National Provider Identifier

Effective January 1, 2008, all Provider Enrollment Applications must be submitted with the provider's NPI. Applications received without the provider's NPI will be pended until the fiscal agent receives NPI information.

For Colorado Medicaid, the provider types listed below are not required to submit claims with an NPI:

Case Management providers
Home and Community Based Services or Waiver providers
Managed Care Health Plans
Non-ambulance transportation providers
 

Important Change of Ownership (CHOW) Information for Pharmacy Providers

Pharmacy providers must contact Provider Enrollment prior to the Change of Ownership (CHOW) effective date. The advanced notice is crucial for the timely effective date of termination of the old and assignment of the new provider numbers for new claim submissions.

Lawful Presence Verification August 2006 - This document contains additional information about complying with C.R.S. § 24-76.5-103 (verifying the lawful presence in the United States). It also contains the 'REQUEST FOR WAIVER ' RESTRICTIONS ON PUBLIC BENEFITS' form.

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Provider Enrollment Application Workshop

This document contains the slides from the recent Colorado Medical Assistance Program Provider Enrollment Application Workshop. Providers are strongly encouraged to attend the workshop. Workshop attendance provides valuable interaction with provider field representatives and other providers regarding the provider enrollment process. Therefore, these presentation slides are intended to be an informational aid to the provider enrollment application process and not a substitute for the workshop.

Please check the workshop section in the provider bulletin for the next Provider Enrollment Application Workshop.

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With the exception of Substance Abuse providers, individual providers who will affiliate with a group and will not receive direct reimbursement must complete the Rendering Provider Application. Please click on the link below and download your enrollment documents. Any other version of the application received from rendering providers will be returned.

Rendering Provider Application

Electronic Rendering Provider Application
Rendering providers can complete the new electronic application online, print it and mail it to ACS Provider Enrollment.

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Standard/Billing Enrollment Documents

Individual or group providers requesting direct reimbursement must complete the Enrollment Application. This includes individual Substance Abuse providers.

Please click on the your provider type to download your enrollment documents and mail all enrollment forms to:

ACS State Healthcare
Colorado Medical Assistance Program Provider Enrollment
P.O. Box 1100
Denver, Co 80201-1100