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Billing Manuals

All manual sections 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 manual sections contain HIPAA updates. Providers are required to download and use the revised manual sections.

 

To locate a subject or heading within a Manual:

  1. Open the manual section in Adobe
  2. Select the Binoculars on the Adobe Menu bar at the top of the page
  3. Select Find...
  4. Enter the topic or title in the "Find What:" box
  5. Press "Enter" to locate the information

 

Little Billing Book  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. This booklet does not replace the Provider Manual sections.

 

General Provider Information
This section contains essential general information common to all Colorado Medical Assistance Program providers.

 

Appendices (10/09)

 

Billing Information
This section contains general billing information for all provider types.

 

Dental Billing Manual (01/09)
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.

 

Dental Provider Certification

 

Pharmacy Billing Instructions

This document can be found in the Pharmacy section.

 

CO-1500 Specialty Billing Information
This section contains program specific benefit, procedural, and billing information for providers billing on the CO-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 CO-1500 Specialty Billing Information manual.

 

 Ambulatory Surgical Centers  EPSDT
 Audiology  Independent Laboratory

 Nurse Home Visitor Program 

 Physical, Occupational, Speech and Language Therapy

 

 

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.

 

Dialysis

FQHC/RHC
Home Health
Hospice

IP/OP Hospital 
Nursing Facility
PRTF

UB-04 Certification

 

 

 

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:

 

  • State's Web Portal (Batch or Interactive) X12N 270 - Eligibility Inquiry
  • Fax-Back: 1-800-493-0920 Toll free
  • CMERS: 303-534-3500 Denver Metro; 1-800-237-0044 Toll free Colorado

Maintain copies of all eligibility and coverage information in the client's file for billing purposes.

 

Colorado Medicaid Eligibility Response System (CMERS)/FAXBACK Eligibility (06/2007) - This document contains instructions on how to use and access the CMERS and FAXBACK Medicaid Eligibility systems. 

                                              

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