Billing Manuals
All manuals are in the Adobe Acrobat PDF format. You can download the free Adobe® Reader® by clicking on the link at the bottom of this page.
The manuals contain HIPAA updates. Providers are required to download and use the revised manuals.
To locate a subject or heading within a Manual:
- Open the manual in Adobe
- Select the Binoculars on the Adobe Menu bar at the top of the page
- Select Find...
- Enter the topic or title in the "Find What:" box
- Press "Enter" to locate the information
Little Billing Book (08/10)
This booklet contains general Colorado Medical Assistance Program billing information. Use this booklet as a guide to the comprehensive billing information in the Provider Manual sections. The layout of the booklet allows providers print the pages front-to-back. This booklet does not replace the Provider Manual sections.
General Provider Information (01/12)
This section contains essential general information common to all Colorado Medical Assistance Program providers.
Appendices (02/12)
Billing Information (12/11)
This section contains general billing information for all provider types.
Dental Billing Manual (12/11)
This document contains current benefit, procedural and billing information and the 2006 ADA Paper Claim Instructional Reference for Dental providers. Effective April 1, 2008, all dental claims and PARs must be submitted on the 2006 ADA claim form. The Dental Certification must be submitted with all paper claims.
EPSDT (12/11)
This document contains current EPSDT benefit, procedural and billing information and the EPSDT Paper Claim Instructional Reference for EPSDT providers.
This document can be found in the Pharmacy section.
HCPCS / NDC Crosswalk for Billing Physician-administered Drugs
This document provides Healthcare Common Procedure Coding System (HCPCS) codes and their corresponding National Drug Code (NDC) numbers for use in billing physician-administered drugs
Colorado 1500 Specialty Billing Information (01/12)
This section contains program specific benefit, procedural, and billing information for providers billing on the Colorado 1500.
Colorado 1500 Specialty Billing Manuals
The Department and its fiscal agent, ACS, are in the process of separating the Colorado 1500 Specialty Billing Information manual into individual provider-specific manuals. The individual manuals will be posted as they are completed. The specialty manuals listed below have been updated to reflect specific benefit, procedural, and billing information for those provider types billing on the Colorado 1500. If your provider type is listed below, please use your provider-specific manual for reference when submitting paper claims on the Colorado 1500 claim form. When the manual for your provider type is completed, you will no longer need to reference the Colorado 1500 Specialty Billing Information manual.
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Ambulatory Surgical Centers (12/11) Audiology (01/12) Independent Laboratory (12/11) Medical/Surgical Services (01/12) Nurse Home Visitor Program (12/11) OP Substance Abuse Treatment (12/11) |
Physical, Occupational, Speech and Language Therapy (12/11) Screening, Brief Intervention and Referral to Treatment (SBIRT) (12/11) Supplies and Durable Medical Equipment (DME) (01/12) Telemedicine (12/11) Therapeutic Residential Child Care Facility Program (TRCCF) (12/11) Vision and Eyewear (01/12) |
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Non-Emergency Medical Transportation (NEMT) Process 01/12 |
HCBS Specialty Billing Information
This section contains program specific benefit, procedural, and billing information for Home and Community Based Services for HCBS providers.
UB04 Specialty Billing Manuals
The specialty manuals listed below have been updated to reflect specific benefit, procedural, and billing information for providers billing on the UB-04. Please use these manuals when submitting claims on the UB-04.
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Dialysis (12/11) FQHC/RHC (12/11) Home Health (12/11) Hospice (12/11) |
IP/OP Hospital (01/12) Nursing Facility (12/11) PRTF (12/11) |
Eligibility Verification
The fiscal agent, ACS, and the Department's Customer Service staff are unable to provide you with the guarantee number used to verify client eligibility and coverage. You can verify eligibility and receive a guarantee number through one of the electronic methods:
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State's Web Portal (Batch or Interactive) X12N 270 - Eligibility Inquiry
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Fax-Back: 1-800-493-0920 Toll free
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CMERS: 1-800-237-0044 Toll free
Maintain copies of all eligibility and coverage information in the client's file for billing purposes.
Colorado Medicaid Eligibility Response System (CMERS)/Automatic Voice Response System (AVRS) Instructions - This document contains instructions on how to access and use the CMERS/AVRS Medicaid Eligibility system.
FaxBack Eligibility Instructions - This document contains instructions on how to access and use the FaxBack Medicaid Eligibility system.
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