participating providers.
SCA’s are for limited periods of authorized services, only
when network providers are unable or unavailable to
provide services to members, or under specific
circumstances, such as continuity of care and/or network
adequacy. The SCA process must be followed for each
member the non-contracted provider sees.
Contracted – providers can treat, bill and be paid for
services when seeing our members by simply requesting an
authorization for services.
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What is RBRVS?
Resource-based Relative Value Scale is a plan used to
determine how much money medical providers should
be paid. It is partially used by Medicare in the US and
by nearly all Health Maintenance organizations
(HMOs).
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Overview of RBRVS
In 1992, Medicare significantly changed the way it pays
for physicians' services. Instead of basing payments on
charges, the federal government established a
standardized physician payment schedule based on
RBRVS.
Link to the American Medical Association website with
additional info on RBRVS.
http://www.ama-assn.org//ama/pub/physicianresources/solutions-managing-your-practice/codingbilling-insurance/medicare/the-resource-basedrelative-value-scale/overview-of-rbrvs.pagee
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What is the reimbursement for Child Health Plan plus (CHP+)
for PT/OT/ST providers?
For Co Acc CHP+ HMO: 70% of the Colorado Adjusted Medicare
RBRVS Professional Fee Schedule.
Colorado Access will update the Medicare Fee Schedule in
accordance with CMS’ published updates and compensate
Provider based on the Medicare Fee Schedule that is current on
the date services are rendered.
SMCN fee scheduled are posted on line at:
http://www.chpplusproviders.com/feeSchedule.asp
CPT
CODE
CHILD HEALTH PLAN PLUS (CHP+ HMO)
PT/OT/ST 2013 SAMPLE FEE SCHEDULE
DESCRIPTION
AMOUNT
92506
EVALUATION OF SPEECH, LANGUAGE, VOICE, COMM
92507
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMM - INDIVIDUAL
$49.63
92508
TREATMENT OF SPEECH, LANGUAGE, VOICE, COMM - GROUP, 2 OR MORE
$14.53
92526
TREATMENT OF SWALLOWING DYSFUNCTION
95928
CENTRAL MOTOR EVOKED POTENTIAL STUDY ; UPPER LIMBS
$207.81
95929
CENTRAL MOTOR EVOKED POTENTIAL STUDY; LOWER LIMBS
$209.01
97001
PHYSICAL THERAPY EVALUATION
$52.33
97002
PHYSICAL THERAPY RE-EVALUATION
$29.50
97003
OCCUPATIONAL THERAPY EVALUATION
$59.27
97004
OCCUPATIONAL THERAPY RE-EVALUATION
$37.39
97010
APP OF A MODALITY TO ONE OR MORE AREAS; HOT OR COLD
97014
APP OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIM
97026
APP OF A MODALITY TO ONE OR MORE AREAS; INFRARED
97032
APP OF A MODALITY TO ONE OR MORE AREAS; ELECTRICAL STIM - Each 15 min
97035
APP OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND - Each 15 min
97110
THERAPEUTIC PROCEDURE, ONE OR MORE AREAS - Each 15 min
$22.40
97112
APP OF A MODALITY TO ONE OR MORE AREAS; ULTRASOUND
$23.36
97116
GAIT TRAINING (INCLUDES STAIR CLIMBING)
$19.78
97124
MASSAGE, INCLUDING EFFLEURAGE, PETRISSAGE AND/OR TAPOTEMENT
$18.35
97140
MANUAL THERAPY TECHNIQUES
$20.97
97530
THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) - Each 15 min
$24.56
97532
DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION - Each 15 min
$18.34
97535
SELF-CARE/HOME MANAGEMENT TRAINING - Each 15 min
$24.32
97542
WHEELCHAIR MANAGEMENT - Each 15 min
$21.21
$152.56
$53.93
$4.27
$11.19
$4.27
$13.34
$8.80
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All Early Intervention claims should be billed on a HCFA 1500
form.
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HCFA 1500 claim forms can be purchased at the office supply
stores such as Office Depot and Staples.
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CHP HMO Timely filing is 120 days from the date of service or
60 days from the last timely EOP date to appeal or send a
corrected claim
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SMCN Timely filing is 180 days from the date of service or 60
days from the last timely EOP date to appeal or send a
corrected claim.
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Colorado Access strongly recommends that you enroll in
the Electronic Funds Transfer (EFT) program through
Emdeon. This will make your payments faster and more
secure.
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To enroll please call Emdeon toll free at 1-866-506-2830
with questions or to enroll. Additional information can
also be found at Coaccess.com/provider-claims-FAQ
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There are 3 methods of payment to choose from:
◦ 1. EFT through Emdeon
◦ 2. Virtual Credit Card (VCC): A merchant fee will apply
◦ 3. Paper Check: The first payment will be via VCC than you will
need to opt out of the VCC in order to receive a conventional
check
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Providers have the right to appeal any claim when they
disagree with the outcome of a claim
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Claim appeals must include:
◦ A copy of the claim
◦ A Claim appeal form (available on our website) or cover
letter
◦ Detailed information supporting the reason for the appeal
◦ All other supporting documentation
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If additional information is requested by Colorado Access, the
provider has 30 days to submit the requested information
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Claim appeals will be processed within 45 days
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Initial or Corrected claims:
◦ Colorado Access Claims
◦ P.O. Box 17470
◦ Denver, CO 80217-0470
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Claim appeals:
◦ Colorado Access Claim Appeals
◦ P.O. Box 17189
◦ Denver, CO 80217-0189
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ClaimRemedi: www.claimremedi.com (Payer ID: coacc)
CPSI: www.cpsinet.com (Payer ID: coacc)
Emdeon: www.emdeon.com (Payer ID: 84129)
ENS: www.enshealth.com (Payer ID: coacc)
MedAssets/ Xactimed: www.medassets.com (Payer ID: coacc)
Office Ally: www.officeally.com (Payer ID: coacc)
Practice Insight: www.practiceinsight.net (Payer ID COA)
Relay Health: www.relayhealth.com (Payer ID: coacc)
SSI Group: www.thessigroup.com (Payer ID: coacc)
S&S Datalink: www.sasdatalink.com (Payer ID: coacc)
Note: There is also a list of secondary vendors on the website and in the provider manuals
Colorado Access
Clinical Support Services
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To request an authorization for EI services please submit your
request forms to:
FAX# 1-877-232-5976
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Our Clinical team will process the request within two business
days for contracted providers.
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Authorized EI services will be for one year at a time or until
the child’s third birthday.
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An authorization letter will be provided that will include all
necessary information pertaining to the authorization request
1. If the requesting provider is not contracted
The process for non-contracted providers:
 The Clinical Staff will contact the provider to notify
them that we will need to do a SCA and gather
preliminary information
 The Clinical Staff will notify Provider Contracting who
will begin the SCA process which includes contacting
the provider to discuss SCA requirements and rates.
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SCA must be signed and returned by the
provider
SCA is then returned to the Clinical staff to
complete the authorization process
The SCA MUST be billed with the claim in
order for the claim to pay correctly.
This process can take up to 3 days if all
parties respond quickly with needed
information.
2. Missing information on the request:
 Authorization requests from providers that
are missing phone and fax numbers slow our
ability to contact you if additional information
is needed.
3. Eligibility issues.
 We can work with the State and research
these issues and have corrections made when
appropriate but this may take time depending
on the situation.
Colorado Access
Provider Network Services
Credentialing@coaccess.com
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Jennifer Rogers-Manager, Credentialing Program,
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Erin Webber-Credentialing Program Coordinator,
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Stacey Matthews-Credentialing Program Coordinator,
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Shanna Salazar-Credentialing Program Coordinator
How can you get a hold of us?
Email us at Credentialing@coaccess.com
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Colorado Access is committed to providing a QUALITY
network of providers.
The Credentialing Team completes a “quality check” on all
the providers that fall under the credentialing scope in the
network using National Committee for Quality Assurance
(NCQA) and URAC standards.
Credentialing is a requirement under NCQA and URAC.
Managed Care Organizations are required to credential their
providers prior to executing the provider contract.
Credentialing is performed for individual providers that fall
within the scope of credentialing.
Re-credentialing occurs every 3 years.
Allopathic Physician (MD)
 Osteopathic Physician (DO)
 Doctor of Dental Science (DDS)*
 Doctor of Dental Medicine (DMD)*
 Podiatrist (DPM)
 Certified Nurse Midwife (CNM)
 Nurse Practitioner (NP)
 Physician Assistant (PA)
 Optometry (OD)
 Physical Therapy (PT)
 Occupational Therapy (OT)
 Chiropractor (DC)
 Speech Pathology (SLP)
*Dentist who provide care under the medical benefit program only
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Psychiatrist (MD, DO)
 Psychologist (PsyD, PhD, EdD)
 Licensed Clinical Social Worker (LCSW)
 Licensed Professional Counselor (LPC)
 Licensed Marriage Family Therapist (LMFT)
 Clinical Nurse Specialist (CNS)
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Colorado Health Care Professional Credentials
Application (26 pages)
Current DEA Certificate (if applicable)
Current Professional Liability Insurance (must include
the providers name who are covered under the
policy)
You can get a copy of the Colorado Health Care
Professional Credentials Application at
http://www.coaccess.com/credentialing
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The Universal Provider Datasource (UPD) is a part of CAQH’s credentialing application
database that seeks to make the provider credentialing process more efficient for
providers as well as healthcare organizations.
CAQH has created an online database that collects all provider information necessary
for credentialing, CAQH helps eliminate the paperwork and hassle that many providers
face during the credentialing process.
CAQH will help avoid the hassles of completing the same paperwork for multiple
healthcare organizations.
Colorado Access participates with CAQH.
There is no cost for the providers to participate with CAQH.
To have an account with CAQH, an healthcare organization will need to submit a
request. To create an account with CAQH, we will need the provider’s full name,
degree, date of birth, office address, and phone number. Once in the system, the
provider creates a user name and password, and can complete the application online.
To learn more about CAQH please visit the website at https://upd.caqh.org/OAS/
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The credentialing process can take up to 60 days after the
request has been received from the Provider Network
Services.
If the application is incomplete or if there is additional
information needed to complete the credentialing process, a
Credentialing Program Coordinator will contact you.
After the credentialing process has been completed, you will
receive a letter from the credentialing department.
When you receive this letter , this does not mean your
contact is effective with Colorado Access. You will need to
contact your Provider Contract Coordinator to obtain the
effective date of your contract.
Questions??