Enrollment for Existing Providers
Provider Enrollment Updates
Provider information updates and affiliation changes may be made through the Web Portal and are effective within 24 hours. Providers may update the following information: Addresses, Phone, Fax, Publication Preferences (including Email), Medicare Information, and Affiliations.
You must first log-on to the Web Portal. If you need assistance completing your update through the Web Portal, please click on End-user (left side of screen), then click on Training. This takes you to the Web Portal tutorial. Select the specific category on the left side of screen and then click on "Help" on the navigation bar on the top of the screen. The "Help" category provides additional details about your specific update.
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When sending update requests that require State approval, providers should submit the update requests by using the update form below. Please be sure to include the reason for the request or it may be denied. Changes done on the Update form will be effective 5 business days from date of receipt.
Provider Enrollment Update Form Follow the instructions on the form to update your provider information.
Electronic Provider Enrollment Update Form - This new electronic Enrollment Update form can be completed online, printed, and mailed to ACS, P.O. Box 1100, Denver, CO 80201-1100.
Please click on the following link for updates that must be submitted on the provider's letterhead or on the Provider Enrollment Application:
List of possible updates with submission method and comments
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.
W-9 Form - Request for Taxpayer Identification Number (TIN) Verification and the
Electronic Funds Transfer (EFT) - State of Colorado Authorization Agreement for Automatic Deposits (ACH Credits) Form (All providers participating in the Colorado Medical Assistance Program are required to receive Medical Assistance Program payments electronically.)
Publication Email Notification Preference Form - Complete this form to specify how you will receive emails containing important notifications (including time-sensitive information) and bulletin links from the Colorado Medical Assistance Program. Only one email address per provider may be on file.
Group providers must complete a separate EDI Enrollment form if they did not complete the Provider Application containing Electronic and EDI information. Individual providers who only bill under a group number, and do not wish to have access to the web portal may sign and submit only page 18 (provider participation agreement signature page).
EDI Enrollment
Download, complete and submit all pages of the Provider Application for EDI Enrollment. Providers should follow the instructions carefully to avoid EDI processing delays.
After processing, EDI Services will fax or mail your trading partner information to you. The State will follow-up on the enrollment process and send you the necessary user names and passwords for accessing the Web Portal.
Providers and Submitters already enrolled for EDI
- Provider EDI Update Form - Please use this form to update previously submitted Provider EDI enrollment information.
- Submitter EDI Update Form - Please use this form to update previously submitted Submitter EDI enrollment information.
Primary Care Physician Program
To enroll in the Primary Care Physicians Program (PCPP), physicians must be enrolled as a Medical Assistance Program provider. To enroll, please complete, sign and submit the Application Documents listed above with the Primary Care Physician Enrollment form.
If you are already enrolled in the Colorado Medical Assistance Program, and want to become a Primary Care Physician, please download, complete and submit the Primary Care Physician (PCP) Enrollment Form.
Primary Care Physician (PCP) Enrollment Form
Primary Care Physician Program (PCPP) Revised Contract
Please mail all enrollment forms to:
ACS State Healthcare
Colorado Medical Assistance Program Provider Enrollment
P.O. Box 1100
Denver, Co 80201-1100