Frequently Asked Questions

Colorado Medicaid eConsult is a platform that allows referring providers (treating practitioners) to communicate asynchronously (store and forward) with a specialist (reviewer). The eConsult platform will facilitate the exchange of non-urgent medical guidance to determine the optimal treatment for members.

Referring providers will send an electronic medical question to a specialist (reviewer) for review. The reviewer assists the treating practitioner with diagnosis and management of the member’s health care needs or refers the member for a face-to-face visit when appropriate.

Participating providers can access the web-based platform at https://www.ColoradoMedicaideConsult.com.

Yes, sufficient Health Insurance Portability and Accountability Act (HIPAA) security controls, privacy settings and business agreements have been built into the platform.

Health First Colorado contracted Primary or Specialty Care providers (MD, DO, NP, PA), termed Referring Providers, are eligible to submit eConsults for Medicaid members. Referring Providers must enroll in the program and complete training to gain access to the Colorado Medicaid eConsult Platform.

Yes, PCMP, Treating Practitioner, and Referring Provider are used interchangeably. These terms all refer to the provider who initiates the eConsult for specialist review. This provider is responsible for the members’ ongoing care and for incorporating the specialist’s recommendations into the treatment plan.

Yes, Specialist, Consulting Provider/Practitioner, and Reviewer all refer to the same role, the provider who receives the eConsult from the PCMP, reviews the case, and responds with recommendations or guidance. This provider offers expertise to support the PCMP/treating practitioner/referring provider in managing the members’ care.

As part of the onboarding process, SNC offers different types of training sessions that include the following:

• Live interactive web-based training sessions
• On demand video training sessions
• Written user guides for all user roles

Yes, training is essential and will be required for all participating users.

Live refresher training sessions will be available from SNC upon request. Self-paced training videos and User Guides are also accessible within the User Guides and Info Section within the eConsult platform at any time for enrolled users.

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

eConsult provides access to a panel of Specialists, termed Reviewers, to address health inquiries that may not be available locally or where there are barriers to specialty access for members. Reviewers respond to eConsults within three business days.

While not all specialists (reviewers) are physically in Colorado, all participating providers must be enrolled as a Health First Colorado Provider and licensed to practice in the State of Colorado. Priority will always go to Colorado-based reviewers first. If a Colorado-based reviewer is unavailable, the eConsult will be routed to the national network.

Referring providers may be able to view information about a specialist (reviewer) prior to selecting them, depending on what the specialist has included in their profile. This could include their title, photo, and any other information they’ve chosen to share, such as a resume or CV.

No, eConsults are not required. eConsult may be incorporated into the healthcare organization’s workflow as the standard first step to a referral for routine, non-urgent outpatient requests.

If a member’s need is urgent or the referring provider feels the member’s need can only be resolved with a face-to-face (F2F) specialty visit, referring providers always have the option to use their established referral pathways to initiate an in-person specialty visit.

Yes, if your selected specialty is available for a pediatric member it will be displayed in the system. The system will not identify whether the Member is adult or pediatric. As certain pediatric specialties have specific age cutoffs, the referring provider will need to identify whether adult or pediatric care is most appropriate.

Referring providers 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.

Adult Specialties (21)

Pediatric Specialties (15)

*OB/GYN specialists can address eConsults for patients aged 14 and older.

The eConsult platform is designed specifically for referring providers seeking clinical guidance on non-urgent medical care, including medication management for behavioral health conditions, rather than on clinical interventions. The focus of the eConsult platform is on treatment consultation for prescribers (referring providers), not on therapeutic approaches.

Referring providers should outreach to their RAE and utilize existing resources and workflows to refer members to behavioral health providers when necessary.

The eConsult platform enables referring providers to submit eConsults to psychiatrists and addiction medicine specialists for medication management.

A web browser and internet connection are the only technology required to access the platform. No additional software is required. Upon completion of training, Safety Net Connect (SNC) 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 (SNC) can explore Single-Sign On capabilities between your EHR and Colorado Medicaid eConsult when indicated on the Practice Enrollment Form.

The eConsult platform is designed to integrate within capable EHRs, providing a direct link to access eConsults. The platform also supports the acceptance of inbound Single-Sign-On (SSO) requests from systems.

• SSO allows users to access multiple applications with one set of credentials
• The credentials are typically a username and password
• SSO streamlines the login process by connecting access services without having to re-enter credentials each time

Yes, any Health First Colorado Provider can participate in eConsult as a referring provider. Referring providers will send and receive eConsults using the web-based Colorado Medicaid eConsult platform. After the eConsult is complete, the summary may be printed to include in the member’s paper chart.

​Member search criteria include the Medicaid ID or a combination of last name and date of birth. Once an eConsult has been initiated, the record is assigned a searchable Colorado Medicaid eConsult ID number.

Members eligible for eConsults are both enrolled in Health First Colorado Medicaid and assigned to a Regional Accountable Entity (RAE). If both conditions are met and the member does not appear as eligible within the Colorado Medicaid eConsult platform, participating providers should check the Provider Portal to verify eligibility. If the member displays as eligible in the portal, there may be a delay in receiving the member eligibility data from HCPF. In that case, wait 3-5 days and check the member’s eligibility in the platform again.

The State of Colorado requires a referring provider 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 referring provider acknowledges verbal or written consent of the member within the Colorado Medicaid eConsult platform prior to submission. If consent is not granted, the referring provider will be unable to submit an eConsult.

Referring providers can select their preferred specialist (reviewer) if the reviewer has not reached their agreed upon capacity for pending eConsults.

If a specialist (reviewer) is at capacity, the eConsult will be sent to the next available reviewer.

If the specialist (reviewer) has responded to the eConsult and has not closed it, a referring provider can ask a follow-up question regarding the same case and continue the dialog. If the reviewer has closed the eConsult, a follow-up question is not possible. However, the referring provider can resubmit the eConsult with a follow-up question for the reviewer if they are seeking further clarification of the clinical guidance received.

Referring providers should include any clinically relevant information from the member’s record that assists the reviewer in addressing the clinical question. This documentation may include medical history, lab or test results, and images.

Referring providers 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 (reviewer).

Staff users, such as MAs, RNs, or referral coordinators, can support providers in the eConsult process in two ways, designated by their organization’s administrator.

Staff Draft Only: Staff with this user role can initiate eConsults and add supporting documentation based on direction given by a provider. The Referring Provider will ask the clinical question, submit the eConsult, review and sign-off on the specialist’s (Reviewer’s) guidance and recommendation.

Staff Submitter: Staff with this user role can draft eConsults and submit them based on direction given by a provider. The Referring Provider will review and sign-off on the specialist’s (Reviewer’s) guidance and recommendation.

A “Print Office Copy” of the eConsult summary is available for download as a .pdf in the eConsult Detail section of the platform. This document can be printed or uploaded into the member’s record in the referring provider’s EHR. If there is data integration with your EHR, the summary can be electronically sent.

While eConsults demonstrate a significant percentage of resolution that averts the need for a face-to-face specialist visit, the member’s need (while not urgent/emergent) may still require a specialty appointment. The referral request will be submitted according to the referring provider 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. Referring providers can include the eConsult summary to a specialist as part of the referral package, communicating that another specialist’s treatment guidance included a face-to-face specialty care visit. We will share program updates as the program evolves, and more Colorado-based specialists participate.

Prior authorizations and referrals will continue to follow the referring provider’s standard referral process for members.

The referring provider makes the final treatment decision and has the right to request a second opinion. The referring provider does not have any increased liability for using eConsults as they may also refer the member for a face-to-face visit if the reviewer’s eConsult advice cannot address the member’s needs.

Specialists (reviewers) do not have increased liability when participating in eConsults as they are not providing direct patient care.

Yes, an Organizational Administrator (Org Admin) can reassign an eConsult to another referring provider within the same organization, ensuring patient care is not stalled.

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, organizations, or members to use the Colorado Medicaid eConsult platform.

All providers rendering services should submit claims for completed eConsults for fee-for-service reimbursement. Referring providers 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 referring provider 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 (reviewers) participating as reviewers in the Colorado Medicaid eConsult Platform 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.

No. Please visit the eConsult Billing Manual for further details regarding criteria for approved third party eConsult platforms.

HCPF is promoting the utilization of all eConsult platforms, not solely Colorado Medicaid eConsult to increase accessibility to specialty care for members. Different platforms may provide varying specialties which is why HCPF is advocating for exploring multiple avenues across various platforms. For further information regarding the use of third-party platforms please refer to the billing guidelines to confirm acceptability of your current system.

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

FQHCs and RHCs receive reimbursement for member encounters as part of their PPS (Prospective Payment System) rates.

eConsult visits between referring providers and specialty providers do not meet the definition of an FQHC or RHC visit as defined in CCR 8.700. Costs associated with services provided through eConsult visits through an FQHC/RHC are considered allowable costs for the cost report and will be included in the calculation of the reimbursement rate for a patient visit at an FQHC/RHC. HCPF is encouraging the use of eConsult for FQHCs and RCHs to show utilization before their annual cost rate review.

Please email hcpf_econsult@state.co.us for any additional questions regarding billable services for FQHCs and RHCs.

Billing documentation requirements for CPT 99452 include a time-based component. Time spent and captured in the estimated time documentation includes preparation of consult, review of guidance, and communication with the member regarding next steps in care.

The Colorado Medicaid eConsult Platform includes an optional billing tracking tool where referring providers 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 Organization Administrator within the organization.

Yes, an Organizational Administrator (Org Admin) within a practice will have access to a variety of standard reports for utilization and billing purposes in the Colorado Medicaid eConsult Platform.

No, the Prescriber tool is not the same as eConsults. The Prescriber Tool is a shared tool that makes it easier for all stakeholders to work together to make prescription therapy more affordable and thereby improve patient health to the benefit of Coloradans, employers, payers like Medicaid, and the State.

The eConsult platform enables the asynchronous (store-and-forward) exchange of non-urgent medical advice between referring providers (treating practitioners) and specialists (reviewers). This system supports collaborative decision-making to determine the most appropriate treatment plan for members.

Users may submit a support ticket through the Support Center within the platform, or they may submit a support ticket by email to coloradosupport@safetynetconnect.com to receive technical support.