October 31, 2016
Colorado interChange Launches
The Colorado interChange (Medicaid new claims payment system) goes live! Claims and encounters submitted by providers who have not enrolled and/or revalidated will not be paid.
The Colorado interChange
In late 2013, the Department of Health Care Policy and Financing selected a new contractor to design, develop, test and implement a new state of the art Medicaid Management Information System (MMIS), which is called the Colorado interChange. HP Enterprise Services (HPE) was selected to be the Department's new MMIS contractor and fiscal agent. Colorado will be the 15th state to implement the interChange platform, which has been federally certified in 13 states over the past decade.
The overall goal is to replace the legacy MMIS and Fiscal Agent services with a service delivery model that is both flexible and adaptable, with Business Intelligence and Analytics tools that will provide easy access to data and comprehensive reporting.
The Colorado interChange will provide the core MMIS and supporting services, which includes:
- Fiscal Agent Operations Services (taking over for Xerox State Healthcare)
- Provider Web Portal (replacing the current Medical Assistance Program Web Portal)
- Online Provider Enrollment (which was launched September 2015)
- Claims Processing and Payment
- Electronic Data Interchange (EDI)
- Electronic Document Management System (EDMS)
- Provider Call Center
- Help Desk, including Interactive Voice Response (IVR) software General functionality of other systems, services, and/or contracts that currently exist or will interface with the future MMIS
- General IT functionality and business operations
Why do providers need to enroll in the Colorado interChange?
Providers need to enroll in the Colorado interChange to continue providing goods and services to Health First Colorado members when the new system goes live on October 31, 2016. By enrolling in interChange, providers also accomplish the following:
- Revalidation and screening – New federal rules require providers to be revalidated/screened in accordance with the Affordable Care Act, section 6401 (a). The Online Provider Enrollment tool was built with this requirement in mind. It securely captures required information during enrollment and will allow providers to meet future revalidation requirements with ease.
- After enrollment, approved providers will be able to update and maintain their information online. Managing affiliations, addresses, and indicating whether you’re accepting new Health First Colorado members has never been so easy.
- Access to the new Provider Portal for claims submission, messaging, reporting, and checking member eligibility.
What happens if a provider does not enroll into the Colorado interChange or did not complete Revalidation by October 31, 2106?
Starting October 31, 2016, providers that are not enrolled in the Colorado interChange will not be able to submit claims or PARs, receive payments, or verify member eligibility.
When will we start using the Colorado interChange?
The first module of the Colorado interChange is the Online Provider Enrollment tool, which launched in September of 2015. The remaining features and functionality of the Colorado interChange will launch October 31, 2016.
Why did the Department procure a new MMIS?
The Department's current MMIS is over 20 years old, with components that are over 30 years old and is based on a 1970s general design. The Colorado interChange is flexible and adaptable, with Business Intelligence and Analytics tools that will provide easy access to data and comprehensive reporting. Implementation of Colorado interChange also allows us to comply with federal screening rules.
When will providers receive training on the Colorado interChange?
Just like today, providers will not directly access the MMIS, but will use a Provider Portal instead. Training on the new portal will begin in October 2016.