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ATTENTION: Some providers can now temporarily enroll in Health First Colorado (Colorado's Medicaid Program) to provide services during the COVID-19 public health emergency. New applicants will be required to indicate whether they are enrolling temporarily due to the public health emergency or enrolling for the long-term. Refer to the drop-down section further down on this page, titled “New Provider Specialties for COVID-19 Long-Term and Temporary Enrollment,” for further details.
Need to speak to a live agent for help with your enrollment? Please call the Provider Services Call Center at 1-844-235-2387, then select option 2 and then option 5.
Federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening for all existing (and newly enrolling) providers. These regulations are designed to increase compliance and quality of care and to reduce fraud. All providers, medical or nonmedical, who are enrolled with and bill Medicaid for services under the state plan or a waiver must be screened under rule CCR 2505-10 8.100 by enrolling. In addition, providers that provide services through Managed Care Organizations (MCOs), including Child Health Plans Plus (CHP+) and Regional Accountable Entities (RAEs), need to enroll. This is necessary because the validity and currency of all provider licenses to perform any service must be screened.
The Affordable Care Act (ACA) requires physicians and other eligible practitioners to enroll in Health First Colorado to order, prescribe and refer items or services for Health First Colorado members, even when they do not submit claims to Health First Colorado.
Physicians, other practitioners and facilities who render services to Health First Colorado members based on the order, prescription or referral of an OPR provider will not be paid for such items or services unless the OPR provider is enrolled in Health First Colorado and the National Provider Identifier (NPI) number is included on the claim submitted to Health First Colorado.
Providers with prescriptive authority who are enrolled as an active IWG (rendering provider) may be prescribers. They are not required to complete an additional OPR application. OPR enrollments are for providers who do not submit payment directly to Health First Colorado (Colorado’s Medicaid Program) but only prescribe, refer or order for Health First Colorado members. Submitting an OPR application with the same Social Security Number (SSN) as a previously enrolled IWG may result in the application being denied as a duplicate or in denied claims.
Effective April 10, 2020, providers will be allowed to temporarily enroll in Health First Colorado (Colorado's Medicaid Program) to provide services during the public health emergency. Temporary enrollment will end once the public health emergency ends. Prior to any temporary enrollments being terminated, providers will be notified and given the opportunity to convert from temporary enrollment to long term enrollment by updating the application and completing the requirements.
New applicants will be required to indicate temporary enrollment due to the public health emergency or long term enrollment.
In addition to selecting a provider type and primary specialty, each applying provider will need to add one of the following secondary specialties to their application:
This applies only to provider types for which application fees, fingerprinting and/or site visits are required, including:
For providers choosing to enroll temporarily:
The Affordable Care Act (ACA) requires certain providers to remit an application fee. The Centers for Medicare & Medicaid Services (CMS) sets the fee annually. This fee is assessed at initial enrollment, revalidation, and change of ownership, as required, and is assessed in full for each service location enrolled in CO Medicaid.
Effective January 1, 2020 the Provider Enrollment Applications Fee has been set at $595 for the 2020 calendar year.
For questions, please contact Provider Services Call Center (1-844-235-2387).
Providers are reminded to enter the actual DOB for individuals, owners and managing employees, in the appropriate sections of the enrollment application (Provider Identification and Disclosures). In accordance with federal screening rule 42 CFR § 455.104 and Colorado Code of Regulations 10 CCR 2505-10 8.125.15, a verification is completed for all individuals and when the DOB does not match, the application is returned to the provider for correction(s) or denied.
In response to provider suggestions, the Department and DXC have updated provider enrollment letters. Effective July 4, 2019, provider enrollment letters will now include the Health First Colorado ID. The National Provider Identifier (NPI) will also continue to be included in provider enrollment letters.
Providers are encouraged to attach IRS documentation for groups and facilities or Atypical providers that includes the legal name and tax identification number with their Health First Colorado (Colorado’s Medicaid Program) enrollment application. If additional verification is needed during the screening process, the application documents can be used to expedite the enrollment application.
New applications and enrollment updates are currently being processed by the Department's fiscal agent within 30 business days on average.
Providers with any of the following individual types may only have one application associated to a SSN, even if they provide services in multiple locations: Billing individuals; Individuals within a group (IWG); Ordering, prescribing and referring (OPR) providers. An additional application for any of these individual types with the same SSN and same NPI as a previous application (regardless of whether the individual type is the same as on the previous application) may result in the application being denied as a duplicate or denied claims. Individuals may affiliate with multiple groups in different locations.
Ordering, Prescribing, and Referring (OPR) to Individual Within a Group (IWG)
OPRs are not allowed to be rendering individuals on a claim. This may prompt individuals enrolled as OPRs to change their enrollment type to an IWG to allow them to be the rendering on a claim. Before the enrollment type can be updated from OPR to IWG, providers must update their license. If only a training license is on file, then the provider must submit a current, full license through the Provider Web Portal. Once the update is submitted, providers must call the Provider Services Call Center at 1-844-235-2387 to request the change from OPR to IWG. Once the change is complete, an affiliation must be made. Providers may affiliate via the group profile through the Provider Web Portal, or the individual will have access to make the affiliation after the enrollment type change is made.
Individual Within a Group (IWG) to a Billing Individual (BI)
IWGs do not receive direct payment for services rendered. This may prompt individuals enrolled as IWGs to change their enrollment type to a BI to allow them to submit claims for his/her own services and receive direct payment. (Income is reported to the IRS under the individual’s SSN.) Before the enrollment type can be updated from IWG to BI, providers must submit an Electronic Funds Transfer (EFT) update including a W-9 (with the SSN listed) and a voided check or bank letter (signed and dated within the last 6 months). Refer to the Updating an Electronic Funds Transfer (EFT) Provider Web Portal Quick Guide located on the Quick Guides web page. In addition, a separate Provider Maintenance update is required by attaching a completed Affidavit of Lawful Presence form, current license and insurance. The Affidavit of Lawful Presence form is available on the Provider Forms web page under the Provider Enrollment & Update Forms drop-down section. Once the updates are submitted, providers must call the Provider Services Call Center at 1-844-235-2387 to request the change from IWG to BI.
Provider Type Changes
The provider type (e.g. Physical Therapist, Podiatrist, Psychologist) cannot be changed.
If an enrolled individual with an SSN wants to change provider types, the existing enrollment needs to be disenrolled, the affiliations ended and a new application completed. Individual providers such as a billing individual, Individual within a group and ordering, prescribing and referring providers may not be enrolled as two different provider types under the same Social Security Number (SSN).
An additional application for any of these individual types with the same SSN will result in the application being denied as a duplicate. Individuals Within a Group may affiliate with multiple groups in different locations.