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Resources for Special Connections

 
 
 
Communications

 

 

 

  

Medicaid Request for Payment Form

 

Attached is an example of the Medicaid Request for Payment Form for your reference.  Providers please use the Excel form that was created for each facility and emailed to each Provider previously for each Medicaid Request for Payment submittal.  You may contact Gloria Avitia to get a copy of this Excel form for use.

 

   

 
Contacts:

 

Gloria Avitia
Administrative Assistant, Community Treatment &
Recovery Programs
Office of Behavioral Health
Colorado Department of Human Services
3824 W Princeton Circle
Denver, CO 80236
303-866-7517 | gloria.avitia@state.co.us

 

Karen Mooney, LCSW, CAC III
Manager, Women’s SUD Programs
Office of Behavioral Health
Colorado Department of Human Services
3824 W. Princeton Circle
Denver, CO 80236
303-866-7492 | karen.mooney@state.co.us
 

Becca Lembke
Manager, Contracts and Finance
Office of Behavioral Health
Colorado Department of Human Services
3824 W Princeton Circle
Denver, CO 80236
303-866-7511 | rebecca.lembke@state.co.us