Provider Enrollment
If a provider starts an application but forgets the password and security questions to reaccess it, what can they do?
Have it force denied and start over.
What was updated about the ESNP portal process in December 2025?
Providers are now able to remove their ESNP certification from their enrollment.
What is the modifier that now needs to be added to all fee-for-service psychological testing procedure codes?
The SC modifier
What happens at this stage of an enrollment application, J-State Review Required?
The HCPF benefit manager(s) review the application and either approve or deny it.
What was the recent change to policy for members who are receiving 6 liters of oxygen or more per minute?
A prior authorization is now needed
What do we do with a seller's AR balance during a CHOW?
Per statute, Nursing facility regulation 8.443.15, we always move the AR balance to the buyer's enrollment, whether they agree or not.
What is one major task that all EDI trading partners are going to have to do when we transition to Edifecs?
ALL trading partners must re-enroll with the new vendor.
Does a provider have to bill Colorado Medicaid if they know it's not going to be a covered service?
No, there is no legal requirement that providers have to bill Colorado Medicaid. If the provider knows the service is not covered and properly discloses that to the member, they do not need to bill Colorado Medicaid to receive a denial.
That said, we recommend they do so to demonstrate they have done their due diligence.
When does the new pharmacy benefit vendor manager transition occur?
On April 1st, 2026, it will transition to MedImpact Healthcare Systems, Inc.