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Frequently Asked Questions


Eligibility | Electronic Reports | Software Vendor |  FINANCE FAQs: | Electronic Funds Transfer (EFT) | Paper Checks/Warrants | Accounts Receivable (AR) Balances | Notification of Non-PaymentCommon Billing Questions | Web Portal 






Q: Who determines a client's eligibility?
Q: What is delayed/retroactive eligibility?
Q: What needs to be done to get setup for Fax-Back?
Q: What are Load Letters and Late Bill Override Dates?
Q: What is Dual Eligibility?
Q: What is Presumptive Eligibility (PE)?
Q: What is the Modified Medical Program?
Q: What are Qualified Medicare Beneficiaries?
Q: Are non-citizens eligible for Medicaid benefits?


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Electronic Reports


Q: How are Accept/Reject and Provider Claim Reports retrieved electronically?
Q: Who do providers contact to get set up for electronic report retrieval?
Q: If several group providers want to get all reports under a single trading partner ID, what needs to be done?
Q: For what length of time are the reports available electronically?
Q: How can duplicate copies of PCRs be obtained?


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Q:Where can a software vendor interested in programming a practice management system get a copy of the Colorado Medical Assistance Program Specification Manual(s)?


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Electronic Funds Transfer (EFT) 


Q:Is EFT a requirement?
Q:What needs to be done to have EFT established?
Q:How long does it take to set up/update EFT?
Q:Does a new EFT document need to be submitted for a change in bank information?
Q:What steps need to be taken for EFT deposits that don't show in an account?


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Paper Checks/Warrants 


Q:What steps need to be taken when a check payment is not received?
Q:How can a copy of a cashed check be obtained?
Q:How can a check be reissued?
Q:What if Provider Enrollment is not notified of an address change?
Q:Is there a better way to receive Colorado Medical Assistance Program payments?


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Accounts Receivable (AR) Balances 


Q:Who should be contacted to find out about an AR balance?
Q:What creates an AR balance?
Q:What are the steps to take to when the AR balance is paid in full (have a canceled check), but a balance still appears on the PCR?



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Notification of Non-Payment 


Q:What generates a Notification of Non-Payment letter?
Q:What reasons would cause a provider to need a new provider number?
Q:What is an IRS 147 C Letter and why is it requested?
Q:What reasons would cause the need to submit a W-9 more than once?
Q:Why would a provider who is already enrolled in the Colorado Medical Assistance Program, but bills infrequently, need to complete another W-9?
Q:When does the provider bill using the group provider number vs. the individual's provider number?



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Common Billing Questions

The following questions and answers are designed to help all providers with common problems that often occur when billing the Colorado Medical Assistance Program.  


Q:What unit should be contacted for which services (the fiscal agent's EDI Services Unit vs. the fiscal agent's Provider Services Unit)?
Q:If Medicare claims don't automatically crossover to Medicaid, what steps does a provider need to take?
Q:How long should a provider retain client records?
Q:What is an LBOD, and how is it used?
Q:What is a Delay Reason Code?
Q:What should a provider do if the PHP (Pre-paid Health Plan) denies the claim for "Not a benefit"?
Q:Why does a claim reject with statement saying it cannot be billed electronically?
Q:How does a provider bill the Colorado Medical Assistance Program when there is a contractual write-off with other insurance?
Q:Where can CHP+ information be obtained?
Q: How can the Colorado Medicaid fee schedule be accessed?
Q: How are a baby's charges covered when the baby doesn't have a Colorado Medical Assistance Program client ID number?




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Web Portal  


Q:What is the Web Portal?
Q:How can more information be obtained for Colorado Medical Assistance Program providers who are interested in submitting claims electronically through the Web Portal?
Q: If the proper paperwork has been submitted to use the Web Portal and a username and password haven't been received, what needs to be done?


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