To avoid delays in enrollment processing, please click on the Submitter and Enrollment link listed below and print and complete the document.

 

To update previously submitted DSH EDI enrollment information, please click on the Update form link listed below and print and complete the document.

 

DSH EDI Submitter Enrollment and Agreement

 

DSH EDI Update form

 

Hospital Provider Authorization form - This is a copy of page 8 in the DSH EDI Submitter Enrollment and Agreement. This form must be completed and signed by each hospital authorizing a clearinghouse or other submitting hospital provider to access information on an authorizing hospital provider's behalf.

 

 DSH Frequently Asked Questions and Answers  - This document contains frequently asked questions and answers about DSH enrollment and DSH enrollment forms.

 

Please mail completed DSH EDI forms to:
DSH EDI Enrollment
Colorado Medical Assistance Program
DSH EDI Submitter Services
P.O. Box 1100
Denver, CO 80201-1100

Department of Health Care Policy and Financing · 1570 Grant Street · Denver, CO 80203-1818 · (303) 866-2993 Phone · (303) 866-4411 Fax