Medicaid Colorado
Colorado Medicaid Home Health (HH), UB-04 Hardcopy
Colorado Home Health is a standard fee-for-service claim. Each type of service provided by a specific discipline is listed individually on the claim. For Type of Bill (Field Locator 4), Colorado Medicaid allows the third digit for Type of Bill to be 1 - 4 only for home health claims.
Detail Charge Line Section (Field Locators 42-49): Use the Tiered Rates Function under Billing Rates to enter new rates for Home Health Aide Visits (acute and long-term visits are services that requires multiple charge lines to be reported for one visit). Choose an effective date, such as the first of the month, to start using these new rates (see more information below on recalculating claims).
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Go to Billing Rates in Administration>Financial>Billing Rates>Rates tab. |
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Enter a new rate for the Home Health Aide Visit (Revenue Code 570). |
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Select the check box in the T.R. column to indicate that the Tiered Rates Detail information should be used for this Insurance Code Service. Once selected, the Tiered Rates grid appears. |
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In the From column, enter 1h 1m. Leave the Thru column blank. |
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When you select the OK button, the application will return you to the Bill Rates screen. |
On the claim form, this service will be reported as two separate charge lines. If more than one home health aide visit occurs in one day, the application will group the services accordingly and print only two charge lines for the given date of service.
Recalculating Claims: Most likely, you will need to recalculate claims for services already entered in the current claim cycle. For example, assume the current date is February 10, 2005 and you have already entered all services from February 1 - 9. If the effective date for the new rates is set at February 1, 2005 you will need to recalculate the claims for the February Services already entered.
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Select the appropriate Pay Source/Patients, but DO NOT select the check box for 'Generate Void/Replacements for Closed Claims' (doing so will generate many Void/Replacement claims). |
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Select a Start Date that is the same as the effective date for the new Bill Rates that you have entered. |
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This function will recalculate your current working claims for the selected pay source and patient.
The following fields or areas in the application may be required for Colorado Medicaid Home Health (HH), UB-04 Hardcopy.
Colorado Medicaid Home Health (HH), 837I 4010A1 Electronic
Refer to the Colorado Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional setup information.
The following fields in the application are required for Colorado Medicaid Home Health (HH), 837I 4010A1 Electronic.
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Yby default for each carrier. Change to N where applicable. |
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Enter the appropriate Colorado Medicaid-assigned ID codes for Medicare crossover claims and the primary identifier of each third-party payer (including the code of 77016 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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For the patient's attending physician and referring physician (PCP), enter either the physician's federal tax ID or Social Security Number. Enter the physician's taxonomy code. Enter the physician's Colorado Medicaid provider ID in the State License Number field. |
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Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter 77016 in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter the submitter ID assigned by Colorado Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
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If this is a voided or replaced claim (third digit of the type of bill is a 7 or 8), enter the document control number or the ICN of the original claim in Claims>Process>Annotate Claims. |
Colorado Medicaid Home Health (HH), 837I 5010A2 Electronic
Refer to the Colorado Medicaid Home Health (HH), UB-04 Hardcopy instructions for additional setup information.
For Colorado Medicaid Home Health (HH), 837I 5010A2 Electronic, define the following items:
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In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance. |
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
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Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA. |
The following fields in the application are required for Colorado Medicaid Home Health (HH), 837I 5010A2 Electronic.
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Yby default for each carrier. Change to N where applicable. |
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Enter the appropriate Colorado Medicaid-assigned ID codes for Medicare crossover claims and the primary identifier of each third-party payer (including the code of 77016 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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For the patient's attending physician and referring physician (PCP), enter either the physician's federal tax ID or Social Security Number. Enter the physician's taxonomy code. Enter the physician's Colorado Medicaid provider ID in the State License Number field. |
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Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter 77016 in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter the submitter ID assigned by Colorado Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
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If this is a voided or replaced claim (third digit of the type of bill is a 7 or 8), enter the document control number or the ICN of the original claim in Claims>Process>Annotate Claims. |
Colorado Medicaid Hospice (HO), UB-04 Hardcopy
Colorado Hospice is a standard benefit claim. Each type of service provided by a specific discipline is listed individually on the claim.
Condition Code 17, Occurrence Codes 27, 42 and 55, and Value Codes A1 through C3 are generated automatically. However, all other codes must be entered through the Claims>Process>Annotate Claims window.
The following fields or areas in the application may be required for Colorado Medicaid Hospice (HO), UB-04 Hardcopy.
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Select Print Variation – Use the first and last dates of service on each separate claim |
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Select Print Variation – Print Admit Date from the Admissions & Status window as of the claim date |
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Select Print Variation – Print '01' (termination), '30' (still active), or '20' (died) |
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If your agency reports Condition Codes, you must enter these codes in patient claim constants. |
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If your agency reports Occurrence Codes, you must enter these codes in patient claim constants. |
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If your agency reports Occurrence Span Codes, you must enter these codes in patient claim constants. |
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If your agency reports Value Codes, you must enter these codes in patient claim constants. |
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Enter the appropriate 4-digit Revenue code in billing rates for this insurance. Ensure that "0001" is entered into the Total Revenue section. |
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Select the appropriate Payer Type. The Payer Type must be completed even if you do not process electronic submissions. Enter the Payment Source Code and Payer Name in Patient Claim Constants:
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If applicable, enter the carrier code in patient claim constants. |
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Select Print Variation – Print the Secondary physician's Additional Physician No. |
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Select Print Variation – Print the patient's diagnosis code as of the patient's admission date. |
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Select Print Variation – Print physician's Medicaid Provider ID (Other Phys No) and 1D qualifier. |
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Select Print Variation – Print secondary physician's information with NPI. |
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Select Print Variation – Print tertiary physician information with NPI. |
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If your agency needs to report remarks, enter any remarks in patient claim constants. |
Colorado Medicaid Hospice (HO), 837I 4010A1 Electronic
Refer to the Colorado Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
The following fields in the application are required for Colorado Medicaid Hospice (HO), 837I 4010A1 Electronic.
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable. |
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Enter the appropriate Medicare ID for Medicare crossover claims and the primary identifier of each third-party payer (including the code of 77016 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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For the patient's attending physician and referring physician (PCP), enter either the physician's federal tax ID or Social Security Number. Enter the physician's taxonomy code. Enter the physician's Colorado Medicaid provider ID in the State License Number field. |
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Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter 77016 in the Receiver ID (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter the submitter ID assigned by Colorado Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
Colorado Medicaid Hospice (HO), 837I 5010A2 Electronic
Refer to the Colorado Medicaid Hospice (HO), UB-04 Hardcopy instructions for additional setup information.
For Colorado Medicaid Hospice (HO), 837I 5010A2 Electronic, define the following items:
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> |
In Administration>Financial>Insurance Codes>Print Variations, select the check box under FL 14-15 to ensure the ANSI 5010 Billing Template compliance. |
Note: If values other than 3 or 1 are required, enter them in Patient>General>Claim Constants or Administration>Financial>Claim Constants.
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> |
Ensure that either I or Y is selected for ANSI 5010 in the Rel Infor(Release of Information) field in Patient>General>Payers>HIPAA. |
The following fields in the application are required for Colorado Medicaid Hospice (HO), 837I 5010A2 Electronic.
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable. |
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Enter the appropriate Medicare ID for Medicare crossover claims and the primary identifier of each third-party payer (including the code of 77016 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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For the patient's attending physician and referring physician (PCP), enter either the physician's federal tax ID or Social Security Number. Enter the physician's taxonomy code. Enter the physician's Colorado Medicaid provider ID in the State License Number field. |
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Enter the agency's provider taxonomy code in the Provider Taxonomy Code field in Administration>Financial>Insurance Codes>General. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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Enter the submitter ID assigned by Colorado Medicaid in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
Colorado Medicaid HCBS Waiver, 837P 4010A1 Electronic
Colorado Medicaid requires a proprietary CO-1500 paper claim form.
Create a new Medicaid Regular fee-for-service insurance code selecting the CMS-1500 (08/05) paper claim form. Once the insurance code and print variations have been set up, you will have an option of printing onto the CMS-1500 (08/05) form, and then transferring this information manually to the proprietary CO-1500 form required by Colorado, if paper claim submission is needed.
You must also download and install the appropriate electronic format from the Client Support website.
It is recommended to select the following print variations for the HIPAA EMC files in Administration>Financial>Insurance Codes>Print Variations.
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Print the Attending Physician's State License Number and 0B Qualifier |
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Summarize the charges by type of service (non-consecutive days) |
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Print only agency name, address, zip code and phone number (exclude city and state) |
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The following fields in the application are required for Colorado Medicaid HCBS Waiver, 837P 4010A1 Electronic.
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In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable. |
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If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file). |
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Enter the appropriate Colorado Medicaid-assigned ID for each insurance carrier (including the identifier of 056000522 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company. |
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If the code other than the default A (Assigned) is selected in the Medicare Assign field in Patient>General>Payers>HIPAA, then C (Not Assigned) will print to the claim file. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem. |
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Enter the agency's assigned trading partner ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
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If this is a voided or replaced claim (third digit of the type of bill is a 7 or 8), enter the document control number or the ICN of the original claim in Claims>Process>Annotate Claims. |
Colorado Medicaid HCBS Waiver, 837P 5010A1 Electronic
Colorado Medicaid requires a proprietary CO-1500 paper claim form.
Create a new Medicaid Regular fee-for-service insurance code selecting the CMS-1500 (08/05) paper claim form. Once the insurance code and print variations have been set up, you will have an option of printing onto the CMS-1500 (08/05) form, and then transferring this information manually to the proprietary CO-1500 form required by Colorado, if paper claim submission is needed.
You must also download and install the appropriate electronic format from the Client Support website.
It is recommended to select the following print variations for the HIPAA EMC files in Administration>Financial>Insurance Codes>Print Variations.
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Print the Attending Physician's State License Number and 0B Qualifier |
|||||||||
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Summarize the charges by type of service (non-consecutive days) |
|||||||||
|
|||||||||
|
Print only agency name, address, zip code and phone number (exclude city and state) |
|||||||||
The following fields in the application are required for Colorado Medicaid HCBS Waiver, 837P 5010A1 Electronic.
|
In Patient>General>Payers>HIPAA, the Assign Benefits (Assignment of Benefits) and Rel Infor (Release of Information) fields are currently set to Y by default for each carrier. Change to N where applicable. |
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If the Rel Infor (Release of Information) field in Patient>General>Payers>HIPAA is set to Y, select the appropriate patient signature code, if different from the default code of B (Signed authorization form for CMS-1500, Block 12/13 on file). |
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Enter the appropriate Colorado Medicaid-assigned ID for each insurance carrier (including the identifier of 056000522 for Colorado Medicaid) in Administration>Financial>Insurance Codes>Carrier Codes. |
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Select the appropriate code identifying the type of insurance policy within a specific insurance program in the Insurance Type Code field in Administration>Financial>Insurance Codes>General and/or Administration>Financial>Insurance Companies>Company. |
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If the code other than the default A (Assigned) is selected in the Medicare Assign field in Patient>General>Payers>HIPAA, then C (Not Assigned) will print to the claim file. |
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Enter 77016 in the Receiver ID (File Recipient) field in Administration>Financial>Insurance Codes>EMC. |
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Enter CO Medicaid in the Receiver Name (Payer) field in Administration>Financial>Insurance Codes>EMC. |
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In Patient>General>Payers>Pay Source>HIPAA, select 01 (EPSDT) if the services are provided under the EPSDT problem. |
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Enter the agency's assigned trading partner ID in the Submitter ID field in Administration>Financial>Insurance Codes>EMC. |
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Select the Test Submission Indicator check box in Administration>Financial>Insurance Codes>EMC to indicate if this is a test file being sent. |
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If this is a voided or replaced claim (third digit of the type of bill is a 7 or 8), enter the document control number or the ICN of the original claim in Claims>Process>Annotate Claims. |
