Provider Support – Program Information

News and Updates

7/1/13 - New Key Performance Indicator: Well Child Visits

Since 2011, as part of the Accountable Care Collaborative (ACC) Program, Colorado Medicaid Regional Care Collaborative Organizations (RCCOs) and Primary Care Medical Providers (PCMPs) have had the opportunity to earn incentive payments based on three (3) Key Performance Indicators (KPIs):

  1. 30-day all-cause inpatient hospital readmissions
  2. Emergency Room (ER) visits
  3. High-cost imaging

Effective July 1, 2013 HCPF began measuring a fourth KPI, Well Child Visits, based on CMS-416 criteria. Beginning in early 2014, HCPF will begin to provide financial incentive payments to RCCOs and PCMPs for this KPI.

7/1/13 - Primary Care Medical Provider (PCMP) Agreement with the Department of Healthcare Policy and Financing Can be Completed Online

Effective immediately, providers can complete a Primary Care Medical Provider (PCMP) contract for the ACC Program through the Colorado Medical Assistance Program Web Portal. Please refer to the step by step PCMP Online Contract Instructions. (PDF, 965 KB)

4/18/13 - The Colorado Beacon Consortium: Strengthening the Capacity for Health Care Delivery Transformation in Rural Communities - a case study by The Commonwealth Fund

6/29/12 -  CMS Comprehensive Primary Care (CPC) Initiative Update from Rocky Mountain Health Plans

Download news release (PDF, 52.5 KB)

6/15/12 -  CMS Comprehensive Primary Care (CPC) Initiative Application is Available Now!

Download news release (PDF, 63.4 KB)

4/11/12 - Colorado Selected as a Demonstration Site for Comprehensive Primary Care (CPC) Initiative

Download news release (PDF, 353 KB)

Important Operational Aspects about the Accountable Care Collaborative

Role of Medical Providers in the Accountable Care Collaborative

  • Provide access to medically necessary health and medical care
  • Work to support the creation of a medical neighborhood
  • Participate at a community level to improve health outcomes

 

Verifying Member ACC Enrollment

Colorado Medicaid’s web portal will identify if the Medicaid client is enrolled in the ACC Program. The State’s web portal will also show the Member’s Regional Care Collaborative Organization (RMHP for Region 1). RMHP providers who are familiar with RMHP’s provider portal may also access the State’s Medicaid web portal through RMHP’s provider portal.

To help providers identify Medicaid patients who are in the ACC Program, RMHP began distributing ACC ID cards to enrolled ACC members in fall 2013. ACC Members are encouraged to show their RMHP ACC ID card AND their Medicaid ID card when they get care. The ACC ID card includes contact information and the member’s PCP.

ACC ID Card

An eligibility verification resource table is available to identify additional ways to check Member eligibility.

Claims and Provider Reimbursement

RMHP as an RCCO does NOT pay claims.  All claims for ACC Members will be paid directly by the State of Colorado, or the local Behavioral Health Organization, in the same way that Medicaid claims are currently paid for Medicaid fee-for-service clients. Pharmacists should also continue to submit claims to Colorado Medicaid following all Colorado Medicaid requirements.

Regular Medicaid fees will be paid by Colorado Medicaid at Colorado Medicaid rates to all providers. Behavioral health providers should continue to submit claims to the Behavioral Health Organization. During the first year, participating Primary Care Providers will be paid a $4 per member per month (pmpm) by the Department of Health Care Policy and Financing. Providers that are certified as a Children’s Medical Home will not receive the $4 pmpm rate for assigned children, but will continue to receive the enhanced payment for EPSDT services rendered. If a certified Children’s Medical Home provider sees children and adults, they will receive the $4 pmpm payment for their assigned adult patients.

How do I submit claims?

The Medicaid claims submission process for the ACC Program is the same as the current Medicaid claims submission process. Providers should consult the Colorado Medicaid Provider Billing Manuals on the Department’s website for detailed information regarding claims submissions. 

Prior Authorizations Requirements

RMHP as RCCO does not administer Medical Authorizations

Medical Authorizations will be reviewed and processed in the same way that Medical authorizations are administered today through Colorado Medicaid or a Medicaid-contracted vendor.


For Hospital Facilities

Notify us if a member is hospitalized.


Requirements for Participation as a Primary Care Medical Provider

Primary Care Medical Provider (PCMP) Requirements

In order to participate as a Primary Care Medical Provider, you must be an enrolled Medicaid provider that meets any one of these criteria: 

  • Certified by the Department as a provider in the Medicaid and CHP+ Medical Homes for Children program; OR 
  • A Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) or a clinic or other group practice with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology; OR  
  • An individual physician, advanced practice nurse or physician assistant with a focus on primary care, general practice, internal medicine, pediatrics, geriatrics, or obstetrics and gynecology

 

The PCMP must sign two documents:

  • A written agreement between the Primary Care Medical Provider and a Regional Care Collaborative Organization (RCCO). The RCCO for Region 1 is Rocky Mountain Health Plans. Call RMHP for a copy of the Accountable Care Collaborative Program PCMP agreement with Rocky Mountain Health Plans.
  • A written agreement between the Primary Care Medical  Provider and the State of Colorado.  Effective August 2013, the State version of the PCMP agreement can be completed online.  Please read and follow the step by step PCMP Online Contract Instructions. (PDF, 965 KB)

 

All other medical providers only need to be a Colorado Medicaid provider to participate. Please contact RMHP to verify that your name, specialty and contact information is correct.

RESOURCES

Region 1 contact information

If you reside on the western slope or in Larimer County, call RMHP ACC Customer Service at 970-254-5771 or 800-667-6434.