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.
Can providers view third-party liability coverage within the provider portal's eligibility tools?
Yes, they can view third-party liability during an eligibility check in the provider portal.
What is the next state holiday after Presidents' Day?
Monday, May 26, 2025 - Memorial Day
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
Name at least two categories of services that require attachments?
• Non-Emergent Medical Transportation (NEMT) • Standardized Trip Logs must be attached to all claims • 25+ Mile Verification Form for trips more than 25 miles one way (EOB 5537) • Physician Administered Drug or Durable Medical Equipment (DME)/Supply • Manually-priced codes require an invoice for the drug or supply so claims agents can calculate the correct reimbursement (EOB 0653) • Surgical/Medical • Unlisted Procedure Code Form along with Operative report to indicate a comparable listed code and description of procedure that was performed (EOB 0653) • Med 178 Form – Sterilization consent form signed by the member (EOB 6700)
Can providers who are not enrolled with Colorado Medicaid bill a member for services that would be covered if they were enrolled?
No, members cannot be billed if the provider chooses to not enroll with Health First Colorado
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 (HCPF) 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.
If a provider didn't revalidate their enrollment 3 years ago and now needs to have an active enrollment, what should they do?
Providers should have their revalidation link reopened, gain access to their former portal, and continue with revalidation. Once reenrollment capabilities are launched, they will use the reenrollment features.
What are the three categories of doula services that are offered to members?
1. Prenatal support 2. Continuous labor and delivery support 3. Postpartum support
What is the known system issue in Women's Health right now?
Some Professional or Institutional Claims for Elective Abortion or Non-Viable Pregnancy are Denying for EOB 5972 Professional or institutional claims with a date of service (DOS) on or after 1/1/2026 for procedure codes associated with elective abortion or non-viable pregnancy and billed with ancillary services are denying for EOB 5972 - "The abortion service is not a benefit of the Colorado Medicaid Program." Affected claims will be reprocessed. A resolution is in process.
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.
They are unable to complete the legal name change themselves because you are able to do maintenance requests after you've passed reval, but they can fill out all the proper forms and provide the documentation needed to us, and we can submit a transmittal. Once the transmittal is complete, they can submit their revalidation.
A new feature will be launched in the coming month that will allow providers to complete the legal name change through the reval process.
What are at least two region claim codes and what do they mean?
10 – Paper Claims with No Attachments 11 – Paper Claim with Attachments 20, 21 – Batch Claim 22 – Web Portal Claim with No Attachments 23 – Web Portal Claim with Attachments 25 – PBM Pharmacy Claims 30, 31, 40 – Claims Converted from Old MMIS 50 – Provider Initiated Adjustment (via paper) 51, 52, 53, 55, 57, 58 – System Initiated Adjustments 54 – Mass Void 56 – Mass Void Request or Single Claim Void 59 – Provider Initiated Electronic Adjustment 80 – Claim Resubmission by DXC Systems Engineer 92 – Batch Reconsideration Claims with Attachments 93 – Provider Initiated Batch Reconsideration Adjustment with Attachments 94 – Web Portal Reconsideration Claims with Attachments 95 – Provider Initiated Web Portal Reconsideration Adjustment with Attachments