Provider Enrollment
What is the enrollment processing timeline for applications?
New applications, revalidations and enrollment updates are currently being processed by the Department's fiscal agent within eight (8) business days on average.
Is an NPI number required for HCBS enrollment?
No, only for certain specialties is an NPI required
What is the only way to get eyeglasses or contacts covered by CO Medicaid?
Following an eye surgery and using modifier 55
What is the timely filing policy at HCPF?
Providers always have at least 365 days from the date of service (DOS) to submit a claim.
Who is the Medicaid Operations Office Director & Deputy Director?
Ralph Chaote and Stephanie Denning
What is the 2025 application fee amount?
$730
What is a Program Approved Service Agency?
A Program Approved Service Agency (PASA) is an agency that has been approved to provide direct community-based services to individuals with intellectual or developmental disabilities approved for Medicaid waiver services.
What is the minimum amount of time for speech therapy sessions to count as billable?
Where do providers file appeals?
Office of Administrative Courts
1525 Sherman Street, 4th Floor
Denver, Colorado 80203
Phone: 303-866-2000
FAX: 303-866-5909
When are mid-year reviews and end-of-year reviews?
Mid-year reviews are in March & end-of-year reviews are in September.
When are providers notified that it's time to revalidate, and when can they no longer access the revalidation link?
6 months before revalidation and 6 months after revalidation
What is a bilateral procedure, and how do you get it paid?
A surgical or medical procedure performed on both sides of the body during the same operative session. Use modifer 50.
Who creates the PARs for HCBS providers?
Case Management Agencies complete the Prior Approval and/or Cost Containment requests for their specific programs according to instructions published in the regulations for the Department of Health Care Policy & Financing (the Department).
What are the two requirements for a group legal name change?
Attach a 147C from the Internal Revenue Service (IRS) and a current W-9.
Name the four RAE Regions?
Rocky Mountain Health Plans (RMHP) and RMHP PRIME, Northeast Health Partners (NHP), Colorado Community Health Alliance (CCHA), & Colorado Access (COA)
What are the enrollment types for which a change of ownership is accepted?
Hospitals-General and Mental, Hospice, Nursing Facilities, Home Health Agencies, Pharmacies (including Indian Health Services Pharmacies)
What are two of the six data points that EVV verifies?
In the pediatric behavioral health benefit, what is the difference between these two procedure codes, 97151 & 97151 TJ
97151 is for initial assessment (1x12 months) and 97151 w/TJ is for reassessment (2x6 months)
Name five places of service?
What is the lower of pricing logic?
Either coinsurance and deductible or difference between Medicare paid amount and Health First Colorado allowed amount, whichever is lower
What are the required attachments for a PT 01 General Hospital enrollment?
License, CLIA certificate, W9 (signed and dated within the last six [6] months), and Voided business check or bank letter
What is an example of a manual priced procedure code, and what is required for the claim to pay?
PAD or DME -- an invoice for the PAD or supply item so Gainwell can pay the claim correctly.
What are two services not covered by FFS Behavioral Health Benefit?
After correctly making an EFT update to an enrollment, when should a provider expect to start seeing payments in their bank account?
Once the update has been processed by the Department's fiscal agent, an additional two (2) weeks are needed to establish EFT.
Correctly name 5 vendors that work with Colorado Medicaid?
Gainwell, Deloitte, Optum, Sandata, Acentra, Dentaquest, Prime Therapudics... ?