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FAQs

Provider Enrollment Frequently Asked Questions (FAQs)

Revised: June 2014

W-9

Electronic Funds Transfer (EFT)

IRS LTR 147C Form

Enrollment


W-9

1. Why does an individual doctor/provider have to submit a W-9 with their social security number (SSN)?
All individual providers enrolling via their SSN AND requesting direct payment under the Colorado Medical Assistance Program must submit a completed W-9. The W-9 must be completed with the individual’s name as the legal name, the ‘Individual’ entity type checked, and social security number entered. The form must be signed by the individual and dated (within six months of current date).

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2. How does a business complete the W-9?
If the enrolling provider is a business venture or institution, the W-9 must include the legal business name, dba if appropriate, check the entity type and enter the federal employer identification number (EIN) associated with that entity. The form must be signed by an authorized representative and dated (within six months of current date).

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3. If there is an individual, business venture, or institution name change do I need to submit a new W-9?
Yes, for direct pay providers. When the legal name of an enrolled provider changes (individual, business venture, or institution), a W-9 completed with the new information is required. Please include a letter indicating the change and attach a copy of the supporting documentation for the legal name change.

Indirect pay individuals do not require a W-9, only a letter requesting the name change. The request must include a copy of the supporting documentation for the legal name change.

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Electronic Funds Transfer (EFT)

1. Is EFT a requirement?
The State requires EFT for the following:
a. All in-state and border provider groups, clinics and facilities
b. Individual providers who are requesting direct payment

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2. If my bank information changes do I have to submit a new EFT form?
Yes. Each time your bank information changes, you must complete and submit a new EFT form as well as a new W-9. Please note: processing EFT information takes about a month. While your EFT information is in process, paper checks (warrants) will be mailed to the billing address on file.

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IRS LTR 147C Form

What is an IRS LTR 147C form and when is it required?
An IRS LTR 147C is a form issued by the Department of the Treasury Internal Revenue Service (IRS) that shows the entity legal name, dba, address and EIN exactly as registered. Providers requesting direct payment are added to the State's financial system and the information is screened with the IRS.

A copy of the IRS LTR 147C form may be required for legal name and EIN verification. Providers may want to submit a copy of the form with the W-9 to avoid delays in payments. A copy of the IRS LTR 147C form can be obtained by calling 1-800-829-4933. 

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Enrollment

1. What is a group provider?
A group provider is a facility, agency or clinic that will submit claims on behalf of one or more individual providers enrolled in the Colorado Medical Assistance Program. Group providers complete and submit the standard provider application, income is reported under the EIN. Examples: organized health clinic, dental clinic, rehab agency, rural health clinic, and federally qualified health center.

An individual provider may enroll as a sole proprietor by using their EIN. Please note: a sole proprietor may be required to submit and complete a rendering provider application in addition to the standard provider application.

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2. What is an individual provider?
An individual provider is a person rendering services under the Colorado Medical Assistance Program. Individual providers enroll with their SSN and complete the rendering provider application to affiliate, or associate, with a group provider that will submit claims on their behalf. Usually, individual providers do not want to receive direct payment with income reported to the IRS under their SSN.

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3. What is a direct reimbursement or direct pay provider?
A direct reimbursement or direct pay provider is a provider who receives payment for services rendered through the Colorado Medical Assistance Program. Direct pay providers enrolling via their SSN, will submit their own claims and have income reported to the IRS under their SSN. The standard provider application must be completed for enrollment.

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4. What is an affiliation and how is it updated?
An affiliation is the relationship between an individual provider (non billing) who is associated with a billing group, in order for the group to submit claims on behalf of the individual provider. For example a dentist (non billing & enrolled using SSN) affiliated to a dental clinic (billing entity enrolled using EIN), or a physician (non billing & enrolled using SSN) affiliated to a health clinic (billing entity enrolled using EIN). This avoids having any claims paid and reported to the IRS under the individual’s social security number.

Providers that have the capability should update their information through the Web Portal. There is a limit of 400 affiliations that can be entered through the Web Portal, anything over 400 must be submitted on a form or letterhead to the fiscal agent. Changes made through the Web Portal are effective within 24 hours. If you are unable to update your information in the Web Portal, submit a Provider Enrollment Update Form or send a request on letterhead (including the group provider number, each individual’s provider number, and the effective date of each affiliation) to the address listed below. Changes sent by mail may take up to two weeks for completion. Affiliation terminations should be updated similarly. Please call Provider Services at 1-800-237-0757 toll free Colorado for assistance.

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5. How do I enroll to provide behavioral health services to Medicaid clients?
Medicaid behavioral health services are provided primarily by State contracted Behavioral Health Organizations (BHOs). Behavioral health providers must apply to become a network provider with the BHO in their area. If the network is not accepting new providers, behavioral health providers are limited to providing services to Medicaid clients with diagnoses that are not covered under the BHO contract. BHO contact information is located in the Behavioral Health Organizations section of the Department's website at colorado.gov/hcpf.

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6. Why do I have to provide Proof of Lawful Presence?
Pursuant to C.R.S. § 24-76.5-103, on or after August 1, 2006, each individual applicant (enrolling via SSN) who is 18 years of age or older AND requesting direct reimbursement, must complete and sign the affidavit. A photocopy of the required identification documentation must be included with the standard provider application.

Please refer to the Department of Revenue’s website at colorado.gov/revenue⇒Library⇒Rules for Evidence of Lawful Presence⇒Evidence of Lawful Presence: HB06S-1023 for further information.

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7. What does it mean if my provider ID is terminated for no claims?
If a provider does not submit any claims for 24 consecutive months, the State of Colorado will request provider termination for no claims activity. Notification is sent to effected providers 30 days prior to termination with instructions. Once terminated, if the provider wants to reactivate their enrollment, a new application with the terminated/originally assigned provider number noted on the application must be completed and submitted.

If the provider voluntarily terminated his/her enrollment, a new application noting the terminated provider number must be completed and submitted. Pharmacy providers should contact Provider Services at 1-800-237-0757 for special instructions.

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8. What do I do if there is a change of ownership (CHOW)?
In the event of a CHOW, the purchasing or new owner of the company must complete and submit a standard provider application to obtain a new Colorado Medical Assistance Program provider number. A new NPI number associated with the new owner is highly recommended to avoid claim processing issues and delayed payments. The selling provider’s old Colorado Medical Assistance Program provider number is terminated and they must submit a letter with the following information to verify the change:
a. The name of the new (purchasing) provider
b. The change of ownership effective date
c. A forwarding address
The new owner cannot use the previous owner’s Colorado Medical Assistance Program provider number.
All providers, including Pharmacy providers, must contact Provider Services at 1-800-237-0757 prior to the CHOW effective date. Advance notice is crucial for timely termination of the old provider number, assignment of the new provider number, and processing claims.

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9. What do I do if there is a change of federal employer identification number (EIN)?
If there has been a change of EIN, the provider’s Colorado Medical Assistance Program provider number associated to the old EIN is terminated. The provider must complete and submit a standard provider application, using the new EIN to obtain a new Colorado Medical Assistance Program provider number. A new NPI number associated with the new EIN is highly recommended to avoid claim processing issues and delayed payments. The old Colorado Medical Assistance Program provider number cannot be used with the new EIN. Providers must contact Provider Services at 1-800-237-0757 prior to the new EIN effective date. Advance notice is crucial for timely termination of the old provider number, assignment of the new provider number, and processing claims.

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10. How do I update my Colorado Medical Assistance Program provider information (demographics)?
Providers who have the capability, should update their information through the Web Portal. The Web Portal allows providers to verify and change the following: addresses, affiliations, fax number, phone number, county, publications preference, and email address. (Please note three addresses are kept on the provider file: billing, location, and mail-to.) Changes made through the Web Portal are effective within 24 hours. If you are unable to update your information in the Web Portal, submit a Provider Enrollment Update Form or send a request on letterhead to the address listed below. Changes sent by mail may take up to two weeks for completion. Please call Provider Services at 1-800-237-0757 toll free Colorado for questions.

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11. How do I update my license information?
Complete and submit a Provider Enrollment Update Form or send a request on letterhead to the address listed below. Please include a copy of the license showing effective and expiration dates.

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12. Which address does outgoing correspondence get sent to?
All provider enrollment outgoing correspondence is sent to the mail-to address noted in the provider application. If the provider does not have a mail-to address indicated, correspondence is sent to the location address noted in the provider application.

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13. What happens if the U.S. Post Office is unable to deliver my mail?
When undeliverable correspondence is returned with “Returned Mail Notification” and includes an address update from the U.S. Post Office, updates are made to the provider’s mail-to address to match the forwarding address. (This is the only address change that will be made without written instruction from the provider or the State of Colorado.)

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14. Can I receive Colorado Medical Assistance Program bulletins electronically?
All Colorado Medical Assistance Program bulletins are available on the Department's website at colorado.gov/hcpf⇒Provider Services⇒Provider Bulletins. To receive email notifications, you must have a valid email address on file and an email notification will be sent when a new bulletin has posted. The email contains a link to the latest bulletin. If you have a TPID, please submit Publication Preferences information through the Web Portal. You may also complete and submit a Provider Enrollment Update Form or the Publications Preference Form. Please note: providers can have only one email address on file with the fiscal agent. The person receiving the email notification should forward the email to all additional personnel requiring the updated information.

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15. Why am I not receiving my Colorado Medical Assistance Program checks?
The Colorado Medical Assistance Program has several different systems from which it retrieves information. If your correct address is on file with the Colorado Medical Assistance Program but you are not receiving your checks, please call Provider Services at 1-800-237-0757 toll free Colorado for assistance. Confirm that the State has your correct address information. The State of Colorado uses a separate financial system and your billing address must be current. If the address is not correct, submit a Provider Enrollment Update Form to correct. For additional information, please refer to the Paper Checks/Warrants FAQs in the Provider Services FAQ section of the Department’s website at colorado.gov/hcpf⇒Provider Services⇒Frequently Asked Questions.

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16. How do I use the Provider Enrollment Checklist?
The checklist specifies additional documentation required with the application in order to become a Colorado Medical Assistance Program provider. When required documentation is omitted, the application is pended and a notification letter is sent to the mail-to address in the application indicating the missing information. If the required information is not received within 60 days, the application is denied and the provider must complete a new application or send a copy of the original application supplemented with the missing information.

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17. How many days can my enrollment be backdated?
Most enrollment effective dates can be backdated 120 days from the date the application is received by the Department’s fiscal agent. If services were rendered over 120 days prior to enrollment approval, the provider must complete and submit a Provider Enrollment Update Form , or a request on the provider’s letterhead, explaining the reason for the request. The request will be reviewed and the provider will be notified by letter of the outcome.
Please note: backdate requests may be denied.

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18. How do I complete the Provider Disclosures area in the application?
Begin by checking the appropriate entity type for the applicant (see definitions provided). Then Fields A through F must be completed with the requested information. Check the appropriate box in the instruction area. If any area is not completed with either information or a check in the box, the application will be considered incomplete.

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19. What is Medicare Certification?
Medicare Certification is a letter from Medicare confirming the provider’s Medicare enrollment including the effective date. The Medicare Remittance Notice (MRN) does not meet the requirements because it does not indicate the enrollment effective date. Crossover claims are affected if the Medicare Certification is incorrect or missing.

The following provider types require Medicare Certification: General Hospital (in state), QMB Benefit Only, X-ray Facility, Mental Hospital, Dialysis Center, Hospice, Independent Lab, Ambulatory Surgical Center, Emergency Transportation, Rural Health Clinic, Federally Qualified Health Center, Nursing Home Swing Bed Facility, Comprehensive Outpatient Rehabilitation Agency, and Home Health.

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20. How long will it take to process my application?
An application takes eight business days to process unless the provider type requires State approval or if information is missing or incomplete. Providers are responsible for submitting all required information to ensure timely application processing.

Provider types requiring State approval are:
General Hospital (in state), Psychiatric Residential Treatment Facility, Residential Child Care Facility, Rural Health Clinic, Mental Hospital, Behavioral Health Organization, Hospice, Case Manager, Federally Qualified Health Center, School Health Services, Nursing Facility, HCBS Waiver Programs, Health Maintenance Organization, Community Mental Health Center, Family Planning Clinic, Dialysis Center, out of state Pharmacy/Supply/Transportation, Mail Order Pharmacy, Rural Dispensing Physician Site, Pharmacy, Indian Health Service/Tribally Operated Pharmacy, Home Health, HCBS Developmentally Disabled, Regional Care Coordination Organization, and Audiologists for the Colorado Hearing Intervention Program (CHIP) only.

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21. Do I have to complete an application for each individual provider if I already have a group number?
Yes. A separate application must be completed for each individual who is not enrolled in the Colorado Medical Assistance Program and will render services to Colorado Medical Assistance Program clients. (If an individual provider is actively enrolled in the Colorado Medical Assistance Program, an additional application is not required – only to add the affiliation. See affiliation information listed above.)

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22. How does a group enroll as multiple provider types?
A group must fill out a new application for different provider types. Please note this does not apply to Waiver Services (HCBS) (34). Individuals enrolling with their SSN may only select one provider type.

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23. Our organization has two or more different locations, how does this effect enrollment?
A separate application must be completed for each location.

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24. Do I need a supervising advanced practice nurse or physician?
Registered nurses, by state regulation, require on premise supervision by an advanced practice nurse (APN) or physician (MD) when services are provided.  The supervising APN/MD must be identified by name on the “On-premise supervision for non-physician practitioners” form.

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25. How do I update signature authorization information for claims submission?
Providers should complete and submit the ‘Signature Authorizations’ page from the standard provider application, or submit the request on letterhead. Be sure to include the provider’s address, the Colorado Medical Assistance Program provider number, and contact information for questions.

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26. When can I start seeing Colorado Medical Assistance Program clients?
Do not begin seeing clients until you receive an enrollment approval letter that contains your Colorado Medical Assistance Program Provider number and effective date. This letter includes additional enrollment information, please verify all information on the document is correct. If any of the information is incorrect, please make corrections on the document and return it to the address listed below.

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27. Why was my application denied?
Applications awaiting missing or incomplete information for more than 60 days are denied and a denial letter is sent to the provider stating the status and reason. To re-apply, the provider must complete a new application or send a copy of the original application supplemented with the missing information.

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28. How do I terminate my Colorado Medical Assistance Program enrollment?
To terminate your Colorado Medical Assistance Program enrollment, you must submit a Provider Enrollment Update Form, or submit a written request on letterhead to the below address. The letter must include the provider’s name, Colorado Medical Assistance Program provider number, the reason for and effective date of the termination. Notification is required 30 days prior to the requested termination date.

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Document submission address:
Xerox State Healthcare
Provider Enrollment
P.O. Box 1100
Denver, CO 80201-1100

 

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