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Transition Referral Information Form
Department staff have the ability to verify the social security number of clients who are submitting a HUD application, but do not have a social security card. You can learn about the process in the DAL SSN verification form and in the SSN verification form.
Denver Housing Authority (DHA) has Section 8 vouchers for Denver residents who are CCT participants. Here are the eligibility criteria:
Denver Housing Authority CCT Housing Packet
Under Provider Training and Provider Information
Physician Billing Files
Pharmacy Billing Files
Third Party User Form
The following forms are for HCBS Service Providers and SEP Agency Case Managers who experience a critical incident involving a client enrolled under the following waiver programs: Brain Injury, Children's HCBS, Children with Autism, Consumer Directed Care, Elderly, Blind and Disabled, and Community Mental Health Supports.
Please print the relevant questionnaire from the list below and enter all requested information. All questions must be answered in order to make a Prior Authorization Request (PAR) determination. Unless another address is specified on the form, mail the completed the form and the completed PAR to:
ColoradoPAR Provider Line
eQHealth Solutions Customer Service
888-801-9355 (toll free phone)
ColoradoPAR Provider Fax
eQHealth Solutions Fax Line
Additional information and ongoing updates can be found on ColoradoPAR.com, the Department’s Website, or the eQHealth Solution ColoradoPAR Program provider website.
Provider Application for TPA/EDI Enrollment.
The Department's fiscal agent EDI Services offers technical assistance to providers who electronically submit Colorado Medical Assistance Program claims. This assistance includes:
Our Support Unit can provide you with detailed information that will make your transition to an electronic environment an easy one. EDI Support is available Monday through Friday, 8:00 a.m. - 5:00 p.m. at 1-800-237-0757 (toll free).
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.
EDI Submitter Enrollment Form (05/15)
All switch vendors that submit electronic transactions to the Colorado Medical Assistance Program are required to complete the Switch Vendor Submitter Enrollment Application (05/15). Please download, complete and submit the application to the address on the last page of the application.
Providers already enrolled for EDI
DSH EDI Documents
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
Proof of Lawful Presence form
On Premise Supervision form for non-physician practitioners
Copy of the Provider Participation Agreement (can only be signed from within the Online Provider Enrollment tool)
EFT Exemption Instructions (Only for Case Managers and Out of State providers)
For more provider enrollment forms and information, please go to the Provider Enrollment web page.
For provider enrollment update forms and information, please see "Update Forms" below.
State of Colorado Medical Assistance Program state plan for Medication Therapy Counseling, Supplement to Attachment 3.1-A, section 6.d.
If interested in participating in this program please contact Sara.Haynes@state.co.us
The PDL is developed based on safety, effectiveness, and clinical outcomes from classes of medications where there are multiple drug alternatives available and supplemental rebates from drug companies, allowing Colorado the ability to provide medications at the lowest possible costs.
Please visit the Pharmacy and Therapeutics (P&T) Committee page for more information.
The Supplemental Rebate Agreement template is in MS Word format and may be modified to facilitate the submission of supplemental rebate offers.
The Colorado Medicaid program has established an extensive formulary in order to provide pharmaceutical benefits to Medicaid clients. In order for a provider to prescribe a drug that is not on this established list, the provider must receive an approval on a prior authorization request from the Department.
Note: A provider can submit a request either by phone or by fax to Medicaid’s Prior Authorization Helpdesk. The Helpdesk phone number is 1-800-365-4944. It is open 24 hours a day, seven days a week. If the request meets the PA criteria, the medication coverage will be allowed.
Appendix P - Prior Authorization Procedures and Criteria
The Global Prior Authorization policy was developed to protect the health of Medicaid's most vulnerable clients. Clients who qualify will be exempt for one year from prior authorization requirements for non-preferred drugs. They will also be exempt from prior authorization requirements for non-PDL drugs currently requiring prior authorization. Clients who do not qualify for a Global Prior Authorization may still be eligible for prior authorizations for individual drugs.
Medicaid Covered Drugs for Medicare-Medicaid Eligible Members
The PAR Status Inquiry in the Colorado Medical Assistance Web Portal (Web Portal) allows providers to make PAR status inquiries about all PAR types. Please review the online Training, User Guide, and the Help feature for additional information.
Submit all PARs to the appropriate Authorizing Agency listed in Appendix D of the Billing Manuals Appendices section.
Synagis® Prior Authorization Request (PAR) Form