Colorado Medicaid eConsult Program

eConsult is an asynchronous consultation service in which the Member’s treating health care provider (PCMP) requests the opinion and/or treatment advice of a specialty provider. The specialty provider’s expertise assists in the management of the Member’s care without the need for a face-to-face visit.

HCPF is establishing a network of specialists located in Colorado. Some specialists are located out of state as part of the national network to increase accessibility.
All specialists regardless of location must be a Health First Colorado Provider and licensed to practice in the State of Colorado.

Yes, if your selected specialty is available for pediatric Members it will display in the system. The system will not identify whether the Member is adult or pediatric. As certain pediatric specialties have specific age cutoffs, the PCMP will need to identify whether adult or pediatric care is most appropriate.

​PCMPs will be presented with the option to select a specialty type of either Adult or Pediatrics. When selected, the platform will display a list of available adult and pediatric specialties.

The State of Colorado requires a PCMP to inform the Member that a clinical question will be shared with a remote specialist who will respond with advice regarding the Member’s treatment.
The PCMP acknowledges verbal or written consent of the Member within the Colorado Medicaid eConsult platform prior to submission. If consent is not granted, the PCMP will be unable to submit an eConsult.

Colorado Medicaid eConsult is web-based. A web browser and internet connection are the only technology required to access the platform. No additional software is required. Safety Net Connect will provide participating providers with a username and password for accessing the Colorado Medicaid eConsult system. The system and all Member data are username and password protected.

Yes, Safety Net Connect will explore Single-Sign On capabilities between your EHR and Colorado Medicaid eConsult when indicated on the Practice Enrollment Form.

If the specialist has responded to the eConsult and has not closed it, a PCMP can ask a follow-up question regarding the same case and continue the dialog. If the specialist has closed the eConsult, a follow-up question is not possible. The PCMP can resubmit the eConsult with a follow-up question for the specialist if they are seeking further clarification.

Yes, PCMPs may request a specific specialist if one is available. Safety Net Connect is in the process of building the Colorado-based specialist network on the Colorado Medicaid eConsult platform. Please encourage your local specialists to participate and help build the network.

Yes, an Organizational Administrator (Org Admin) can reassign an eConsult to another PCMP within the same organization.

While eConsults demonstrate a significant percentage of resolution without a face-to-face visit, the Member’s need (while not urgent/emergent) may still require a specialty appointment. The referral request will be submitted according to the PCMP organization’s standard referral process.

​It is unlikely that a Member requiring a referral for a face-to-face visit will be seen by the same specialist who conducted the eConsult. We will share program updates as the program evolves and more Colorado-based specialists participate.

Prior authorizations and referrals will continue to follow the PCMP’s standard referral process.

​Member search criteria includes the Medicaid ID or a combination of Last name, First Name and Date of Birth. Once an eConsult has been initiated, the record is assigned a searchable Colorado Medicaid eConsult ID number. The PCMP may also use the “Alt ID” feature to enter the Member’s identifier that coincides with the PCMP’s EHR.

The PCMP makes the final treatment decision and has the right to request a second opinion. The PCMP does not have any increased liability for using eConsults as they may also refer the Member for a face-to-face visit if the specialist’s eConsult advice cannot address the Member’s need.
Specialists do not have increased liability when participating in eConsults as they are not providing direct care.

​No, eConsults are permissible only between health care providers and cannot be initiated directly by Members.

Currently, the Colorado Medicaid eConsult platform is available only to Members with Health First Colorado Medicaid, not for managed Medicaid or uninsured patients.

No, there is no cost for participating providers and organizations to use the Colorado Medicaid eConsult platform. There is no cost or copay for the Member either.

All providers rendering services should submit claims for completed eConsults for fee-for-service reimbursement. PCMPs can bill eConsults under CPT code 99452 (treating provider, interprofessional internet consultation). Along with the billing documentation requirements outlined by the AMA, requirements for HCPF include the PCMP to “sign off” on the eConsult within the Colorado Medicaid eConsult platform to bill. FQHCs and RHCs will not submit fee-for-service claims for reimbursement for eConsult. Please see the FQHC/RHC question in the FAQ for more information.
Specialists participating in the Colorado Medicaid eConsult bill eConsults through a separate process and do not capture these encounters with a CPT code. For the latest information, please visit the eConsult Billing Manual.

​The Colorado Medicaid eConsult Platform includes an optional billing tracking tool where PCMPs can document the estimated time spent on each eConsult. This information becomes part of the Print Office Copy of the eConsult and the billing report that can be accessed by the Org Admin within the Organization.
Billing documentation requirements for CPT 99452 include a time-based component. Time spent includes preparation of consult, review of guidance, and communication with the Member regarding next steps in care.

If a member is ineligible in eConsult, it may be due to a delay in receiving the member eligibility data from HCPF. First, confirm the Member’s eligibility in the HCPF Provider Web Portal. If the Member displays as eligible in the portal, wait 3-5 days, and check the Member’s eligibility in the platform again.

​eConsults may be submitted only by eligible providers with MD, DO, NP, or PA license types. Providers with other licenses and staff members can draft an eConsult and add diagnosis codes, additional information and supporting documentation on behalf of an eligible participating provider. The PCMP is required to ask the clinical question, submit the eConsult, acknowledge and sign-off on the specialist’s guidance and recommendation.

Yes, an Organizational Administrator (Org Admin) can view the status of eConsults, including those that are in progress or completed by PCMPs across their organization.

Yes, an Organizational Administrator (Org Admin) can track utilization of eConsults within the organization, by PCMP, submitting site, Medicaid ID, and specialty.

PCMPs should include any clinically relevant information from the Member’s record that will help the specialist to provide advice in response to the clinical question. Documentation may include medical history, lab or test results, and images.

​Yes, any PCMP enrolled as a Colorado Medicaid provider can participate in eConsult. You will send and receive eConsults using the web-based Colorado Medicaid eConsult platform. You may print your completed eConsult to save the record in the Member’s paper chart.

PCMPs cannot fax directly to the Colorado Medicaid eConsult system, however, if a fax is saved as a .pdf, it can be uploaded to the platform as supporting documentation to accompany the eConsult when it is sent to the specialist.

Participation in Colorado Medicaid eConsult is based on each PCMP Practice Site, all of which have a unique Medicaid ID. Organizations with several PCMP practice sites can elect to enroll any number of their sites to participate in Colorado Medicaid eConsult.

Please visit the eConsult Billing Manual for further details regarding criteria for approved third-party eConsult platforms.