Colorado Medical Assistance Program Web Portal
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If you have your Trading Partner ID (TP ID), but have not received your login information, please call 303-866-4473. If you have completed the EDI enrollment but do not have your login information or TP ID, please call 1-800-237-0757. Both are toll free numbers. Otherwise, please complete and submit the applicable EDI Enrollment form on the Provider Services EDI Support page as soon as possible. The State will follow up on the enrollment process and send you the necessary User Names and Passwords for accessing the Colorado Medical Assistance Program Web Portal.
|Web Portal News|
Changes Effective as of October 25, 2013:
Clarification on Use of Eligibility Inquiry to Verify Dates of Service
As of October 25, 2013, the Department implemented certain changes to be compliant with the HIPAA Operating Rules. One of these changes is to allow future dates of service (up to the end of the current month) to be verified in an 270 Eligibility Inquiry. Providers should be aware that, because a client’s eligibility can change daily, these future dates of service are not guaranteed even though they may be returned in the 271 Eligibility Response. The guarantee number that is provided on an Eligibility Response is only effective for today's eligibility date and does not guarantee eligibility for future dates. Please contact the Department’s fiscal agent Provider Services call center at 1-800-237-0757 with questions.
Options for Web Portal New Service Type Code Field Enhancement
The values that are available in the new Service Type Code field are those required to be compliant with the HIPAA Operating Rules. If a user wants to inquire on a service type that is not available in the new Service Type Code field, the user should select ‘30 Health Benefit Plan Coverage’ from the menu. The eligibility response will be sent back with all available service type information that the client is eligible for on that date. Please note that co-payment requirements have not changed with this enhancement.
Web Portal Quick Sheets and Job Guides
Transactions available through the Colorado Medical Assistance Program Web Portal
The Colorado Medical Assistance Program Web Portal offers Eligibility Inquiries, Claim Status Inquiries, Batch Eligibility Inquiries, Claim Submissions, Prior Authorization Request (PAR) Status Inquiries, and the File and Report Service (FRS) for retrieving reports, including PAR Letter Reports. Enhancement services include: Provider Specialty Lookup for referral purposes, a dashboard on the main menu page for system and transaction status information, and MMIS provider data maintenance for updating Medical Assistance Program Provider File information (e.g., address, phone number, email address). Online Training, User Guides, and Help Guides are available to assist users with data entry and transaction submissions. In addition, users can access a Claim Activity Tracing Report which provides claim summary information on all claim submissions during a user-defined time frame.
Providers who have the capability should update their information through the Colorado Medical Assistance Program Web Portal. If you are unable to update your information using the Colorado Medical Assistance Program Web Portal, submit a Provider Enrollment Update Form or call Provider Services at 1-800-237-0757 (toll free) for assistance. Most providers are allowed to verify and change addresses, affiliations, fax number, phone number, county, publications preference, and email address.
Enhanced eligibility responses - Interactive responses are enhanced to reduce redundancies in the third party liability (TPL) sections. Batch responses have also been converted to user-friendly formats similar to the interactive response.
Purge Functionality - Trading Partners who have a large number of claims and experience slowness during claim entry should consider setting up a purge process on their older claims. The purge service helps to optimize the use of disk space and keeps the Colorado Medical Assistance Program Web Portal running efficiently. A Trading Partner Administrator (TPA) has the authority to purge (delete) large numbers of his/her claims and PAR transactions based on the date of submission. The link for the purge service is called "Claims/PAR Purge" and is found under the Administration option on the main menu. Claims and PARs that are not deleted by the TPA will automatically purge every two years based on the date of submission. Deleted claims do not affect claims that are successfully accepted by the MMIS. For additional information, please review the online Training, User Guides, and Help Guides.
Claim Adjustments and Voids
How to Adjust a Claim through the Colorado Medical Assistance Program Web Portal - Instructions for adjusting claims
How to Void a Claim through the Colorado Medical Assistance Program Web Portal - Instructions for voiding claims