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Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/2022)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
The February 2022 Health First Colorado provider bulletin (B2200475) covers several changes. Effective February 1, 2022, claims requiring electronic visit verification (EVV) go through pre-payment review, and claims without the needed EVV records may deny with EOB 3054. The bulletin also describes at-home OTC COVID-19 test billing under HCPCS E1399 with modifier U1 from January 15, 2022, requires the ordering provider's NPI on DMEPOS claims effective July 1, 2022, and notes that 24 physician-administered drug codes became subject to prior authorization effective January 18, 2022.
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What to do
Action · 18 steps
01Already effective January 18, 2022: Submit a prior authorization request to Kepro through the Kepro PA portal for any member receiving one of the listed physician-administered drug codes, and make sure an approved prior authorization is on file before administration.
02Prior authorization for J2323 and J2350 is already exempted, so no request is needed for those two.
03Already effective January 15, 2022: At-home OTC COVID-19 tests are billed under DMEPOS with HCPCS E1399 and modifier U1.
04Bill one unit per test at the same per-test price the provider charges retail, up to 15 units per member per month, with no co-pay and no prior authorization.
05Use the NPI of the ordering provider, such as a pharmacist, and bill all of these claims to Gainwell Technologies fee-for-service, including for members in the Denver Health and Rocky Mountain Health Plan networks.
06Already effective July 1, 2022: DMEPOS claims must contain the NPI of the ordering provider, who must be actively enrolled with Health First Colorado.
07Professional claims use loop 2420e with qualifier DK, and paper claims use field 17.b.
08If these conditions are not met, the claim will be denied.
09Already effective February 1, 2022: When an EVV denial with EOB 3054 is received, check Sandata for missing records and submit a manual entry if needed, and check for incomplete or unverified visits and adjust them.
10Wait 24 hours after the visit transmits, then re-bill or adjust the claim.
11Providers using a Provider Choice System must make the adjustments in their vendor system and re-transmit to Sandata.
12Behavioral health: Submit claims to fee-for-service through the Provider Web Portal when the member is not attributed to a Regional Accountable Entity, is in county custody for some services, has an ICD-10 diagnosis the RAE does not cover, or needs acute short-term care in primary care.
13Services denied by the RAE for lack of medical necessity cannot be billed to fee-for-service.
14Already effective January 1, 2022: Claims for CPT T1019 with a date of service on or after that date and billed below the 2022 rates must be adjusted to receive the increased rate of $6.28 in Denver County or $5.81 outside Denver County.
15Already effective January 10, 2022: Records dated on or after January 10, 2016 must be retained for seven years under Section 8.130.
16Timely filing is 365 days from the date of service, and if a claim does not appear on the Remittance Advice within 30 days of transmission, contact the fiscal agent and resubmit if necessary.
17Telemedicine: Use POS 02 for telemedicine provided other than in the patient's home, and POS 10 for telemedicine provided in the patient's home.
18Check current applicability of all of these dates before acting on them.
Codes mentioned
E1399A9286J02489636596366Q0220M0220M0221T1019J0172J0897J0585J0586J0587J0588J2786J3380J0517J1459J1556J1557J1561J1566J1568J1569J1572J1599J2182J2350J1745J1300J2323J2357U07.1U09.9Z20.822Z86.16J12.82Z11.52B99.9J18.9Z13.9M35.81M35.89Z11.59B94.8O98.5Z20.818Z20.828R05R06.02R50.9
Original notice
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2200475 - 02/2022)
hcpf.colorado.gov · Always check the source before changing claims.
Related changes
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Related policy hubs
Colorado Medicaid policiesCO policy changesCode E1399Code A9286Code J0248Code 96365Code 96366Code Q0220Code M0220Code M0221Code T1019Code J0172Code J0897Code J0585Code J0586Code J0587Code J0588Code J2786Code J3380Code J0517Code J1459Code J1556Code J1557Code J1561Code J1566Code J1568Code J1569Code J1572Code J1599Code J2182Code J2350Code J1745Code J1300Code J2323Code J2357Code U07.1Code U09.9Code Z20.822Code Z86.16Code J12.82Code Z11.52Code B99.9Code J18.9Code Z13.9Code M35.81Code M35.89Code Z11.59Code B94.8Code O98.5Code Z20.818Code Z20.828Code R05Code R06.02Code R50.9