Colorado Medicaid—Automated For Your Success.
With rising reimbursement rates that are some of the highest in the country, Colorado Medicaid possesses vast potential for home care agencies. Clear advantages notwithstanding, many providers face difficulty when attending to the administrative side of running an agency. A complex billing experience with multiple portals, systems, processes, and requirements can make providers hesitate to break into the lucrative Medicaid market. This is where Paradigm comes in, taking over the back-office tasks that agencies struggle with to ensure companies can maximize their growth and success. Automating billing, streamlining EVV operations, payment posting, client eligibility checks, and more—Paradigm takes care of it all.
How Paradigm Helps.
Billing
Enrollments
Eligibility
EVV Support
Training
MedicaidinColorado.
Electronic Visit Verification
Understanding EVV and Medicaid billing in Colorado can be complex. EVV (Electronic Visit Verification) is a technology used to verify that home or community-based service visits occur. The purpose of EVV is to ensure that services are delivered to members and that providers only bill for services rendered. Here's a breakdown to help clarify:
EVV Requirements:
Colorado uses the Provider Choice Model, meaning that providers may use the state sponsored aggregator Sandata or any alternative EVV that integrates with it.
EVV Aggregator:
As the state aggregator, Sandata is responsible for transmitting all EVV data to the payer. All claims must adhere to EVV guidelines to ensure compliance and avoid issues with payment and audits.
Billing Process:
Providers can submit claims directly through the state portal (PEAK) or by utilizing a third-party clearinghouse.
Rates
The current Medicaid reimbursement rates in Colorado range between $24.44 to $32.52 per hour. The rates have consistently been raised every six months over the last four years, translating into increasingly attractive fee schedules.
It is essential to note that rates may differ in the case of MCO’s due to the individual negotiation of contracts with agencies. While growth prospects are considerable, agencies must undertake thorough reviews of MCO (Managed Care Organization) contracts to ensure optimal rates.
Payers
State-Direct:
Colorado Medicaid is managed by Health First Colorado and offers various waiver programs for personal care services. These programs bill to the state and are designed to increase Medicaid coverage.
Click here for a comprehensive waiver list.
MCO's (Managed Care Organizations):
Colorado has two region-specific MCO’s, Denver Health and Rocky Mountain Health Plans Prime (RMHP Prime).
