Appendix A - Colorado Department of Health Care Policy and Financing Information

Appendix B - Fiscal Agent Information

Appendix C - PAR and Review Agencies

Appendix D - Programs and Authorizing Agencies

Appendix E - County Departments of Human/Social Services

Appendix F - Border Towns

Appendix G - Blank (previously Third Party Reporting Form)

Appendix H - Blank (previously Certification & Request for Timely Filing Extension)

Appendix I - Provider Participation Agreement

Appendix J - Blank (previously Acknowledgment/Certification Statement for a Hysterectomy)

Appendix K - Blank (previously Certification Statement for Abortion to Save the Life of the Mother)

Appendix L - Blank (previously Certification Statement for Abortion for Sexual Assault (Rape) or Incest)

Appendix M - Procedures Requiring Prior Authorization

Appendix N - PAR Denial Reasons

Appendix O - PDCS Denial Codes

Appendix P - PA Criteria for Physicians and Pharmacists

Appendix Q - Revenue Codes

Appendix R - PCR Messages (04/13)

Appendix S - PDCS PCR Messages

Appendix T - Community Mental Health Services Program (04/13)

Appendix U - Forms

Appendix V - Terms, Acronyms and Abbreviations

Appendix W - ICD-9-CM Diagnosis and Procedure Codes

Appendix X - HCPCS-NDC Crosswalk for Billing Physician-Administered Drugs

Appendix Y - Medical Foods

Please select your provider type from the list below and use your provider-specific manual for reference when submitting paper claims on the Colorado 1500 claim form.

Colorado 1500 General Billing Information (12/12)
This manual section contains general Colorado 1500 billing information to be used with the Colorado 1500 Specialty Manuals listed below.

Colorado 1500 Specialty Billing Information (04/13)
This manual section contains specific benefit, procedural, and billing information for Managed Care, Obstetrical Care, School Health Services, and Transportation providers billing on the Colorado 1500.

Ambulatory Surgical Centers (05/13)

Audiology (01/12)

Durable Medical Equipment (DME) & Supplies (05/13)

Early Periodic Screening, Diagnosis, and Treatment (EPSDT) (02/12)
This document contains current EPSDT benefit, procedural and billing information and the EPSDT Paper Claim Instructional Reference for EPSDT providers.

Immunization Benefit Manual (05/13)

Independent Laboratory (12/11)

Medical/Surgical Services (01/12)

Nurse Home Visitor Program (12/11)

Outpatient Substance Abuse Treatment (06/12)

Physical and Occupational Therapy (10/12)

Prenatal Plus Program (04/13)

Residential Child Care Facility Program (RCCF) (04/13)

Screening, Brief Intervention & Referral to Treatment (SBIRT) (12/11)

Speech Therapy (10/12)

Telemedicine (05/13)

Vision and Eyewear (07/12)

Dental Billing Manual (05/13)

Dental Provider Certification

HCBS Specialty Billing Information (10/12)
This section contains program specific benefit, procedural, and billing information for Home and Community Based Services providers.

Colorado Choice Transitions (CCT) Reference Manual (11/12)
This document is located on the Colorado Choice Transitions Web page.

HCBS and CCT FY 12-13 Rates (5/13)

Pharmacy
Pharmacy billing Instructions are located in the Pharmacy section.

Non-Emergency Medical Transportation Process (01/12)

Non-Emergency Medical Transportation Fact Sheet (01/12)

Transportation Rates & PAR Requirements (10/12)

Non-Medical Transportation FAQs (07/12)

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 (12/11)

FQHC/RHC (12/11)

Home Health (05/13)

Hospice (12/11)

IP/OP Hospital (09/12)

Nursing Facility (12/11)

Psychiatric Residential Treatment Facilities (PRTF) (12/11)

UB-04 Certification